Reducing Health Disparities by Tackling Tobacco Use

A general class of small area estimation using calibrated hierarchical likelihood approach with applications to COVID-19 data

The direct estimation techniques in small area estimation (SAE) models require sufficiently large sample sizes to provide accurate estimates. Hence, indirect model-based methodologies are developed to incorporate auxiliary information. The most commonly used SAE models, including the Fay-Herriot (FH) model and its extended models, are estimated using marginal likelihood estimation and the Bayesian methods, which rely heavily on the computationally intensive integration of likelihood function. In this article, we propose a Calibrated Hierarchical (CH) likelihood approach to obtain SAE through hierarchical estimation of fixed effects and random effects with the regression calibration method for bias correction. The latent random variables at the domain level are treated as 'parameters' and estimated jointly with other parameters of interest. Then the dispersion parameters are estimated iteratively based on the Laplace approximation of the profile likelihood. The proposed method avoids the intractable integration to estimate the marginal distribution. Hence, it can be applied to a wide class of distributions, including generalized linear mixed models, survival analysis, and joint modeling with distinct distributions. We demonstrate our method using an area-level analysis of publicly available count data from the novel coronavirus (COVID-19) positive cases.

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

Background

Prioritizing and managing multiple behavior changes following a cardiac hospitalization can be difficult, particularly among smokers who must also overcome a serious addiction.

Hypothesis

Hospitalized smokers will report a strong interest in smoking cessation (SC) but will receive little assistance from their physicians.

Methods

We asked current smokers hospitalized for an acute cardiac event to prioritize their health behavior priorities, and inquired about their attitude toward SC therapies. We also assessed SC cessation prescriptions provided by their physicians.

Results

Of the 105 patients approached, 81 (77%) completed the survey. Of these, 72.5% ranked SC as their greatest health change priority, surpassing all other behavior changes, including: taking medications, attending cardiac rehabilitation (CR), dieting, losing weight, and attending doctor appointments. Patients felt that SCM (44%), CR (41%), and starting exercise (35%) would increase their likelihood for SC. While most patients agreed that smoking was harmful, 16% strongly disagreed that smoking was related to their hospitalization. At discharge, medication was prescribed to ~32% of patients, with equal frequency among patients who reported interest and those who reported no interest in using medications.

Conclusion

The majority of hospitalized smokers with cardiac disease want to quit smoking, desire help in doing so, and overwhelmingly rate cessation as their highest health behavior priority, although some believe smoking is unrelated to their disease. The period following an acute cardiac event appears to be a time of great receptivity to SC interventions; however, rates of providing tailored, evidence‐based interventions are disappointingly low.

Flavored Tobacco Use Among U.S. Adults by Age Group: 2013-2014

OBJECTIVE

This study sought to assess patterns of flavored tobacco product (FTP) use and their associations with (1) susceptibility to smoke cigarettes among young adults aged 18-29 who have never smoked; (2) quit attempts in the past 12 months among current cigarette users by age group (18-29, 30-49, and 50+).

METHODS

We used the 2013-2014 National Adult Tobacco Survey (n = 75,233) to estimate the prevalence of single-, dual-, and poly-use of FTP (menthol cigarettes, e-cigarettes, cigars, regular pipes/hookahs, and smokeless). Logistic regression models were performed to examine the associations between FTP use and smoking behaviors.

RESULTS

Among current tobacco users, young adults aged 18-29 (72.7%) had a higher prevalence of FTP use than other age groups (30-49: 51.7% and 50+: 37.9%). For FTP use within each age group, dual- and poly-FTP use was most popular among young adults aged 18-29 and menthol cigarette use was most popular among older adults aged 50+. Compared with not using any tobacco products, FTP use was associated with higher odds of susceptibility to cigarette smoking among young adult never smokers (single FTP use: aOR =5.5, CI: 4.2-7.3; dual/poly FTP use: aOR =10.7, CI: 6.2-18.4). FTP use was not associated with quit attempts among current cigarettes users aged under 50, while dual/poly-FTP use was associated with higher odds of quit attempts among current cigarette users aged 50 + (aOR =1.7, CI: 1.2-2.4).

CONCLUSIONS

This study shows the heterogeneity of FTP use among adults by age group and demonstrates its associations with susceptibility to cigarette smoking among young adult never smokers.