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Lowe AT, Maki A, Figueroa C, Venugopal PD. Place-based estimates of cigarette butt litter raise environmental justice concerns in the United States. PLoS One 2024; 19:e0308930. [PMID: 39146265 PMCID: PMC11326580 DOI: 10.1371/journal.pone.0308930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
Littering of cigarette butts is a major environmental challenge. In 2022, ~124 billion cigarette butts were littered in the United States. This litter may pose an environmental justice concern by disproportionately affecting human and environmental health in communities of color or communities of low socioeconomic status. However, the lack of data on the distribution and magnitude of cigarette butt littering prevents an environmental justice analysis and limits the ability to tackle this environmental challenge. We conducted an environmental justice assessment of tobacco product waste, specifically cigarette butts, through spatially-explicit, place-based estimates across the contiguous U.S. We built a bottom-up model by synthesizing census tract-level population and smoking prevalence, state-level cigarette consumption, and published littering data to assess the spatial pattern of cigarette consumption and littering, and its implications for environmental injustice in >71,600 U.S. census tracts. Further, we compared the model output to urbanicity (rural-urban commuting area) and Social-Environmental Risk (SER; CDC Environmental Justice Index). Cigarette butt density was not uniformly distributed across the U.S. and ranged from 0-45.5 butts/m2, with an area-weighted average of 0.019 ± 0.0005 butts/m2. Cigarette butt density was 96 times higher in metropolitan vs. rural areas. Cigarette butt density increased significantly with SER, with 5.6 times more littered cigarette butts, and a steeper response to population density, in census tracts with the highest SER vs. the lowest SER. These results demonstrate the relative influences of location, smoking prevalence, and population density, and show that cigarette butt littering is a potential environmental justice concern in the U.S. This study provides information that may help devise targeted strategies to reduce cigarette butt pollution and prevent disproportionate impacts. The spatial data layer with place-based cigarette consumption and butt density is a tool that can support municipal, state, and federal level policy work and future studies on associations among cigarette butt pollution and environmental health outcomes.
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Affiliation(s)
- Alexander T Lowe
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Alexander Maki
- Division of Population Health Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Carla Figueroa
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - P Dilip Venugopal
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
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Murphy SE, Guillermo C, Thomson NM, Carmella SG, Wittmann M, Aldrich MC, Cai Q, Sullivan SM, Stram DO, Le Marchand L, Hecht SS, Blot WJ, Park SL. Association of Urinary Biomarkers of Tobacco Exposure with Lung Cancer Risk in African American and White Cigarette Smokers in the Southern Community Cohort Study. Cancer Epidemiol Biomarkers Prev 2024; 33:1073-1082. [PMID: 38780906 PMCID: PMC11299762 DOI: 10.1158/1055-9965.epi-23-1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND After accounting for smoking history, lung cancer incidence is greater in African Americans than Whites. In the multiethnic cohort, total nicotine equivalents (TNE) are higher in African Americans than Whites at similar reported cigarettes per day. Greater toxicant uptake per cigarette may contribute to the greater lung cancer risk of African Americans. METHODS In a nested case-control lung cancer study within the Southern Community Cohort, smoking-related biomarkers were measured in 259 cases and 503 controls (40% White; 56% African American). TNE, the trans-3-hydroxycotinine/cotinine ratio, 4-(methylnitrosamino)-1-3-(pyridyl)-1-butanol (NNAL), mercapturic acid metabolites of volatile organic compounds, phenanthrene metabolites, cadmium (Cd), and (Z)-7-(1R,2R,3R,5S)-3,5-dihydroxy-2-[(E,3S)-3-hydroxyoct-1-enyl]cyclopenyl]hept-5-enoic acid were quantified in urine. Unconditional logistic regression was used to estimate the ORs and 95% confidence intervals (CI) for each biomarker and lung cancer risk. RESULTS TNE, NNAL, and Cd were higher in cases than controls (adjusted for age, race, sex, body mass index, and cigarettes per day). Among cases, these levels were higher in African Americans compared with Whites. After accounting for age, sex, body mass index, and pack-years, a one-SD increase in log-TNE (OR = 1.30; 95% CI, 1.10-1.54) and log-NNAL (OR = 1.27; 95% CI, 1.03-1.58 with TNE adjustment) was associated with lung cancer risk. In this study, in which NNAL concentration is relatively high, the association for log-TNE was attenuated after adjustment for log-NNAL. CONCLUSIONS Smoking-related biomarkers provide additional information for lung cancer risk in smokers beyond smoking pack-years. IMPACT Urinary NNAL, TNE, and Cd concentrations in current smokers, particularly African American smokers, may be useful for predicting lung cancer risk.
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Affiliation(s)
- Sharon E. Murphy
- Department of Biochemistry Molecular Biology and Biophysics and Masonic Cancer Center, University of Minnesota, Minneapolis MN
| | - Cherie Guillermo
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | | | - Milo Wittmann
- Masonic Cancer Center, University of Minnesota, Minneapolis MN, USA
| | - Melinda C. Aldrich
- Division of Genetic Medicine, Department of Medicine. Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Daniel O. Stram
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis MN, USA
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S. Lani Park
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
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Gurram N, Carroll F, Elers CNH, Fox R, Minster ST, Wikaire E, Brown L. Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis. Health Promot Int 2024; 39:daae060. [PMID: 38916147 DOI: 10.1093/heapro/daae060] [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] [Indexed: 06/26/2024] Open
Abstract
Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.
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Affiliation(s)
- Niveditha Gurram
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Felix Carroll
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Christine Ngā Hau Elers
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Ririwai Fox
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Sara Tepaeru Minster
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Erena Wikaire
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
| | - Lynsey Brown
- Insights and Evaluation, Health Promotion Directorate, National Public Health Service, Te Whatu Ora-Health New Zealand, Level 16, 101 The Terrace, Wellington 6011, New Zealand
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Williamson JI, Janda KM, Jones SK. Exploring Smoking Disparities and Sociodemographic Factors in a Peri-urban Landscape: A Census Tract-Level Analysis in McLennan County, Texas. J Community Health 2024; 49:286-295. [PMID: 37932627 DOI: 10.1007/s10900-023-01291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
Cigarette smoking significantly contributes to preventable illness, death, and economic costs. Despite overall reduction in national smoking rates, disparities persist between demographic groups and geographic regions. While some studies have explored urban-rural differences in smoking prevalence, gaps exist in understanding localized patterns. This study focuses on examining smoking rates and related factors at the census tract level in McLennan County, Texas, a county that contains a mixture of urban, peri-urban, and rural areas. This study uses census tract level aggregate sociodemographic, smoking, and health-related data from the American Community Survey and the PLACES Project City Health Dashboard. Geospatial analyses mapped co-occurrence of high prevalence of smoking, mental and physical distress, and co-occurrence of lower routine medical check-ups, household income, and education. Multiple linear regression modeled associations between smoking and sociodemographic, and health-related factors. Geospatial analyses identified census tracts with co-occurring high prevalence of smoking, mental and physical distress, and co-occurrence of lower routine medical check-ups, household income, and education level in McLennan County. Regression analyses identified that smoking rates were positively correlated with frequent physical distress (p < 0.0001) and negatively correlated with the proportion of routine medical check-ups (p < 0.0001) and the proportion living in poverty (p = 0.0002). This study found significant variations in smoking rates, physical and mental distress, medical check-ups, and sociodemographic factors between neighboring census tracts which geospatial analyses examining larger geographic units may have overlooked. Future research should focus on obtaining individual-level and community-level data to develop more targeted interventions sensitive to specific community contexts.
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Affiliation(s)
- Jahsarah I Williamson
- Department of Public Health, Baylor University, One Bear Place #97343, Waco, TX, 76798-7303, USA
| | - Kathryn M Janda
- Department of Public Health, Baylor University, One Bear Place #97343, Waco, TX, 76798-7303, USA
| | - Stephanie K Jones
- Department of Public Health, Baylor University, One Bear Place #97343, Waco, TX, 76798-7303, USA.
