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Wang X, Luo R, Shan G, He H, Chen T, Wang X, Gan L, Wang Y, Chou Y, Cui J, Li P, Zhong Y, Ma J. Prevalence and risk factors for refractive error in older adults in eight ethnicities in China: The China national health survey. Heliyon 2024; 10:e36354. [PMID: 39281499 PMCID: PMC11401125 DOI: 10.1016/j.heliyon.2024.e36354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
Purpose This study aimed to investigate the prevalence of refractive error (RE) and risk factors for myopia among older adults in the Han and various minority ethnic groups across seven provinces in China. Methods This cross-sectional study forms a part of the ophthalmic dataset of the China National Health Survey (CNHS). Face-to-face interviews and ophthalmic examinations were conducted in seven provinces located in western and northern China. The age- and sex-adjusted prevalence of RE among Han and seven other ethnic groups aged 50-80 years were compared. A mixed-effects model was used to identify the risk factors associated with RE. Results A total of 12,902 participants, including 8800 Han and 4102 from ethnic minorities, were included in the study. The age- and sex-adjusted prevalence of myopia, high myopia, hyperopia, and astigmatism ranged from 15.3 % (Manchu) to 22.9 % (Han), 0.2 % (Yugur) to 2.8 % (Han), 21.6 % (Tibetan) to 48.9 % (Uyghur), and 38.7 % (Yi) to 57.5 % (Manchu) across different ethnicities, respectively. Compared to the Han population, the Mongolian (odds ratios (OR) 0.62, 95 % confidence interval (CI) 0.46-0.84, p = 0.002), Tibetan (OR 0.66, 95 % CI 0.52-0.85, p = 0.001), Uyghur (OR 0.63, 95 % CI 0.49-0.80, p < 0.001), Yi (OR 0.65, 95 % CI 0.46-0.92, p = 0.014), and Yugur (OR 0.65, 95 % CI 0.50-0.85, p = 0.001) ethnicities were less likely to have myopia. There was no significant difference in the prevalence of myopia between the Manchu, Korean, and Han ethnic groups. Factors associated with a lower prevalence of myopia included rural residence (p < 0.001), a body mass index (BMI) > 18.5 kg/m2 (all p < 0.001), residence in higher latitude areas (p = 0.020), and a history of smoking (p = 0.002 in the past smoking group, p = 0.031 in the current smoking group). The Mongolian (p = 0.006) and Yugur (p = 0.007) populations, participants living in rural areas (p = 0.012), and those with a BMI >24 kg/m2 (p = 0.038 in the >24.0 ≤ 27.0 kg/m2 group or p = 0.041 in the >27.0 kg/m2 group) were less likely to have high myopia. Factors associated with a higher prevalence of hyperopia included older age (all p < 0.001), rural residence (p = 0.039), higher latitude areas (p = 0.031), smoking history (p = 0.040), and Mongolian (p = 0.001), Uyghur (p < 0.001), Yi (p < 0.001), and Yugur (p = 0.002) ethnicities. Conversely, the Manchu population (p = 0.004) and individuals with higher education levels than illiteracy (p = 0.024 or p < 0.001) were less likely to have hyperopia. Conclusions Myopia affected more than one-fifth of the older adults in the Han population in this survey. Significant differences in the prevalence of RE were observed between minority ethnicities and Han individuals, except for the Manchu and Korean groups.
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Affiliation(s)
- Xuqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Rui Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ting Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Xuejiao Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yuyu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jiantao Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Pan Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Danielsen D, Vinther JL, Holt DH, Jakobsen GS, Bast LS, Andersen S. Factors sustaining legitimacy of smoking in Vocational Education and Training (VET) schools: a qualitative needs assessment. BMC Public Health 2024; 24:683. [PMID: 38438986 PMCID: PMC10913276 DOI: 10.1186/s12889-024-18033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions. METHODS Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation. FINDINGS Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief. CONCLUSIONS The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level.
