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Huh J, Blevins B, Wong K, Lee R, Herzig SE, Unger JB, Oh H. The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review. Drug Alcohol Depend 2024; 262:111391. [PMID: 39047639 PMCID: PMC11330314 DOI: 10.1016/j.drugalcdep.2024.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status. METHODS Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings. RESULTS The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults. CONCLUSIONS The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.
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Affiliation(s)
- Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA.
| | - Brittany Blevins
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Kelly Wong
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Shirin E Herzig
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, USC, USA
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Asiamah-Asare BKY, Robinson S, Powell D, Kwasnicka D. Impact of fly-in fly-out work on health behaviours and affective states: A daily diary study. Stress Health 2024; 40:e3361. [PMID: 38141023 DOI: 10.1002/smi.3361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/09/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Our knowledge about the role of fly-in fly-out (FIFO) work-related factors on the well-being of workers across the FIFO work cycle is limited. This study examined the within-person effects of job demand and control on psychological states and health behaviours. The study employed a daily diary design, with 23 FIFO workers in the Australian mining industry completing a daily diary survey for 28 consecutive days across on-shift and off-shift periods. Multilevel analyses showed FIFO workers experienced higher positive affect and enjoyed better sleep quality, but consumed more alcohol, during off-shift days as compared to on-shift days. Within-person variability in daily demand (workload) was associated with higher anxious affect, whereas job control predicted lower anxious and depressed affects, higher positive affect, more alcohol consumption, and more physical activity. The within-person effect of demand on anxious affect was moderated by job control such that those who generally had more control over their jobs had a smaller effect of demand on anxiety than those with less control. Results suggest potentially modifiable aspects of FIFO work-particularly job control-may help alleviate the impact of workload on poorer health behaviours and mood.
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Affiliation(s)
- Bernard Kwadwo Yeboah Asiamah-Asare
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Daniel Powell
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Lu D, Qing Z, Tu Y, Liu X. Sexual orientation and psychotic-like experiences among Chinese college students: the role of gender. Front Psychiatry 2023; 14:1139484. [PMID: 37743983 PMCID: PMC10514363 DOI: 10.3389/fpsyt.2023.1139484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Objective The mental health of sexual minorities has received increasing attention, but there are few studies on the risk of psychotic-like experiences (PLEs) among sexual minorities. The purpose of this study is to explore the relationship between different sexual orientations and PLEs among college students and the moderating effect of gender. Methods A total of 4,460 college students from seven provinces participated in this cross-sectional survey. The χ2 test and logistic regression were used to investigate the relationship between sexual orientation and PLEs. Results Of the participants, 4.9% identified as bisexual, 1.1% as lesbian/gay, and 5.6% were questioning/unsure; 60.1% of the sample experienced at least one PLE item, 59.2% reported delusional experiences (DEs), and 20.6% had hallucinatory experiences (HEs). Compared with heterosexual college students, bisexual and questioning students showed a higher risk of PLEs, DEs, and HEs, and lesbian/gay students showed a higher risk of HEs. Stratified analysis indicated that sexual orientation was significantly associated with PLEs only for female college students. Conclusion Sexual orientation is a predictive factor of PLEs. In particular, different sexual minority subgroups show the different effects on PLEs between male and female college students. Mental health interventions for PLEs could employ distinct strategies based on different sexual orientations and gender disparity.
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Affiliation(s)
- Dali Lu
- Department of Pediatric Psychology, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Zaihua Qing
- Hunan University of Finance and Economics, Changsha, Hunan, China
| | - Ying Tu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Xiaoqun Liu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
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L Gomes N, S Lopes C. Sexual Orientation Disparities in Depression and Substance Use Among Adults: Results from the Brazilian National Health Survey 2019. LGBT Health 2023. [PMID: 36809196 DOI: 10.1089/lgbt.2022.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.
