The Relationship Between Neighborhood Disorder and Barriers to Cessation in a Sample of Impoverished Inner-City Smokers in Baltimore, Maryland, United States

Introduction

Economic disparities in rates of smoking have been well documented in many countries. These disparities exist on an individual and geographic or neighborhood level. This cross-sectional study examined the relationship between neighborhood physical and social disorder and barriers to smoking cessation among an impoverished urban sample.

Methods

A sample of current smokers were recruited through street outreach, posted advertisements, and word of mouth from impoverished neighborhoods in Baltimore, Maryland, USA for a study of psychosocial factors and smoking behaviors. Neighborhood disorder was assessed with a 10-item scale from the Block Environmental Inventory and barriers to cessation with a 9-item scale.

Results

In the multiple logistic regression model, perceived stress (aOR = 1.60, 95% CI = 1.32 to 1.95), neighborhood disorder (aOR= 1.34, 95% CI = 1.11 to 1.63), and level of nicotine dependence (aOR = 1.97), 95% CI = 1.62 to 2.40) were all strongly associated with barriers to cessation.

Conclusion

The results of this study suggest that neighborhood disorder may lead to barriers to cessation among low-income populations. The findings also indicate that tobacco control interventions should examine and address social and physical aspects of impoverished neighborhoods.

Implications

In many countries, tobacco control programs and policies have been less effective among low-income populations as compared to more affluent populations. Little is known about how neighborhood factors influence smoking cessation. This study examined the relationship between neighborhood disorder and barriers to cessation among a low-income population. We recruited a convenience sample of hard-to-reach cigarette smokers from low-income neighborhoods. Even after controlling for level of nicotine dependence and stress, neighborhood disorder was found to be associated with barriers to cessation. The findings suggest the important role of neighborhood disorder as a barrier to smoking cessation.

"Decide Now, Buy Marlboro": Examining the influence and appeal of Marlboro's new brand architecture among Filipino adolescents

In recent years, Philip Morris International (PMI) launched a global rebranding strategy to expand the reach of Marlboro. Using a mixed-methods design, this study evaluated the appeal and influence of Marlboro advertising among Filipino youth. Six hundred and twenty-three adolescents aged 13-17 years old in Metro Manila participated in a survey, including three advertising conditions: two for Marlboro and one for Mighty, a local cigarette brand. One-way repeated measures analysis of variance (ANOVA) and paired t-tests evaluated differences between the three conditions on participants' attitudes toward advertisements [measured as identification, likeability, and perceived effectiveness (PE)]. Compared to Mighty, never-smokers rated Marlboro advertisements as more identifiable and likeable. Comparing by smoking status (never vs. ever), multivariable logistic regression assessed the influence of these attitudes on intention to smoke. Increased likeability was associated with greater intention to smoke among never-smokers, and greater PE increased odds of intention to smoke for both never- and ever-smokers. Additionally, six focus group discussions (FGD) explored responses to campaign messaging. Themes were compared within and across groups. Marlboro was also appealing to FGD participants, who described the ads as attractive to youth and promoting "adventure" and "freedom", whereas the Mighty brand was seen as being for adults and current smokers. Our findings illustrate that Marlboro advertisements are distinctly appealing to youth. Marlboro rhetoric - where consumers are urged to "decide" to "Be Marlboro" - was particularly powerful. These findings support the need for addressing gaps in policies regulating the marketing and promotion of tobacco in the Philippines.

Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults

BACKGROUND

We assessed whether receipt of coupons-via direct mail or e-mail-was prospectively related to trajectories of smoking behaviours.

METHODS

Data were from a cohort of US adults (n=26 447) who participated in wave 1 (2013-2014) and wave 2 (2014-2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours.

FINDINGS

At wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88).

CONCLUSIONS

Tobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.

Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication

This study explored how structural and cultural forces work together with psychological and communication factors in influencing Pap test compliance among Latinas in Los Angeles County, a group who face health disparities related to cervical cancer screening, incidence and mortality. By adopting a multilevel approach to obtain a grounded understanding of this issue, this work revealed that structural barriers, fatalism, religious service attendance, perceived susceptibility, perceived costs, and cues to action from health care providers are all associated with Pap test compliance. Financial barriers also influence compliance, with underinsurance having a stronger negative impact compared to no insurance at all. These findings provide insights into how communication efforts can be strategically designed to address both individual- and system-level barriers to promote health-seeking behaviors among Latinas, and potentially among other population groups experiencing health disparities due to similar reasons.

Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products

BACKGROUND AND OBJECTIVES

Non-cigarette tobacco marketing is less regulated and may promote cigarette smoking among adolescents. We quantified receptivity to advertising for multiple tobacco products and hypothesized associations with susceptibility to cigarette smoking.