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Affiliation(s)
- Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Johan Lerbech Vinther
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Heering Holt
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gitte Sofie Jakobsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Azagba S, Ebling T, Shan L. Is socioeconomic status related to youth e-cigarette use? Examining family affluence and sexual identity. Addict Behav 2023; 141:107636. [PMID: 36821881 DOI: 10.1016/j.addbeh.2023.107636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/08/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
There is limited evidence about the relationship between socioeconomic status (SES) and youth electronic cigarette use, particularly among sexual minorities. This study investigates whether family affluence is significantly associated with e-cigarette use among youth, including sexual minority youth. Data came from the 2021 National Youth Tobacco Survey (N = 10,515). The prevalence of e-cigarette use for all participants and sexual minority youth (N = 1376) by SES was calculated and ranked according to the Family Affluence Scale. A propensity score weighting method was used to address the imbalance in characteristics among SES groups. The associations of SES with current e-cigarette use and current flavored e-cigarette use were estimated using univariate survey logistic regression for all participants and self-identified sexual minority students. The prevalence of e-cigarette use was similar among socioeconomic groups for all participants and sexual minorities. The propensity score weighting analysis showed no significant association between SES and current e-cigarette use for all participants and sexual minority students. Equally, there was no significant association between SES and current flavored e-cigarette use. Findings suggest that other protective and risk factors might explain youth e-cigarette use more than SES (family affluence scale).
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Affiliation(s)
- Sunday Azagba
- College of Nursing, The Pennsylvania State University, University Park, PA, United States.
| | - Todd Ebling
- College of Nursing, The Pennsylvania State University, University Park, PA, United States
| | - Lingpeng Shan
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
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Yu Z, Qin W, Li J. Intergenerational transmission of parental risky health behaviors in Chinese children: Are there socioeconomic status differences? Front Med (Lausanne) 2023; 9:842817. [PMID: 36698800 PMCID: PMC9870313 DOI: 10.3389/fmed.2022.842817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Risky health behaviors in childhood, including smoking, alcohol consumption, and having a poor diet, are the major sources of non-communicable diseases in adulthood. This study aimed to examine how parents affect children's risky health behaviors and whether intergenerational transmission differs based on socioeconomic status (SES). Methods Data were extracted from the 1991-2015 China Health and Nutrition Survey (CHNS). Smoking (n = 5,946), alcohol consumption (n = 7,821), and sugar-sweetened beverages (SSBs) consumption (n = 3,537) were used as proxies for risky health behaviors in children. A binary choice model for panel data with a random-effect specification was employed to examine whether risky health behaviors can be transmitted from parents to their children. Subsequently, we conducted a seemingly unrelated estimation test (SUEST) to explore the differences in parental transmission between the different SES groups. Results We found strong intergenerational persistence of smoking, alcohol drinking, and SSBs drinking behaviors, except for the mothers' smoking behavior. Mothers had a greater influence on children's alcohol drinking and SSBs drinking behaviors than fathers both in urban and rural areas and in different SES groups. The intergenerational transmission of SSBs drinking behavior exhibited a decreasing trend with increasing SES for both urban and rural families. In urban areas, mothers' alcohol drinking behavior has a decreasing trend with increasing education level, occupation, and income; however, in rural areas, the influence of mothers' alcohol drinking behavior occurred in the same direction with increasing education level and occupation type. In rural areas, the influence of fathers' drinking and smoking behaviors on children appears to mostly increase with increasing SES. Meanwhile, the influence of such behaviors among urban fathers would decrease with increasing SES. Conclusion Parents' behaviors and SES can influence the initiation of risky health behaviors in their offspring. Thus, to promote healthy behaviors, policymakers can introduce health education programs for parents, particularly for those living in rural areas and with a low SES.