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Heris C, Caudell RZ, Barrett EM, Brinckley MM, Cohen R, Kennedy M, Whop LJ, Calma T, Maddox R. The social determinants of Aboriginal and Torres Strait Islander adults who do not smoke in regional Australia. Aust J Rural Health 2024; 32:275-285. [PMID: 38366719 DOI: 10.1111/ajr.13084] [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: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018-2019. This paper seeks to better understand smoke-free behaviours, and to systematically quantify associations between a range of SDOH and non-smoking/never-smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. OBJECTIVE To explore the social determinants of health (SDOH) related to non- and never-smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. DESIGN Cross-sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never-smokers and non-smokers (ex- and never-smokers). The social determinants of health exposures related to socioeconomic position, well-being and access to healthcare. SETTING Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018-2019. PARTICIPANTS Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). RESULTS High income was associated with non-smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66-2.57) and never-smoking (PR = 2.02; 1.46-2.79), as was completing year 10 (non-smoking PR = 1.34; 1.12-1.61 and never-smoking PR = 1.56; 1.20-2.03). Better food security was associated with a higher prevalence of never-smoking (PR = 2.42; 1.48-3.98). Lower psychological distress scores were associated with non-smoking (PR = 1.30; 1.10-1.53) and never-smoking (PR = 1.56; 1.21-2.01). Never-smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22-2.06). Having a usual healthcare provider was associated with non-smoking (PR = 1.38; 1.02-1.86). Positive exposure to the SDOH were associated with non- and never-smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non-smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Christina Heris
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Reuben Z Caudell
- Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Eden M Barrett
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Makayla-May Brinckley
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- School of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rubijayne Cohen
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Michelle Kennedy
- School of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Lisa J Whop
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Tom Calma
- Consultant to the Commonwealth Department of Health, Canberra, Australian Capital Territory, Australia
| | - Raglan Maddox
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Kundu A, Sultana N, Felsky D, Moraes TJ, Selby P, Chaiton M. An overview of systematic reviews on predictors of smoking cessation among young people. PLoS One 2024; 19:e0299728. [PMID: 38466736 PMCID: PMC10927074 DOI: 10.1371/journal.pone.0299728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Understanding the factors that influence smoking cessation among young people is crucial for planning targeted cessation approaches. The objective of this review was to comprehensively summarize evidence for predictors of different smoking cessation related behaviors among young people from currently available systematic reviews. We searched six databases and reference lists of the included articles for studies published up to October 20, 2023. All systematic reviews summarizing predictors of intention to quit smoking, quit attempts, or smoking abstinence among people aged 10-35 years were included. We excluded reviews on effectiveness of smoking cessation intervention; smoking prevention and other smoking behaviors; cessation of other tobacco products use, dual use, and polysubstance use. We categorized the identified predictors into 5 different categories for 3 overlapping age groups. JBI critical appraisal tool and GRADE-CERqual approach were used for quality and certainty assessment respectively. A total of 11 systematic reviews were included in this study; all summarized predictors of smoking abstinence/quit attempts and two also identified predictors of intention to quit smoking. Seven reviews had satisfactory critical appraisal score and there was minimal overlapping between the reviews. We found 4 'possible' predictors of intention to quit smoking and 119 predictors of smoking abstinence/quit attempts. Most of these 119 predictors were applicable for ~10-29 years age group. We had moderate confidence on the 'probable', 'possible', 'insufficient evidence', and 'inconsistent direction' predictors and low confidence on the 'probably unrelated' factors. The 'probable' predictors include a wide variety of socio-demographic factors, nicotine dependence, mental health, attitudes, behavioral and psychological factors, peer and family related factors, and jurisdictional policies. These predictors can guide improvement of existing smoking cessation interventions or planning of new targeted intervention programs. Other predictors as well as predictors of intention to quit smoking need to be further investigated among adolescents and young adults separately.
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Affiliation(s)
- Anasua Kundu
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nahid Sultana
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Daniel Felsky
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Theo J. Moraes
- Institute of Medical Science, University of Toronto, Toronto, Canada
- The Hospital for Sick Children (SickKids), Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Peter Selby
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Michael Chaiton
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Brünés N, Lindstroem MB, Ulrik CS, Andersen O, Lisby M, Godtfredsen NS, Hansen TL, Pisinger C, Graven V, Marsaa K, Thomsen LH. Opportunistic screening for COPD among socially marginalized patients. BMC Pulm Med 2024; 24:113. [PMID: 38443835 PMCID: PMC10916054 DOI: 10.1186/s12890-024-02927-9] [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: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease associated with premature death. Tobacco exposure is the main risk factor, but lower socioeconomic status, early life insults, and occupational exposures are also important risk factors. Socially marginalized people, facing homelessness, substance use disorder, and mental illness, are likely to have a higher risk of developing COPD, and, furthermore, experience barriers to healthcare access and consequently poorer outcomes. OBJECTIVE This study aims to assess COPD prevalence and the impact of opportunistic screening among hospitalized patients who are in contact with hospital social nurses. These patients constitute a group of patients with a high prevalence of psychiatric and somatic diseases, substance use, low life expectancy, and are socially marginalized. METHODS The present prospective longitudinal study includes a clinical examination at baseline. Participants will have spirometry done and be interviewed regarding risk factors, socioeconomic conditions, and respiratory symptoms. The 5-year follow-up assessment incorporates data from baseline and register data over the 5 years, including information on morbidity, use of COPD medication, hospital contacts, mortality, and socioeconomic factors. ANTICIPATED RESULTS Referral for further diagnostic work-up and management after the screening, including COPD treatment and smoking cessation support, is expected to improve survival rates. The study is still enrolling patients. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov , NCT04754308 with study status: "enrolling".
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Affiliation(s)
- Nina Brünés
- Department of Quality and Patient Care, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Lisby
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Health, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Leth Hansen
- Department of Quality and Patient Care, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Frederiksberg, Frederiksberg, Denmark
- Tryg Foundation, Virum, Denmark
| | - Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Marsaa
- Department of Multidisease, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Laura Hohwü Thomsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
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Sheffer CE, Shevorykin A, Freitas-Lemos R, Vantucci D, Carl E, Bensch L, Marion M, Erwin DO, Smith PH, Williams JM, Ostroff JS. Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop. Subst Abus 2023; 44:313-322. [PMID: 37842906 DOI: 10.1177/08897077231200987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop. METHODS We used the Delphi Technique to systematically identify the specific competencies and corresponding knowledge and skill sets required to achieve these proficiencies. Educational content was developed to teach these competencies in a virtual workshop. The workshop was evaluated by 11 experts in the field by examining pre- and post-training changes in perceived knowledge, skill, and confidence levels and other quantitative and qualitative feedback. Repeated measures analysis of variance and paired sample t-tests were used to examine pre-post training differences. RESULTS Six competencies and corresponding skill sets were identified. After exposure to the virtual workshop, the experts reported significant increases in the overall proficiency for each competency as well as increases in nearly all levels of knowledge, skill, and confidence within the competency skill sets. Qualitative and quantitative findings indicate that content was relevant to practice. CONCLUSIONS These findings provide preliminary support for 6 competencies and skills sets needed to improve therapeutic interpersonal interactions that recognize the importance of social and cultural influences in the treatment of tobacco use.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Philip H Smith
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH, USA
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tsui J, Sloan K, Sheth R, Ewusi Boisvert E, Nieva J, Kim AW, Pang RD, Sussman S, Kirkpatrick M. Implementation planning for equitable tobacco treatment services: a mixed methods assessment of contextual facilitators and barriers in a large comprehensive cancer center. Transl Behav Med 2023; 13:539-550. [PMID: 36940412 PMCID: PMC10848232 DOI: 10.1093/tbm/ibac122] [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] [Indexed: 03/22/2023] Open
Abstract
Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population characteristics and multilevel context specific to settings serving diverse patients are needed to improve tobacco cessation among cancer patients. We examined tobacco use screening and implementation needs for tobacco treatment services to inform equitable and accessible delivery within a large comprehensive cancer center in the greater Los Angeles region. We conducted a multi-modal, mixed methods assessment using electronic medical records (EMR), and clinic stakeholder surveys and interviews (guided by the Consolidated Framework for Implementation Research). Approximately 45% of patients (n = 11,827 of 26,030 total) had missing tobacco use history in their EMR. Several demographic characteristics (gender, age, race/ethnicity, insurance) were associated with greater missing data prevalence. In surveys (n = 32), clinic stakeholders endorsed tobacco screening and cessation services, but indicated necessary improvements for screening/referral procedures. During interviews (n = 13), providers/staff reported tobacco screening was important, but level of priority differed as well as how often and who should screen. Several barriers were noted, including patients' language/cultural barriers, limited time during visits, lack of smoking cessation training, and insurance coverage. While stakeholders indicated high interest in tobacco use assessment and cessation services, EMR and interview data revealed opportunities to improve tobacco use screening across patient groups. Implementing sustainable system-level tobacco cessation programs at institutions requires leadership support, staff training, on routine screening, and intervention and referral strategies that meet patients' linguistic/cultural needs.