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Affiliation(s)
- Nayara L Gomes
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Study, Methods and Control, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil
| | - Claudia S Lopes
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Ehlke SJ, Kendzor DE, Smith MA, Sifat MS, Boozary LK, Cohn AM. Single-use, co-use, and polysubstance use of alcohol, tobacco, and cannabis in sexual minority and heterosexual females. Am J Addict 2023; 32:66-75. [PMID: 36250728 DOI: 10.1111/ajad.13344] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Alcohol, tobacco, and cannabis use are more prevalent in sexual minority females than heterosexual females, and their use is associated with adverse consequences. Identifying disparities in substance use patterns by sexual identity may inform interventions targeting this vulnerable group. This study examined differences between heterosexual and sexual minority females on patterns of past 30-day tobacco, alcohol, and cannabis use. METHODS N = 3020 females (18.8% sexual minority) completed an online survey (September 2020-October 2021) that queried about past 30-day tobacco/nicotine (cigarettes, e-cigarettes, large cigar/LCCs, and other products), alcohol, and cannabis use. Participants were classified into one of eight patterns: no use, tobacco/nicotine-only, alcohol-only, cannabis-only, alcohol and tobacco/nicotine, tobacco/nicotine and cannabis, alcohol and cannabis, and polysubstance use. A multinomial logistic regression model examined the association between sexual identity and each substance use group, controlling for demographics. RESULTS Across both groups, no substance use was the most common pattern. Polysubstance use was the most common substance use pattern among sexual minority females. In adjusted regression models, sexual minority females were more likely to report cannabis-only (adjusted odds ratio [AOR] = 2.58), tobacco/nicotine and cannabis co-use (AOR = 1.74), alcohol and cannabis co-use (AOR = 2.50), and polysubstance use (AOR = 2.60), compared to heterosexual females. [Correction added on 23 November 2022, after first online publication: In the preceding paragraph, the AOR and CI values were corrected.] DISCUSSION AND CONCLUSIONS: Substance use patterns that involve cannabis are more common among sexual minority females. SCIENTIFIC SIGNIFICANCE This study extends prior research by using a large sample of females to examine differences based on sexual identity in patterns of tobacco/nicotine, alcohol, and cannabis use beyond single substance use and considers co-use and polysubstance use.
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Affiliation(s)
- Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael A Smith
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Munjireen S Sifat
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laili K Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Psychology, Cellular and Behavioral Neurobiology, University of Oklahoma, Norman, Oklahoma, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Amos N, Bourne A, Hill AO, Power J, McNair R, Mooney-Somers J, Pennay A, Carman M, Lyons A. Alcohol and tobacco consumption among Australian sexual minority women: Patterns of use and service engagement. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103516. [PMID: 34753044 DOI: 10.1016/j.drugpo.2021.103516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support. METHODS This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support. RESULTS Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol. CONCLUSIONS The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.
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Affiliation(s)
- Natalie Amos
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Level 3, 780 Elizabeth St, Melbourne, Victoria, 3004, Australia
| | - Julie Mooney-Somers
- University of Sydney, Faculty of Medicine and Health, Sydney Health Ethics, Level 1 Medical Foundation Building, 91-97 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Building NR1, Bundoora, Victoria, 3086, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
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Nguyen N, McQuoid J, Neilands TB, Dermody SS, Holmes LM, Ling PM, Thrul J. Same-day use of cigarettes, alcohol, and cannabis among sexual minority and heterosexual young adult smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:215-223. [PMID: 32804517 PMCID: PMC7887119 DOI: 10.1037/adb0000678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Sexual minority (SM) young adults have higher rates of substance use than heterosexuals, but little is known about daily use of multiple substances, which confer numerous health risks for this population. Using daily diary data from a smartphone-based study, we examined the associations between sexual identity (i.e., SM vs. heterosexual) and patterns of same-day multiple substance use (i.e., cigarettes and alcohol, cigarettes and cannabis, alcohol and cannabis, and all 3 substances). METHOD Young adult smokers (N = 147, aged 18-26, 51.7% female, 41.5% SM, 40.8% White) reported consecutive daily assessments on substance use over 30 days. We used generalized estimating equations to examine associations between sexual identity and patterns of same-day multiple substance use, controlling for demographic factors and psychological distress. RESULTS Of 2,891 daily assessments, 16.7% reported same-day use of cigarettes and alcohol, 18.1% cigarettes and cannabis, 1.5% alcohol and cannabis, and 15.0% use of all 3 substances. SM participants (vs. heterosexuals) had significantly greater odds of reporting days with use of cigarettes and cannabis [Adjusted Odds Ratio (AOR) = 2.05, 95% Confidence Interval (CI) [1.04, 4.01]] and use of all three substances (AOR = 2.79, 95% CI [1.51, 5.14]) than days with single substance use or no use. CONCLUSIONS These findings warrant tailored interventions addressing multiple substance use among SM young adults and temporally accurate measures of multiple substance use patterns. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Julia McQuoid