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Affiliation(s)
- Zexuan Yu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Wen Qin
- Infirmary of Shandong University, Jinan, China
| | - Jiajia Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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A Comparison of Mathematical and Statistical Modeling with Longitudinal Data: An Application to Ecological Momentary Assessment of Behavior Change in Individuals with Alcohol Use Disorder. Bull Math Biol 2022; 85:5. [PMID: 36495364 DOI: 10.1007/s11538-022-01097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
Ecological momentary assessment (EMA) has been broadly used to collect real-time longitudinal data in behavioral research. Several analytic methods have been applied to EMA data to understand the changes of motivation, behavior, and emotions on a daily or within-day basis. One challenge when utilizing those methods on intensive datasets in the behavioral field is to understand when and why the methods are appropriate to investigate particular research questions. In this manuscript, we compared two widely used methods (generalized estimating equations and generalized linear mixed models) in behavioral research with three other less frequently used methods (Markov models, generalized linear mixed-effects Markov models, and differential equations) in behavioral research but widely used in other fields. The purpose of this manuscript is to illustrate the application of five distinct analytic methods to one dataset of intensive longitudinal data on drinking behavior, highlighting the utility of each method.
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Denney JT, Sharp G, Kimbro RT. Community social environments and cigarette smoking. SSM Popul Health 2022; 19:101167. [PMID: 35879966 PMCID: PMC9307492 DOI: 10.1016/j.ssmph.2022.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/21/2022] Open
Abstract
Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.
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Cambron C, Lam CY, Cinciripini P, Li L, Wetter DW. Socioeconomic Status, Social Context, and Smoking Lapse During a Quit Attempt: An Ecological Momentary Assessment Study. Ann Behav Med 2021; 54:141-150. [PMID: 31612218 DOI: 10.1093/abm/kaz034] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts. PURPOSE The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt. METHODS Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse. RESULTS Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted. CONCLUSIONS Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse.
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Affiliation(s)
- Christopher Cambron
- College of Social Work, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Cho Y Lam
- Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Paul Cinciripini
- Department of Behavioral Science, M. D. Anderson Cancer Center, The University of Texas, Austin, TX
| | - Liang Li
- Department of Biostatistics, M. D. Anderson Cancer Center, The University of Texas, Austin, TX
| | - David W Wetter
- Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Elliston KG, Schüz B, Albion T, Ferguson SG. Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study. JMIR Mhealth Uhealth 2020; 8:e15948. [PMID: 32706728 PMCID: PMC7407250 DOI: 10.2196/15948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/18/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual’s environment.
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Affiliation(s)
| | - Benjamin Schüz
- Institute of Public Health and Nursing Science, University of Bremen, Bremen, Germany.,Leibniz Science Campus, Digital Public Health, Bremen, Germany
| | - Tim Albion
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Stuart G Ferguson
- College of Health and Medicine, University of Tasmania, Hobart, Australia
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Prevalence and risk factors of myopia in Han and Yugur older adults in Gansu, China: a cross-sectional study. Sci Rep 2020; 10:8249. [PMID: 32427926 PMCID: PMC7237487 DOI: 10.1038/s41598-020-65078-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/26/2020] [Indexed: 12/27/2022] Open
Abstract
Few studies have investigated the prevalence of myopia in Northwest China. This cross-sectional study aimed to investigate the prevalence and associated factors of myopia and high myopia in adults aged 40–80 years in the Han and Yugur populations living in Gansu Province, Northwest China. A total of 3,845 participants were included. The overall age- and sex-adjusted prevalence of myopia (spherical equivalent (SE) < −0.5 D), high myopia (SE < −6.0 D) and hyperopia (SE > + 0.5 D) were 16.4%, 0.7% and 26.2% in Yugur participants, respectively, and 34.3%, 5.0% and 19.2% in Han participants, respectively. The prevalence of myopia and high myopia in Han participants was significantly higher than that in Yugur participants (both P < 0.001). Yugur population, birth in rural areas, smoking history and outdoor work were found to be negatively associated with myopia. Higher education level and a family history of myopia were found to be positively associated with myopia in the study population. High myopia was negatively associated with Yugur population, aging, birth in rural areas and was positively associated with a family history of myopia. This study provided valuable information regarding the environmental risk factors of myopia and revealed an ethnic disparity in the prevalence of myopia in Gansu Province, Northwest China.