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Affiliation(s)
- Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajiv Sheth
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jorge Nieva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Matthew Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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10
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Bares CB, Sharma V, Lopez-Quintero C. Socio-demographic Correlates of Electronic Cigarette and Cannabis Co-use Among Naïve and Tobacco Adolescent Users. JOURNAL OF PREVENTION (2022) 2023; 44:457-475. [PMID: 37038010 PMCID: PMC11101152 DOI: 10.1007/s10935-023-00729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
The increasing co-use of e-cigarette and cannabis among youth has become a public health challenge. The present analyses aimed to identify prevalence and correlates of past-month co-use of e-cigarettes and cannabis among adolescents with and without prior tobacco use. For this panel study, 5 years of cross-sectional data (2014-2018) were used from 8th, 10th-, and 12th-grade adolescents in the Monitoring the Future study, a nationally representative survey of U.S. students. We examined prevalence and correlates of e-cigarettes and cannabis co-use among adolescents who had ever used tobacco (n = 15,136) and among those who had never used tobacco (n = 56,525). Adolescents who had ever used tobacco showed significantly higher rates of e-cigarettes and cannabis co-use compared to adolescents who had never used tobacco (17.1% vs. 2.2%, p < 0.01). Results from adjusted multinomial regression models showed that overall, Black and Hispanic adolescents tobacco users were less likely than Whites to co-use e-cigarettes and cannabis. Black adolescents who had used tobacco previously were more likely than Whites to have used cannabis exclusively. Black and Hispanic tobacco-naïve adolescents were more likely than Whites to have used cannabis exclusively, while Black tobacco-naïve adolescents were less likely to use e-cigarettes exclusively or co-use e-cigarettes and cannabis. Overall, males and twelve graders were more likely than males and eight graders to use or co-use cannabis or e-cigarettes, respectively. Among lifetime tobacco users, higher levels of parental education were associated with co-use of cannabis and e-cigarettes. Racial/ethnic-specific patterns of e-cigarette and cannabis co-use depends on adolescents' prior experience with tobacco. The higher rates of use and co-use of e-cigarettes and cannabis among prior tobacco users suggest that targeted interventions are needed for this group. Identified socio-demographic groups at higher risk of co-use of e-cigarettes and cannabis need to be further studied.
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Affiliation(s)
- Cristina B Bares
- School of Social Work, University of Michigan, 1080 South University, Ann Arbor, MI, 48109, USA.
| | - Vinita Sharma
- School of Public and Population Health, Boise State University, Boise, ID, 83725, USA
| | - Catalina Lopez-Quintero
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
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11
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Zvolensky MJ, Heggeness LF, Mayorga N, Garey L, Buckner JD, Businelle MS, Redmond BY. Financial Strain Among Black Smokers in Terms of Abstinence Expectancies. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01720-4. [PMID: 37488316 DOI: 10.1007/s40615-023-01720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, USA.
- HEALTH Institute, University of Houston, Houston, USA.
| | - Luke F Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Nubia Mayorga
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
- HEALTH Institute, University of Houston, Houston, USA
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Michael S Businelle
- HEALTH Institute, University of Houston, Houston, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
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12
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Córdoba-Doña JA, Benítez-Rodríguez E, Escolar-Pujolar A, Santos-Sánchez V. Age-period-cohort analysis of lung cancer mortality inequalities in Southern Spain: missed opportunities for implementing equitable tobacco control policies. Int J Equity Health 2023; 22:132. [PMID: 37438851 PMCID: PMC10339480 DOI: 10.1186/s12939-023-01946-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Lung cancer mortality in European countries shows different epidemiological patterns according to sex and socioeconomic variables. Some countries show decreasing rates in both sexes, while others show a delayed profile, with increasing mortality in women, inconsistently influenced by socioeconomic status. Our aim was to evaluate the effect of age, period and birth cohort on lung cancer mortality inequalities in men and women in Andalusia, the southernmost region in Spain. METHODS We used the Longitudinal Database of the Andalusian Population, which collects demographic and mortality data from the 2001 census cohort of more than 7.35 million Andalusians, followed up between 2002 and 2016. Mortality rates were calculated for men and women by educational level, and small-area deprivation. Poisson models were used to assess trends in socioeconomic inequalities in men and women. Finally, age-period-cohort (APC) models were used separately for each educational level and gender. RESULTS There were 39,408 lung cancer deaths in men and 5,511 in women, yielding crude mortality rates of 78.1 and 11.4 × 105 person-years, respectively. In men higher mortality was found in less educated groups and inequalities increased during the study period: i.e. the rate ratio for primary studies compared to university studies increased from 1.30 (CI95:1.18-1.44) to 1.57 (CI95:1.43-1.73). For women, educational inequalities in favour of the less educated tended to decrease moderately. In APC analysis, a decreasing period effect in men and an increasing one in women were observed. Cohort effect differed significantly by educational level. In men, the lower the educational level, the earlier the peak effect was reached, with a 25-year difference between the least-educated and college-educated. Conversely, college-educated women reached the peak effect with a 12-year earlier cohort than the least-educated women. The decline of mortality followed the same pattern both in men and women, with the best-educated groups experiencing declining rates with earlier birth cohorts. CONCLUSIONS Our study reveals that APC analysis by education helps to uncover changes in trends occurring in different socioeconomic and gender groups, which, combined with data on smoking prevalence, provide important clues for action. Despite its limitations, this approach to the study of lung cancer inequalities allows for the assessment of gaps in historical and current tobacco policies and the identification of population groups that need to be prioritised for public health interventions.