METHODS

Wave 1 of the nationally representative PATH (Population Assessment of Tobacco and Health) study interviewed 10 751 adolescents who had never used tobacco. A stratified random selection of 5 advertisements for each of cigarettes, e-cigarettes, smokeless products, and cigars were shown from 959 recent tobacco advertisements. Aided recall was classified as low receptivity, and image-liking or favorite ad as higher receptivity. The main dependent variable was susceptibility to cigarette smoking.

RESULTS

Among US youth, 41% of 12 to 13 year olds and half of older adolescents were receptive to at least 1 tobacco advertisement. Across each age group, receptivity to advertising was highest for e-cigarettes (28%-33%) followed by cigarettes (22%-25%), smokeless tobacco (15%-21%), and cigars (8%-13%). E-cigarette ads shown on television had the highest recall. Among cigarette-susceptible adolescents, receptivity to e-cigarette advertising (39.7%; 95% confidence interval [CI]: 37.9%-41.6%) was higher than for cigarette advertising (31.7%; 95% CI: 29.9%-33.6%). Receptivity to advertising for each tobacco product was associated with increased susceptibility to cigarette smoking, with no significant difference across products (similar odds for both cigarette and e-cigarette advertising; adjusted odds ratio = 1.22; 95% CI: 1.09-1.37).

CONCLUSIONS

A large proportion of US adolescent never tobacco users are receptive to tobacco advertising, with television advertising for e-cigarettes having the highest recall. Receptivity to advertising for each non-cigarette tobacco product was associated with susceptibility to smoke cigarettes.

Why Peer Crowds Matter: Incorporating Youth Subcultures and Values in Health Education Campaigns

Grounded on research showing that peer crowds vary in risk behavior, several recent health behavior interventions, including the US Food and Drug Administration's Fresh Empire campaign, have targeted high-risk peer crowds. We establish the scientific foundations for using this approach. We introduce peer crowd targeting as a strategy for culturally targeting health behavior interventions to youths. We use social identity and social norms theory to explicate the theoretical underpinnings of this approach. We describe Fresh Empire to demonstrate how peer crowd targeting functions in a campaign and critically evaluate the benefits and limitations of this approach. By replacing unhealthy behavioral norms with desirable, healthy lifestyles, peer crowd-targeted interventions can create a lasting impact that resonates in the target audience's culture.

The Impact of Health Warning Labels for Swedish Snus Advertisements on Young Adults' Snus Perceptions and Behavioral Intentions

INTRODUCTION

This study examined the impact of warning labels conveying the potential harms and addictiveness of Swedish snus and the potential-reduced harms of Swedish snus among young adult nonsmokers and smokers.

METHODS

A convenience sample of young adults aged 18-30 residing in the United States (n = 517, 56% male, 33% smokers) participated in an online experiment. Participants completed baseline measures and were randomized to 1 of 5 experimental conditions where they viewed a Swedish snus ad with warning labels that varied by condition: (1) Control-no warning; (2) Addiction-warning conveying the addictiveness of snus; (3) Harm-warning communicating the potential harms of snus; (4) Harm Reduction-warning conveying the potential-reduced harms of snus compared with cigarettes; (5) Harm Reduction Switch-warning communicating the potential-reduced harms of snus when switching completely from cigarettes to snus. Outcomes measured included perceived harms and addictiveness of snus, thoughts about not using snus, and intentions to use snus.

RESULTS

Participants in the Harm Reduction and Harm Reduction Switch conditions perceived snus to be less harmful than cigarettes compared with the Control, Addiction, and Harm conditions. Nonsmokers in the Harm Reduction condition reported fewer thoughts about not using snus than nonsmokers in the Harm condition.

CONCLUSIONS

Warnings conveying the potential-reduced harms of Swedish snus compared with cigarettes generate perceptions that snus is less harmful than cigarettes and produce fewer thoughts about not using snus among nonsmokers. Such perceptions have been associated with snus use in prior studies.

Comparing the Relative Efficacy of Narrative vs Nonnarrative Health Messages in Reducing Health Disparities Using a Randomized Trial

OBJECTIVES

We compared the relative efficacy of a fictional narrative film to a more traditional nonnarrative film in conveying the same health information.

METHODS

We used a random digit dial procedure to survey the cervical cancer-related knowledge, attitudes, and behavior of non-Hispanic White, Mexican American, and African American women, aged 25 to 45 years, living in Los Angeles, California, from 2011 to 2012. Participants (n = 704) were randomly assigned to view either a narrative or nonnarrative film containing the same information about how cervical cancer could be prevented or detected, and they were re-contacted 2 weeks and 6 months later.