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Daily stress as link between disadvantage and smoking: an ecological momentary assessment study. BMC Public Health 2019; 19:1284. [PMID: 31606051 PMCID: PMC6790015 DOI: 10.1186/s12889-019-7631-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior. Method A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether socioeconomic disadvantage (indicated by educational attainment, income and race) exerts indirect effects on smoking (cigarettes per day) via daily stress. Stress experience was assessed at the end of each day using Ecological Momentary Assessment methods. Data were analyzed using random effects regression with a lower-level (2-1-1) mediation model. Results On the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking. This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage. No such effects were found when for income as indicator for social disadvantage. Conclusion These findings highlight the potential for future studies investigating behavioral mechanisms underlying smoking disparities. Such information would aid in the development and improvement of interventions to reduce social inequality in smoking rates and smoking rates in general.
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Andersen S, Pisinger V, Rod MH, Tolstrup J. Associations of school tobacco policies and legislation with youth smoking: a cross-sectional study of Danish vocational high schools. BMJ Open 2019; 9:e028357. [PMID: 31345969 PMCID: PMC6661684 DOI: 10.1136/bmjopen-2018-028357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In vocational high schools, the prevalence of smoking is high (nearly 40% daily smoking in Danish vocational high schools). Schools are increasingly adopting school tobacco policies (STPs) and a national law on smoke-free school grounds has been implemented. Our objective was to explore the extent of STPs in vocational schools and examine the association of STPs and smoke-free school grounds legislation with student smoking. METHODS We used data from the cross-sectional Danish National Youth Study 2014, including 5013 vocational high school students (76% male) at 40 campuses. Implementation of STPs was measured by questionnaires to principals and field observations of smoking practices were conducted. Logistic regression models assessed whether STP characteristics were associated with students' current smoking (ie, daily and occasional) compared with non-current smoking. Negative binominal regression models assessed cigarettes per day among daily smokers. RESULTS Schools covered by the national law on smoke-free school ground had more comprehensive STPs than schools not covered by the law. Student smoking was observed on 78% of campuses, with less visibility of smoking in schools covered by the national law (69% vs 83%). Current smoking was lower for students attending a school covered by the national law (OR=0.86, 95% CI 0.75 to 0.97). Students who attended schools that allowed teacher-student smoking were more likely to smoke (OR=1.13, 95% CI 1.01 to 1.27). CONCLUSIONS A law on smoke-free school grounds was associated with less current smoking in vocational high schools, while school norms that are supportive of teacher-student smoking were associated with greater odds of current smoking. Visibility of student smoking was less prevalent at schools covered by the law on smoke-free school grounds; nevertheless, the visibility of smoking was high. Better enforcement or an extension of the current law on smoke-free school grounds is recommended.
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Affiliation(s)
- Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Hulvej Rod
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Janne Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Tomko RL, McClure EA. Introduction to the special issue: Utilizing ambulatory assessment to better understand the etiology, maintenance, treatment, and remission of addictive disorders. Addict Behav 2018; 83:1-4. [PMID: 29661656 DOI: 10.1016/j.addbeh.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rachel L Tomko
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA.
| | - Erin A McClure
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA
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McQuoid J, Thrul J, Ling P. A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use. Soc Sci Med 2018. [PMID: 29518701 DOI: 10.1016/j.socscimed.2018.02.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants' everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals' experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed.
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Affiliation(s)
- Julia McQuoid
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA 94143, USA.
| | - Johannes Thrul
- Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA 94143, USA
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