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Affiliation(s)
- Juan Antonio Córdoba-Doña
- Preventive Medicine and Public Health Unit, Hospital Universitario de Jerez, Jerez de la Frontera (Cádiz), Jerez de la Frontera, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz, INIBiCA, Cádiz, Spain.
| | - Encarnación Benítez-Rodríguez
- Instituto de Investigación e Innovación Biomédica de Cádiz, INIBiCA, Cádiz, Spain
- Preventive Medicine and Public Health Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Vanessa Santos-Sánchez
- Instituto de Investigación e Innovación Biomédica de Cádiz, INIBiCA, Cádiz, Spain
- Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, Spain
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13
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Stankowski TJ, Alagoz E, Jacobson N, Neuman HB. Factors Associated With Socioeconomic Disparities in Breast Reconstruction: Perspectives of Wisconsin Surgeons. Clin Breast Cancer 2023; 23:461-467. [PMID: 37069035 PMCID: PMC10664705 DOI: 10.1016/j.clbc.2023.03.010] [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: 12/19/2022] [Revised: 02/20/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The objective is to expand our understanding of the factors associated with receipt of breast reconstruction for socioeconomically disadvantaged women within Wisconsin. METHODS A purposeful sample of general/breast and plastic surgeons were identified. One-on-one interviews were conducted, audio-recorded, and transcribed in full (n = 15). Conventional content analysis was performed to identify themes. RESULTS Both general/breast and plastic surgeons perceived that general/breast surgeons served as gatekeepers to which patients are offered a referral for reconstruction. Given the additional recovery time, frequent clinic visits, and potential for complications associated with reconstruction, general/breast surgeons perceived that not all women prioritize it. Surgeons perceived this to be especially true for socioeconomically disadvantaged women. Surgeons identified time off work, travel for visits, and out-of-pocket costs as specific challenges to reconstruction experienced by socioeconomically disadvantaged women. Surgeons perceived that early education, incorporating financial considerations into discussions, and reducing travel burden may help to improve access to reconstruction. CONCLUSION Wisconsin surgeons described factors they perceived contributed to lower rates of reconstruction for socioeconomically disadvantaged women and described ways to increase reconstruction access.
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Affiliation(s)
- Trista J Stankowski
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Esra Alagoz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing, University of Wisconsin-Madison, Madison, WI
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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14
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Arrazola RA, Griffin T, Lunsford NB, Kittner D, Bammeke P, Courtney-Long EA, Armour BS. US Cigarette Smoking Disparities by Race and Ethnicity - Keep Going and Going! Prev Chronic Dis 2023; 20:E45. [PMID: 37262328 DOI: 10.5888/pcd20.220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Although current cigarette smoking among US adults decreased from 42.4% in 1965 to 12.5% in 2020, prevalence is higher among certain racial and ethnic groups, including non-Hispanic American Indian and Alaska Native (AIAN) adults. METHODS We examined trends in current cigarette smoking prevalence, population estimates, and relative disparity among US adults (aged ≥18 y) between 2011 and 2020 by using data from the National Health Interview Survey. SAS-callable SUDAAN was used to obtain prevalence and population estimates, and relative disparity was calculated on the basis of findings in the literature. Trends were significant at P < .05. RESULTS From 2011 to 2020, linear decreases in prevalence and population estimates were observed for non-Hispanic White (20.6% to 13.3%; 32.1 million to 20.7 million), non-Hispanic Black (19.4% to 14.4%; 5.1 million to 4.0 million), and Hispanic (12.9% to 8.0%; 4.2 million to 3.3 million) adults. For non-Hispanic AIAN adults, prevalence remained around 27%, and a linear increase in the population estimate was observed from 400,000 to 510,000. Relative disparity did not change across racial and ethnic categories. CONCLUSION Linear decreases have occurred between 2011 and 2020 for non-Hispanic White, non-Hispanic Black, and Hispanic adults who smoke, but the number of non-Hispanic AIAN adults who currently smoke has increased by 110,000, and relative disparities persist. To reduce racial and ethnic disparities in smoking, understanding how factors at multiple socioecologic levels impact smoking and helping to inform paths to equitable reach and implementation of tobacco control interventions for all population groups are needed.
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Affiliation(s)
- René A Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S107-7, Atlanta, GA 30341
| | | | - Natasha Buchanan Lunsford
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deirdre Kittner
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip Bammeke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth A Courtney-Long
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian S Armour
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Nargis N, Xue Z, Asare S, Bandi P, Jemal A. Declining trend in cigarette smoking among U.S. adults over 2008-2018: A decomposition analysis. Soc Sci Med 2023; 328:115982. [PMID: 37269745 DOI: 10.1016/j.socscimed.2023.115982] [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: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
The United States (U.S.) witnessed considerable reduction in cigarette smoking prevalence in the recent past. While the correlates of smoking prevalence and related disparities among U.S. adults are well documented, there is limited information on how this success was shared among different population sub-groups. Based on data from the National Health Interview Surveys, 2008 and 2018, representative of non-institutionalized U.S. adults (18 years and above), we applied the threefold Kitawaga-Oaxaca-Blinder linear decomposition analysis. We decomposed the trends in cigarette smoking prevalence, smoking initiation, and successful cessation into changes in population characteristics holding smoking propensities constant (compositional change), changes in smoking propensities by population characteristics holding population composition constant (structural change), and the unmeasured macro-level changes affecting smoking behavior in different population sub-groups at differential rates (residual change) to quantify the shares of population sub-groups by sex, age, race/ethnicity, education, marital status, employment status, health insurance coverage, family income, and region of residence in the overall change in smoking rates. The analysis shows that decreases in smoking propensities regardless of the changes in population composition accounted for 66.4% of the reduction in smoking prevalence and 88.7% of the reduction in smoking initiation. The major reductions in smoking propensity were among Medicaid recipients and young adults (ages 18-24 years). The 25-44-year-olds experienced moderate increase in successful smoking cessation, while the overall successful smoking cessation rate remained steady. Taken together, consistent reduction in smoking among U.S. adults by all major population characteristics, accompanied by disproportionately larger reduction in smoking propensities among the population sub-groups with initially higher smoking propensity compared to the national average, characterized the decline in overall cigarette smoking. Strengthening proven tobacco control measures with targeted interventions to reduce smoking propensities among underserved populations is key to continued success in reducing smoking overall and remedying inequities in smoking and population health.
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Affiliation(s)
- Nigar Nargis
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA.
| | - Zheng Xue
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Samuel Asare
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Priti Bandi
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
| | - Ahmedin Jemal
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA
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16
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Bowers S, Chang AY. The Social Determinants of Health and Their Impact on Dermatologic Health, Part 1: The Social Determinants of Health and Their Dermatologic Implications. Dermatol Clin 2023; 41:309-316. [PMID: 36933920 DOI: 10.1016/j.det.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The social determinants of health (SDoH) have significant influences on health and lead to health disparities in a variety of complex and intersecting ways. They are the nonmedical factors that must be addressed to improve health outcomes and achieve greater health equity. They are shaped by the structural determinants of health and impact individual socioeconomic status as well as the health of entire communities. Part 1 of this 2-part review aims to shed light on how the SDoH impact health and their specific implications on dermatologic health disparities.
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Affiliation(s)
- Sacharitha Bowers
- Division of Dermatology, Department of Internal Medicine, Loyola University Medical Center, Stritch School of Medicine, 1S260 Summit Ave, Oakbrook Terrace, IL 60181, USA.
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, Building 90, Ward 92, San Francisco, CA 94110, USA
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17
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Acquah I, Hagan K, Javed Z, Taha MB, Valero-Elizondo J, Nwana N, Yahya T, Sharma G, Gulati M, Hammoud A, Shapiro MD, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events. J Am Heart Assoc 2023; 12:e025581. [PMID: 36926956 PMCID: PMC10111542 DOI: 10.1161/jaha.122.025581] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background Although there is research on the impact of social determinants of health (SDOHs) on cardiovascular health, most existing evidence is based on individual SDOH components. We evaluated the impact of cumulative SDOH burden on cardiovascular risk factors, subclinical atherosclerosis, and incident cardiovascular disease events. Methods and Results We included 6479 participants from the MESA (Multi-Ethnic Study of Atherosclerosis). A weighted aggregate SDOH score representing the cumulative number of unfavorable SDOHs, identified from 14 components across 5 domains (economic stability, neighborhood and physical environment, community and social context, education, and health care system access) was calculated and divided into quartiles (quartile 4 being the least favorable). The impact of cumulative SDOH burden on cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and obesity), systemic inflammation, subclinical atherosclerosis, and incident cardiovascular disease was evaluated. Increasing social disadvantage was associated with increased odds of all cardiovascular risk factors except dyslipidemia. Smoking was the risk factor most strongly associated with worse SDOH (odds ratio [OR], 2.67 for quartile 4 versus quartile 1 [95% CI, 2.13-3.34]). Participants within SDOH quartile 4 had 33% higher odds of increased high-sensitivity C-reactive protein (OR, 1.33 [95% CI, 1.11-1.60]) and 31% higher risk of all cardiovascular disease (hazard ratio, 1.31 [95% CI, 1.03-1.67]), yet no greater burden of subclinical atherosclerosis (OR, 1.01 [95% CI, 0.79-1.29]), when compared with those in quartile 1. Conclusions Increasing social disadvantage was associated with more prevalent cardiovascular risk factors, inflammation, and incident cardiovascular disease. These findings call for better identification of SDOHs in clinical practice and stronger measures to mitigate the higher SDOH burden among the socially disadvantaged to improve cardiovascular outcomes.