RESULTS

At 2 weeks, both films produced a significant increase in cervical cancer-related knowledge and attitudes, but these effects were significantly higher for the narrative film. At 6 months, viewers of both films retained greater than baseline knowledge and more positive attitudes toward Papanicolaou (Pap) tests, but women who saw the narrative were significantly more likely to have had or scheduled a Pap test. The narrative was particularly effective for Mexican American women, eliminating cervical cancer screening disparities found at baseline.

CONCLUSIONS

Narratives might prove to be a useful tool for reducing health disparities.

Telling stories, saving lives: creating narrative health messages

Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.

Hidden addiction: Television

BACKGROUND AND AIMS

The most popular recreational pastime in the U.S. is television viewing. Some researchers have claimed that television may be addictive. We provide a review of the definition, etiology, prevention and treatment of the apparent phenomenon of television addiction.

METHODS

Selective review.

RESULTS

We provide a description of television (TV) addiction, including its negative consequences, assessment and potential etiology, considering neurobiological, cognitive and social/cultural factors. Next, we provide information on its prevention and treatment.

DISCUSSION AND CONCLUSIONS

We suggest that television addiction may function similarly to substance abuse disorders but a great deal more research is needed.

Integrated connection to neighborhood storytelling network, education, and chronic disease knowledge among African Americans and Latinos in Los Angeles

Combining key ideas from the knowledge-gap hypothesis and communication infrastructure theory, the present study aimed to explain the relations among individuals' education, access to community-based communication resources, and knowledge of chronic diseases (diabetes, hypertension, breast cancer, and prostate cancer) among African Americans and Latinos in Los Angeles. Rather than explore the effect of isolated communication resources, this study explored the effect of an integrated connection to community-based storytellers on chronic disease knowledge. The authors hypothesized that individuals' access to a community-based communication infrastructure for obtaining and sharing information functions as an intervening step in the process where social inequality factors such as education lead to chronic disease knowledge gaps in a local community context. With random samples of African Americans and Latinos in Los Angeles, the authors found that access to community-based communication resources plays a mediating role in the case of breast cancer and diabetes knowledge, but not in hypertension and prostate cancer knowledge. The authors discussed these findings on the basis of communication infrastructure theory and knowledge-gap hypothesis.

Peer group self-identification in samples of Russian and U.S. adolescents

Most peer group self-identification research has been conducted in the United States. This article examined the generalizability of self-identified group name research among teens in Ufa, a city in the Russian Federation. A cross-sectional, anonymous collection of data on group self-identification, drug use, addiction concern, sensation seeking, and self-rated school performance was collected from 365 10th grade youth in Ufa and 965 10th grade youth in the United States. The results supported the existence of peer group self-identification by youth in both countries and, in general, replicated the findings that youth who self-identify as a High Risk Youth, are relatively likely to use drugs, show greater concern about becoming an addict, report a greater sensation seeking preference, higher levels of depression, and poorer school performance. Implications of these results are discussed.

Slope distribution of a rough surface measured by transmission scattering and polarization

Transmission scattering from medium to air was used to measure the slope distribution of the rough plane surface of a transparent glass hemisphere. A facet model successfully explained the measured results of refraction, scattering, and polarization: Transmission scattering existed for incident angles greater than the critical angle, all measured curves for the normalized scattered intensity versus the facet slope angle for different detection directions overlapped, and the measured polarization of scattering was approximately constant for >99% of the facets. The slope distribution obtained by transmission scattering agrees with those of the surface profiles in the valid range of the profiler and can represent the slope distribution of the rough surface.

A randomised trial of the impact of counselling on treatment adherence of tuberculosis patients in Sialkot, Pakistan

SETTING

Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan.

OBJECTIVE

To determine whether intensive counselling can improve treatment adherence.

DESIGN

In a randomised controlled intervention trial of 1,019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default.

RESULTS

The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay.

CONCLUSIONS

Intensive counselling has a significant, although limited, impact on treatment adherence.

Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.

COPD in the elderly. A reversible cause of functional impairment

OBJECTIVES

To determine the frequency of referral of patients age 69 years and older to the pulmonary function laboratory at a tertiary-care hospital for airflow limitation studies; to determine the point prevalence of a significant reversible component in patients with COPD as an age-related function; and to determine the proportion of patients who were prescribed bronchodilators following a pulmonary function test (PFT) demonstrating significant reversibility.

DESIGN

A retrospective review of pulmonary function tests of patients 69 years and older within calendar year 1990 was performed. Chart review of those showing significant reversibility to bronchodilators during a PFT was performed to determine level of follow-up.