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA
| | - Sarah S. Dermody
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Louisa M. Holmes
- Social Science Research Institute, Penn State University, University Park, PA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Dworkin ER, Jaffe AE, Fitzpatrick S, Rhew IC, Kaysen D. Daily relationships between posttraumatic stress symptoms, drinking motives, and alcohol consumption in trauma-exposed sexual minority women. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:3-15. [PMID: 33030918 DOI: 10.1037/adb0000680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Sexual minority women (SMW) evidence elevated rates of trauma exposure, posttraumatic stress (PTS), and alcohol consumption. Self-medication models of drinking suggest that individuals may drink to cope with symptoms of PTS, but this possibility remains untested among SMW. Method: The current study used data from drinking days collected via daily diary assessments from 81 trauma-exposed SMW. Participants were mostly White (72.8%) and ranged in age from 18 to 25 (M = 23.8). Participants were followed over 2 14-consecutive-day measurement bursts (720 person-days reported). Analyses were conducted to examine whether coping drinking motives (vs. social, enhancement, and conformity drinking motives), as assessed by an adapted Drinking Motives Questionnaire, mediated the daily level relationship between PTS symptoms (assessed by the PTSD Checklist) and the number of standard drinks per drinking day. Results: Results from multilevel structural equation models indicated that day-to-day fluctuations in PTS symptoms, as well as average levels of PTS symptoms, were associated with increased coping drinking motives. Coping drinking motives, but not other drinking motives, mediated within-person associations between PTS and drinking, such that daily fluctuations in PTS symptoms were associated with stronger-than-normal coping drinking motives, which in turn predicted more drinks per drinking day. Conclusions: Results highlight the importance of coping drinking motives and suggest that alternative coping strategies may help trauma-exposed SMW to manage heightened PTS symptoms without increasing their alcohol consumption. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Emily R Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Anna E Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University
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Sharareh P, Leili T, Abbas M, Jalal P, Ali G. Determining correlates of the average number of cigarette smoking among college students using count regression models. Sci Rep 2020; 10:8874. [PMID: 32483160 PMCID: PMC7264191 DOI: 10.1038/s41598-020-65813-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/27/2020] [Indexed: 11/18/2022] Open
Abstract
College students, as a large part of young adults, are a vulnerable group to several risky behaviors including smoking and drug abuse. This study aimed to utilize and to compare count regression models to identify correlates of cigarette smoking among college students. This was a cross-sectional study conducted on students of Hamadan University of Medical Sciences. The Poisson, negative binomial, generalized Poisson, exponentiated-exponential geometric regression models and their zero-inflated counterparts were fitted and compared using the Vuong test (α = 0.05). A number of 1258 students participated in this study. The majority of students were female (60.8%) and their average age was 23 years. Most of the students were non-smokers (84.6%). Negative binomial regression was selected as the most appropriate model for analyzing the data (comparable fit and simpler interpretation). The significant correlates of the number of cigarettes smoked per day included gender (male: incident-rate-ratio (IRR = 9.21), birth order (Forth: IRR = 1.99), experiencing a break-up (IRR = 2.11), extramarital sex (heterosexual (IRR = 2.59), homosexual (IRR = 3.13) vs. none), and drug abuse (IRR = 5.99). Our findings revealed that several high-risk behaviors were associated with the intensity of smoking, suggesting that these behaviors should be considered in smoking cessation intervention programs for college students.
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Affiliation(s)
- Parami Sharareh
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tapak Leili
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Moghimbeigi Abbas
- Department of Biostatistics, School of Public health, Alborz University of Medical Sciences, Alborz, Iran
| | - Poorolajal Jalal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghaleiha Ali
- Department of Psychiatry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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