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Affiliation(s)
- Isaac Acquah
- Center for Outcomes Research Houston Methodist Houston TX
| | - Kobina Hagan
- Center for Outcomes Research Houston Methodist Houston TX
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research Center for Outcomes Research, Houston Methodist Houston TX
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nwabunie Nwana
- Center for Outcomes Research Houston Methodist Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Martha Gulati
- Division of Cardiology University of Arizona (Phoenix) Phoenix AZ
| | | | - Michael D Shapiro
- Section of Cardiovascular Medicine Wake Forest School of Medicine Winston Salem NC
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine and Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Khurram Nasir
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
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18
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Zvolensky MJ, Bakhshaie J, Garey L, Kauffman BY, Heggeness LF, Schmidt NB. Cumulative vulnerabilities and smoking abstinence: A test from a randomized clinical trial. Behav Res Ther 2023; 162:104272. [PMID: 36746057 DOI: 10.1016/j.brat.2023.104272] [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: 06/27/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Smoking cessation is often associated with socioeconomic and intrapersonal vulnerabilities such as psychopathology. Yet, most research that focuses on predicting smoking cessation outcomes tends focus on a small number of possible vulnerabilities. In a secondary data analysis, we developed and empirically evaluated a comprehensive, cumulative vulnerability risk composite reflecting psychologically based transdiagnostic processes, social determinants of health, and psychopathology. Participants were adult smokers who responded to study advertisements (e.g., flyers, newspaper ads, radio announcements) for an in-person delivered 4-session smoking cessation trial (N = 267; 47% female; Mage = 39.4, SD = 13.8). Results indicated that the decline in point prevalence abstinence (PPA) from quit week to 6-month post-quit was statistically significant (p < .001). There were statistically significant effects of cumulative risk score on the intercept (p < .001) and slope (p = .01). These findings were evident in unadjusted and adjusted (controlling for sex, treatment condition, and nicotine dependence) models. The present results indicate smokers with greater cumulative vulnerability demonstrated poorer smoking cessation outcomes. There may be clinical advantages to better understanding cumulative vulnerability among treatment-seeking smokers and other smoking populations to enhance the impact of public health efforts to reduce smoking.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Luke F Heggeness
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Okeke B, Hillmon C, Jones J, Obanigba G, Obi A, Nkansah M, Odiase N, Khanipov K, Okereke IC. The relationship of social determinants and distress in newly diagnosed cancer patients. Sci Rep 2023; 13:2153. [PMID: 36750604 PMCID: PMC9905536 DOI: 10.1038/s41598-023-29375-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Patients with a new cancer diagnosis can experience distress when diagnosed. There are disparities in treatment of cancer patients based on social determinants, but minimal research exists on the relationship of those social determinants and distress after a new cancer diagnosis. Our goals were to determine the social determinants associated with distress after a new cancer diagnosis and determine the relationship of distress with outcome. Patients with a new cancer diagnosis at one institution from January 2019 to December 2020 were analyzed. Patients were given the National Comprehensive Cancer Network (NCCN) distress thermometer during their first visit. Demographics, tumor characteristics, clinical variables and survival were recorded. Patients were also asked to share specific factors that led to distress, including: (1) financial, (2) transportation, (3) childcare and (4) religious. A total of 916 patients returned distress thermometers. Mean age was 59.1 years. Females comprised 71.3 (653/916) percent of the cohort. On Dunn's multiple comparison, the following factors were associated with increased distress level: female (p < 0.01), ages 27 to 45 (p < 0.01), uninsured (p < 0.01) and unemployed (p < 0.01). Patients with higher distress scores also experienced worse overall survival (p < 0.05). Females, young patients, uninsured patients and unemployed patients experience more distress after a new cancer diagnosis. Increased distress is independently associated with worse overall survival. Social determinants can be used to predict which patients may require focused interventions to reduce distress after a new cancer diagnosis.
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Affiliation(s)
- Brandon Okeke
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Cheron Hillmon
- Department of Care Management, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasmine Jones
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Grace Obanigba
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ann Obi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Meagan Nkansah
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nicholas Odiase
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kamil Khanipov
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
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20
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Hughes K, Olufajo OA, White K, Roby DH, Fryer CS, Wright JL, Sehgal NJ. The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status. Ann Vasc Surg 2023; 92:33-41. [PMID: 36736719 DOI: 10.1016/j.avsg.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although socioeconomic disparities in outcomes of peripheral artery disease (PAD) have been well studied, little is known about relationship between severity of PAD and socioeconomic status. The objective of this study was to examine this relationship. METHODS Patients who had operations for severe PAD (rest pain or tissue loss) were identified in the National Inpatient Sample, 2005-2014. They were stratified by the median household income (MHI) quartiles of their residential ZIP codes. Other characteristics such as race/ethnicity and insurance type were extracted. Factors associated with more severe disease (tissue loss) were evaluated using multivariable regression analyses. RESULTS There were 765,175 patients identified; 34% in the first MHI quartile and 18% in the fourth MHI quartile. Compared to patients in the first quartile, those in the fourth quartile were more likely White (69% vs. 42%, P < 0.001), more likely ≥65 years old (75% vs. 62%, P < 0.001), and were less likely to undergo amputations (25% vs. 34%, P < 0.001). After adjusting for patient characteristics, the fourth quartile was associated with more severe disease [Odds ratio: 1.19, 95% confidence interval (CI): 1.11-1.27] compared to the first quartile. CONCLUSIONS While higher MHI was associated with higher PAD severity, patients with high MHI were less likely to undergo amputations indicating a disparity in the choice of treatment for PAD. Increased efforts are necessary to reduce socioeconomic disparities in the treatment of severe PAD.
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Affiliation(s)
- Kakra Hughes
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD; Department of Surgery, Howard University College of Medicine, Washington, DC.
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Kellee White
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
| | - Dylan H Roby
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD; University of Maryland Capital Region Health, Cheverly, MD
| | - Neil J Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
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21
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Usidame B, Xie Y, Colston D, Titus AR, Henriksen L, Kelly BC, Fleischer NL. The association between local tobacco retail licensing and adult cigarette smoking by race/ethnicity, income, and education in California (2012-2019). Prev Med Rep 2023; 31:102064. [PMID: 36467543 PMCID: PMC9713321 DOI: 10.1016/j.pmedr.2022.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
This study investigates the association between the strength of TRL ordinances and adult cigarette use, and differences in the relationship by sociodemographic characteristics, using California as a case study. We merged geocoded data from the California Health Interview Survey with the State of Tobacco Control Reports from the American Lung Association from 2012 to 2019. Each jurisdiction was graded (A-strongest to F-weakest) based on the strength of their TRL ordinance while current cigarette use was defined as respondents who had smoked 100 or more cigarettes in their lifetime and currently smoke cigarettes every day or some days. We estimated multilevel logistic regression models to test the relationship between the strength of the TRL ordinance and current cigarette use and tested for effect modification by including interaction terms for race/ethnicity, income, and education in separate models. 11.6 % of sample participants from all years (n = 132,209) were current cigarette smokers. Adults in jurisdictions with stronger grades (A-D) had lower odds of current cigarette use (OR = 0.89, 95 % CI: 0.79-1.01) compared to adults in jurisdictions with the weakest grade (F), but the association was not statistically significant (p < 0.07). We found no evidence of effect modification by race/ethnicity, income, or education. We found limited evidence that stronger TRL ordinances were associated with lower adult cigarette smoking in California. However, future studies testing the relationship between TRL ordinances and adult smoking outcomes should examine the role of TRL fees across jurisdictions and adult cigarette use.