SETTING

Referral-based pulmonary division in a tertiary-care hospital.

PATIENTS

Men and women 69 years and older who had interpretable PFTs at Northwestern Memorial Hospital (NMH) during the calendar year 1990 (n = 405). Patients whose PFTs were uninterpretable due to poor effort (n = 10) were excluded from the study.

INTERVENTIONS

No specific interventions were performed as a part of the study. Referring physicians may have requested a PFT with postbronchodilator (albuterol by nebulizer) testing and may have subsequently prescribed bronchodilators for their patients.

MEASUREMENTS

We studied the effect of age, gender, smoking history, and degree of airflow obstruction on changes in spirometry values and reversibility status after bronchodilator (if applicable) as determined by a PFT.

MAIN RESULTS

Of the 405 consecutive elderly patients studied, 193 (47.7%) received bronchodilators and 60 (31.1%) of these patients had significant improvement as judged by the criteria listed in the Methods section. The improvement occurred equally across all age groups (p > 0.05) and the percent responding to bronchodilators increased as the degree of obstruction increased (p < 0.001). Those who had never smoked were twice as likely to respond than were current or former smokers; men were more likely to respond than women. Most patients (84%) who responded were subsequently prescribed bronchodilators.

CONCLUSIONS

Responses to inhaled bronchodilators occur at all ages. Older patients showed greater reversibility as the degree of obstruction increased, while a smoking history reduced the likelihood of a bronchodilator response. COPD in the elderly may differ from the traditional form of the disease.

Delirium and other cognitive impairment in older adults in an emergency department

STUDY OBJECTIVE

To determine the prevalence of delirium and other alterations in mental status in older adults in the emergency department setting.

DESIGN

Prospective, cross-sectional study.

SETTING

Private, nonprofit, academic medical center in a densely populated urban area.

PARTICIPANTS

One hundred eighty-eight adults 70 years or older who presented to the ED.

INTERVENTIONS

None.

RESULTS

Delirium and other alterations in mental status were present in 39.9% of the patients studied; 24% of these patients had delirium. Age and severity of illness were positively correlated with alteration in mental status. Patients with alterations in mental status were more likely to be admitted to an inpatient unit. Among those admitted from home, alterations in mental status in the ED were associated with a higher likelihood of institutionalization at discharge.

CONCLUSION

Alterations in mental status are prevalent in ED patients. Older adults with alterations in mental status, particularly alterations in consciousness and delirium, are at high risk for admission to an inpatient unit and institutionalization after discharge. Standardized mental status testing identified high-risk older adults in the ED.

Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial

OBJECTIVE

To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults.

DESIGN

Randomized controlled trial. Patients were followed in the acute hospital from admission through discharge. Results based on both univariate and multiple regression analyses.

SETTING

Private, nonprofit, academic medical center in a densely populated urban area.

PATIENTS

Adults 70 years of age and older admitted from the Emergency Department to the medicine service (non-ICU admission) who did not have an internist on staff at the admitting hospital. Of 141 randomized patients, 111 (78.7%) met eligibility criteria.

INTERVENTION

Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay.

MAIN OUTCOME MEASURES

Length of stay, total cost of acute hospital care, cost of laboratory, pharmacy, and rehabilitation services.

RESULTS

Patients in the intervention group had 2.1 fewer days of hospitalization, but this shorter length of stay was not statistically significant (P = 0.108). There were no differences in mortality or discharge disposition. In risk-adjusted, multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group (-$2,544, P = 0.029); assignment to the intervention group was associated with a lower predicted cost per patient for laboratory (including cardiology graphics) services (P = 0.007) and pharmacy costs (P = 0.047).

CONCLUSIONS

When controlled for important predictors of expected resource use, care provided by a geriatric management team resulted in a significant reduction in the cost of hospitalization. A reduction in the cost of laboratory, cardiographic, and pharmacy services is consistent with the team's philosophy of defining the services needed based on goals related to functional outcomes.

Are congregate meals meeting clients' needs for "heart healthy" menus?

This is a report of a dietary analysis of meals offered in one large congregate feeding program and clients' consumption patterns as they relate to self-reported dietary restrictions. Most meals exceeded dietary guidelines for kilocalories, cholesterol, and proportion of energy from fat. Of 438 congregate meal clients 60 years of age and older who were surveyed at senior citizen centers and congregate meal sites, 30% reported following a "special diet." The most commonly mentioned dietary modifications were low sodium and/or low fat/low cholesterol. Clients who reported dietary restrictions also reported eating fewer congregate meals per week than did clients who denied dietary restrictions.