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Affiliation(s)
| | - Yanmei Xie
- University of Michigan, Ann Arbor, MI, United States
| | - David Colston
- University of North Carolina Chapel Hill, United States
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22
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Pearson JL. Increasing Future Health Equity-Related Manuscript Submissions to Nicotine & Tobacco Research. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2023; 25:1-2. [PMID: 36250619 DOI: 10.1093/ntr/ntac243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Jennifer L Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, USA
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Rose SW, Ickes M, Patel M, Rayens MK, van de Venne J, Annabathula A, Schillo B. Centering equity in flavored tobacco ban policies: Implications for tobacco control researchers. Prev Med 2022; 165:107173. [PMID: 35870576 PMCID: PMC9722530 DOI: 10.1016/j.ypmed.2022.107173] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 01/03/2023]
Abstract
To achieve equity in protection from poor health outcomes due to tobacco use, tobacco control policies and interventions need to affect socially disadvantaged groups more strongly than advantaged groups. Flavored tobacco bans have been seen as a policy with this potential. However, tobacco control researchers, in close concert with policy advocates, need to consider how to center equity throughout the policy process to achieve equitable outcomes from banning flavored tobacco. In this commentary, we outline the rationale for how and why tobacco control researchers should consider equity throughout the policy process to help fully achieve the potential of flavored tobacco ban policies. These recommendations emerged from a presentation at the Vermont Center on Behavior and Health 2021 Conference. Specifically, we focus on recommendations for tobacco control researchers to center equity including partnering with communities in agenda setting, examining how various policy formulations or exemptions may increase or decrease disparities, determining where flavor policies need to reach and whether policies are equitably reaching all populations disproportionately burdened by flavored tobacco, assessing whether policy implementation/enforcement is carried out equitably to maximize policy benefits, and evaluating policy impact with as much granularity as possible. Considering the entire policy process is central to enhancing equitable outcomes from banning flavored tobacco. Tobacco control researchers can play a key role in ensuring that these policies are viewed through an equity lens to, not just improve population health, but also to reduce harms to those disproportionately burdened by use of flavored products.
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Affiliation(s)
- Shyanika W Rose
- University of Kentucky, Lexington, KY, USA; Markey Cancer Center, Lexington, KY, USA.
| | | | - Minal Patel
- Truth Initiative Schroeder Institute, Washington, DC, USA
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24
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Marital Disruption and Disparity in Tobacco Use in Reproductive-Aged Women: Evidence from India. WOMEN 2022. [DOI: 10.3390/women2040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Marital disruption defined as widowhood, divorce, or separation, has adverse consequences for women’s health and wellbeing. Extant evidence, however, is primarily available for older women or in developed country settings. Consequences of marital disruption for younger women in the developing countries is relatively less visited. The aim of this cross-sectional study is to assess whether maritally disrupted women of reproductive age (18–49 years) had differential risk of tobacco-use compared to their married counterparts. Using nationally representative data from India, we estimated multivariable logistic regressions to obtain the odds in favor of tobacco-use for maritally disrupted women. We found that compared to women remained in marriage, maritally disrupted women were 1.5 times (95% CI: 1.4–1.6) more likely to consume tobacco. The higher risk of tobacco-use of maritally disrupted women was evident in both younger (age 18–34) and older (age 35–49) cohorts. The results were robust across urban and rural areas, high- and low- education groups, and poor- and non-poor households. The higher odds of tobacco-use among maritally disrupted women persisted even after accounting for household fixed effects. The study findings thus, have implications for strengthening targeted tobacco control policies and health promotion among maritally disrupted women in low-and-middle income countries.
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Vilane ZG, Kodali PB, Thankappan KR. Effect of socioeconomic status on smoking cessation behavior in selected African countries: Secondary analysis of Global Adult Tobacco Survey data (2014–2018). PLoS One 2022; 17:e0274746. [PMID: 36121824 PMCID: PMC9484673 DOI: 10.1371/journal.pone.0274746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/04/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Tobacco use remains a global public health challenge. While studies report that smoking cessation reduces the risk of cancer and other NCDs, evidence is scarce in African region on socio-economic determinants of smoking cessation behavior. This study examined the socio-economic differentials of smoking cessation behavior among smokers in four African countries. Methods The study was conducted through secondary analysis of Global Adult Tobacco Survey (GATS) data from four African countries (Ethiopia, Kenya, Senegal and Tanzania). Smoking cessation behavior was assessed using two variables i) intention to quit smoking in next 12 months and ii) previous quit attempts made within 12 months preceding the survey. The weighted percentages for intention to quit smoking and previous quit attempts were computed. The adjusted odds ratios were computed using multinomial logistic regression to identify the association between socio-economic factors and smoking cessation behavior. Results Across the four countries studied, the previous quit attempts among smokers were in the range of 39.6% to 53.7%. Around 7.6% to 15.8% of the smokers tried to quit with an assistance. In Ethiopia over 76.5% of current smokers reported no intention to quit in next 12 months after survey, whereas the same was 50.4% in Senegal. While country specific differences were observed, females, those belonging to the poorest wealth index, unemployed and those without any formal education reported significantly lower odds of previous quit attempts or having an intention to quit smoking. Conclusion The socio-economic vulnerabilities were found to compromise smoking cessation behavior among the smokers in countries studied. Targeted interventions, adherence to smokefree laws, and provision of cessation support are essential to improve quit rates and mitigate tobacco risks among socio-economically vulnerable population.
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Affiliation(s)
- Zinto Gabsile Vilane
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
- * E-mail:
| | - Prakash Babu Kodali
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
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Mahabee-Gittens EM, King KA, Vidourek RA, Merianos AL. Financial Insecurity and Food Insecurity among U.S. Children with Secondhand and Thirdhand Smoke Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9480. [PMID: 35954841 PMCID: PMC9368407 DOI: 10.3390/ijerph19159480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022]
Abstract
Objectives: Smokers with financial and food insecurity may find it difficult to quit smoking and reduce their children’s tobacco smoke exposure (TSE). The objective was to examine the associations between child TSE and financial and food insecurity among U.S. school-aged children. Methods: We examined the 2018−2019 National Survey of Children’s Health data on 17,484 children 6−11 years old. Children were categorized into TSE groups: (1) No TSE: did not live with a smoker; (2) thirdhand smoke (THS) exposure alone: lived with a smoker who did not smoke inside the home; or (3) secondhand smoke (SHS) and THS exposure: lived with a smoker who smoked inside the home. We conducted weighted logistic, ordinal, and linear regression analyses to assess the relationships between child TSE status and financial and food insecurity, adjusting for covariates. Results: Overall, 13.1% and 1.8% of children had THS exposure alone and SHS and THS exposure, respectively. Compared to children with no TSE, children with THS exposure alone were at 2.17 increased odds (95% CI = 1.83, 2.58, p < 0.001) and children with SHS and THS exposure were at 2.24 increased odds (95% CI = 1.57, 3.19, p < 0.001) of having financial insecurity. Children with THS exposure alone were at 1.92 increased odds (95% CI = 1.58, 2.33, p < 0.001) and children with SHS and THS exposure were at 2.14 increased odds (95% CI = 1.45, 3.16, p < 0.001) of having food insecurity. Conclusions: Children with TSE are at increased risk of experiencing financial and food insecurity. When developing tobacco interventions, a holistic approach to tobacco control that addresses ways to decrease financial and food hardships may improve outcomes.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Keith A. King
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA; (K.A.K.); (R.A.V.); (A.L.M.)
| | - Rebecca A. Vidourek
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA; (K.A.K.); (R.A.V.); (A.L.M.)
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA; (K.A.K.); (R.A.V.); (A.L.M.)
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27
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Weinberger AH. Socioeconomic Status and Tobacco Use. Nicotine Tob Res 2022; 24:805-806. [PMID: 35245936 DOI: 10.1093/ntr/ntac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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28
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Shoenbill KA, Baca-Atlas MH, Smith CA, Wilhoit-Reeves SB, Baca-Atlas SN, Goldstein AO. Evaluating a Tobacco Treatment Program's Transition to Telehealth Using a Social Determinants of Health Lens. Nicotine Tob Res 2022; 24:904-908. [PMID: 35038749 PMCID: PMC9272290 DOI: 10.1093/ntr/ntac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/13/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While strong associations exist between social determinants of health (SDOH), socioeconomic status, and smoking, these factors are not routinely assessed in tobacco treatment programs (TTP). This study addresses this gap by evaluating a composite metric of SDOH and a measure of access to care to determine program reach before and after the implementation of telehealth tobacco treatment delivery. AIMS AND METHODS We examined inpatient data from a large TTP during two comparable time periods from April 1, 2019 to September 30, 2019 (pre-telehealth) and from April 1, 2020 to September 30, 2020 (telehealth). The populations were compared using point-of-care data, including 5-digit zip codes mapped to the CDC's Social Vulnerability Index (SVI) and driving distance (in 60-min increments) to the study hospital. Chi-square tests for homogeneity were performed for SVI and driving distance comparisons. RESULTS While distance distributions were significantly different between the pre-telehealth and telehealth populations (χ 2 = 13.5 (df = 3, N = 3234), p = .004, no significant differences existed in the proportion of SVI categories between the two populations (χ 2 = 5.8 (df = 3, N = 3234), p = .12). In the telehealth population, patients with the highest SVI vulnerability had the greatest proportions living >1 h from the hospital. CONCLUSIONS This study offers a novel evaluation of tobacco treatment in relation to an SDOH metric (SVI) and care access (distance to the hospital) for inpatient populations. Patient reach, including to those with high vulnerabilities, remained consistent in a transition to telehealth. These methods can inform future reach and engagement of patients who use tobacco products, including patients with high vulnerability or who reside at greater distances from treatment programs. IMPLICATIONS This study provides the first analysis of inpatient tobacco use treatment (TUT) transition to telehealth delivery of care during the COVID-19 pandemic using the CDC's SVI metric and patient distance to the hospital. The transition resulted in consistent reach to patients at the highest vulnerability. These findings can inform efforts to evaluate SDOH measures and improve reach, engagement, and research on telehealth delivery of inpatient TUT.
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Affiliation(s)
- Kimberly A Shoenbill
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michael H Baca-Atlas
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caleb A Smith
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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29
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Le Foll B, Piper ME, Fowler CD, Tonstad S, Bierut L, Lu L, Jha P, Hall WD. Tobacco and nicotine use. Nat Rev Dis Primers 2022; 8:19. [PMID: 35332148 DOI: 10.1038/s41572-022-00346-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/04/2023]
Abstract
Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco's effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
- Departments of Family and Community Medicine, Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Megan E Piper
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA
| | - Christie D Fowler
- Department of Neurobiology and Behaviour, University of California Irvine, Irvine, CA, USA
| | - Serena Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lin Lu
- Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
- National Institute on Drug Dependence, Peking University Health Science Center, Beijing, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
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Narcisse MR, Shah SK, Felix HC, Dobbs PD, McElfish PA. Association of psychological distress and current cigarette smoking among Native Hawaiian and Pacific Islander adults and compared to adults from other racial/ethnic groups: Data from the National Health Interview Survey, 2014. Prev Med Rep 2022; 25:101660. [PMID: 34950562 PMCID: PMC8671122 DOI: 10.1016/j.pmedr.2021.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Cigarette smoking is the leading cause of preventable deaths worldwide. Research has documented an association between psychological distress and smoking among certain racial/ethnic groups but has not examined this association among Native Hawaiian and Pacific Islander (NHPI) adults. Data from the 2014 general and the NHPI-specific National Health Interview Surveys were analyzed at the University of Arkansas for Medical Sciences Regional Campus (Fayetteville, AR) in April 2021 to determine the association between current cigarette smoking and levels of psychological distress among NHPI adults and to assess the difference in the magnitude of that association among NHPI adults compared to adults of other racial/ethnic groups in the United States. The final analytic sample (n = 34,782) included 1,916 NHPI, 20,430 White, 4,725 Black, 2,001 Asian, and 5,710 Hispanic adults. A significant association between current cigarette smoking and psychological distress levels was found among NHPI adults as well as among adults from other racial/ethnic groups. There was no significant difference in the magnitude of the detected association among NHPI adults compared to the magnitude of the same association detected among adults of other racial/ethnic groups. However, this finding indicates race/ethnicity does not moderate the association between psychological distress and current cigarette smoking. Future studies should explore factors that may further explain the variation in current cigarette smoking within and across all racial/ethnic groups.
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Affiliation(s)
- Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Page D. Dobbs
- University of Arkansas, Department of Health, Human Performance and Recreation, 751 W. Maple St., Fayetteville, AR 72701, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
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Venugopal PD, Morse AL, Alrefai-Kirkpatrick R, Tworek C, Chang HW. The Co-occurrence of Specialty Vape Shops, Social Disadvantage, and Poor Air Quality in the United States: An Assessment of Cumulative Risks to Youth. Health Equity 2022; 6:132-141. [PMID: 35261940 PMCID: PMC8896168 DOI: 10.1089/heq.2021.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: We conducted a cumulative environmental health risk assessment of whether specialty vape shops and poor air quality are more likely to co-occur in socially disadvantaged neighborhoods where racial/ethnic minority youth live. Methods: We examined the population-adjusted incidence of specialty vape shops in relation to youth race/ethnicity, neighborhood socioeconomic status (SES), and air quality (nitrogen dioxide [NO2]) at the census tract level across the conterminous United States for 2018. Results: We did not find disparity in vape shop incidence related to minority youth race/ethnicity. Vape shop incidence was significantly negatively associated with all the youth race/ethnicities examined. The two lowest SES quintiles had nearly double the rate of specialty vape shop incidence compared with the highest SES quintile. Specialty vape shop incidence increased with NO2 concentration, with more vape shops in poor air quality neighborhoods. Conclusions: Specialty vape shops are disproportionately present in neighborhoods with poor air quality and where socially disadvantaged youth live. The increased incidence of vape shops in poor air quality neighborhoods, particularly in an urban context with increased traffic emissions, further points to potentially disproportionate impacts on disadvantaged populations due to cumulative social and environmental risks. This raises environmental justice and health equity concerns. Retailer-focused strategies aimed at limiting youth exposure to electronic cigarettes' labeling and advertising, preventing sales to minors, and limiting the number of retailers in low-SES neighborhoods may reduce initiation and help prevent tobacco-related health disparities among youth.
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Affiliation(s)
- P. Dilip Venugopal
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Beltsville, Maryland, USA
| | - Aura Lee Morse
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Beltsville, Maryland, USA
| | - Rudaina Alrefai-Kirkpatrick
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Beltsville, Maryland, USA
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Beltsville, Maryland, USA
| | - Hoshing W. Chang
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Beltsville, Maryland, USA
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Vallone DM, Perks SN, Pitzer L, Liu M, Kreslake JM, Rath JM, Hair EC. Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups. HEALTH EDUCATION RESEARCH 2022; 36:412-421. [PMID: 34219169 DOI: 10.1093/her/cyab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 05/19/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.
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Tobacco control policies in India were unable to address inequities in Tobacco-related harm. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kong AY, King BA. Boosting the Tobacco Control Vaccine: recognizing the role of the retail environment in addressing tobacco use and disparities. Tob Control 2021; 30:e162-e168. [PMID: 32967986 PMCID: PMC9377406 DOI: 10.1136/tobaccocontrol-2020-055722] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 01/18/2023]
Abstract
Much of the progress in reducing cigarette smoking and tobacco-related morbidity and mortality among youth and adults is attributable to population-level strategies previously described in the context of the Tobacco Control Vaccine. The retail environment is used heavily by the tobacco industry to promote and advertise its products, and variations in exposure to and characteristics of the retail environment exist across demographic groups. It is therefore also an essential environment for further reducing smoking, as well as ameliorating racial, ethnic and socioeconomic tobacco-related disparities. This commentary provides an overview of the importance of incorporating strategies focused on the tobacco retailer environment (availability; pricing and promotion; advertising and display; age of sale; and retail licensure) as part of a comprehensive approach to tobacco prevention and control. To reach tobacco endgame targets, such innovative strategies are a complement to, but not a replacement for, long-standing evidence-based components of the Tobacco Control Vaccine.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ozga JE, Romm KF, Turiano NA, Douglas A, Dino G, Alexander L, Blank MD. Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Exp Clin Psychopharmacol 2021; 29:429-439. [PMID: 34014742 PMCID: PMC9752977 DOI: 10.1037/pha0000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to health-relevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | | | - Geri Dino
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | - Linda Alexander
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
| | - Melissa D. Blank
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
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Joyce CM, Saulsgiver K, Mohanty S, Bachireddy C, Molfetta C, Steffy M, Yoder A, Buttenheim AM. Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies. JMIR Form Res 2021; 5:e27801. [PMID: 34591023 PMCID: PMC8517817 DOI: 10.2196/27801] [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: 02/07/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. OBJECTIVE This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. METHODS Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. RESULTS For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. CONCLUSIONS Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. TRIAL REGISTRATION ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557.
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Affiliation(s)
- Caroline M Joyce
- Department of Epidemiology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Salini Mohanty
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Chethan Bachireddy
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Carin Molfetta
- Penn Medicine Lancaster General Health, Lancaster, PA, United States
| | - Mary Steffy
- Penn Medicine Lancaster General Health, Lancaster, PA, United States
| | - Alice Yoder
- Penn Medicine Lancaster General Health, Lancaster, PA, United States
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Hughes K, Olufajo OA, White K, Roby DH, Fryer CS, Wright JL, Sehgal NJ. The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction. J Vasc Surg 2021; 75:168-176. [PMID: 34506895 DOI: 10.1016/j.jvs.2021.08.071] [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] [Received: 08/22/2020] [Accepted: 08/13/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well-studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. METHODS Patients 40 years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 to 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality, and 30-day all-cause readmission were evaluated using multivariable regression analyses. RESULTS Of the 131,529 patients identified, the majority (61%) were male, and the average age was 69 years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared with patients in the highest MHI quartile (13% vs 10%; overall P < .001). On multivariable analyses, compared with patients in the lowest quartile, those in the highest quartile had lower amputation (adjusted odds ratio [aOR], 0.70; 95% confidence interval (CI), 0.63-0.77; overall P < .001) and readmission (aOR, 0.91; 95% CI, 0.84-0.99; overall P = .028) rates. However, subsequent revascularization (aOR, 1.04; 95% CI, 0.94-1.15) and mortality (aOR, 1.01; 95% CI, 0.79-1.28) rates were not different across the groups. CONCLUSIONS Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.
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Affiliation(s)
- Kakra Hughes
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Md; Department of Surgery, Howard University College of Medicine, Washington, DC.
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Kellee White
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Md
| | - Dylan H Roby
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Md
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Md
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Md; Executive Suite, University of Maryland Capital Region Health, Cheverly, Md
| | - Neil J Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Md
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Beard E, Brown J, Jackson SE, Tattan‐Birch H, Shahab L. Differences between ethnic groups in self-reported use of e-cigarettes and nicotine replacement therapy for cutting down and temporary abstinence: a cross-sectional population-level survey in England. Addiction 2021; 116:2476-2485. [PMID: 33738884 PMCID: PMC8438700 DOI: 10.1111/add.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/13/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The National Institute for Health and Care Excellence (NICE) has called for research into tobacco harm reduction across ethnicities, genders and socio-economic status. Although there is increasing research focused on the latter two, relatively few studies have considered ethnic variations. Therefore this study aimed to assess (i) the association between ethnicity and use of e-cigarettes and nicotine replacement therapy (NRT) for temporary abstinence and cutting down, and (ii) trends in prevalence of these over time. DESIGN Repeated cross-sectional household survey. SETTING England. PARTICIPANTS Between April 2013 and September 2019, data were collected on 24 114 smokers, 16+ of age, taking part in the Smoking Toolkit Study (STS). MEASUREMENTS Ethnicity coding included: White, mixed/multiple ethnic group, Asian, Black and Arab/other ethnic group. Smokers reported whether they were currently using e-cigarettes and/or NRT for cutting down or during periods of temporary abstinence. FINDINGS Odds of e-cigarette use for cutting down and temporary abstinence were significantly lower among those of Asian ethnicity (OR = 0.79, 95% CI = 0.66-0.93) and Arab/other ethnicity (OR = 0.58, 95% CI = 0.40-0.83) compared with White ethnicity. Those of mixed/multiple ethnicity had higher odds for NRT us (OR = 1.42, 95% CI = 1.04-1.94) compared with those of White ethnicity. Trend analysis indicated that for White ethnicity, e-cigarette use by smokers for cutting down and temporary abstinence followed an 'inverse S' shaped cubic curve indicating an overall rise, whereas NRT use followed an 'S' shaped cubic curve, indicating an overall decline. For mixed/multiple ethnicity a similar trend was found for NRT use only, with other ethnicities showing no statistically significant trends (suggesting relative stability over time). CONCLUSIONS In England, e-cigarette use by smokers for cutting down and temporary abstinence is less common among Asian and Arab/other ethnicity smokers compared with White smokers. Smokers of mixed/multiple ethnicity are the most likely to be using NRT compared with other ethnic groups for cutting down and temporary abstinence. E-cigarette use by smokers for cutting down and temporary abstinence has increased over time among White smokers, whereas prevalence in other ethnic groups has remained stable.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Harry Tattan‐Birch
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Rao Seshadri S, Kaulgud R, Jha P. 'You cannot touch taxes easily': making the case for tobacco taxation in India. Health Policy Plan 2021; 36:322-331. [PMID: 33367775 DOI: 10.1093/heapol/czaa171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
India represents over 1.3 billion people with >100 million adult smokers. The catastrophic health costs of smoking are staggering; and estimates show that even modest increases in taxes on cigarettes and bidis would both raise substantial revenues for the government and save ∼69 million years of healthy life over the next four decades. Karnataka represents a good example of tobacco control efforts and their impact. This case study examines the factors that have contributed to tobacco control policy in Karnataka based on 23 semi-structured interviews with key informants engaged in tobacco policymaking and decision-making, tobacco control/taxation research and advocacy. Their narratives indicate that: (i) Domestic taxation policy is complicated by the complex tax structure and centralized control over taxation with the introduction of Goods and Services Tax; (ii) Implementation of legal frameworks is a challenge, due to conflicts with powerful industry and farmer lobbies. A vigorous civil society backed by the Courts is necessary to garner political support; (iii) Action on taxation is hampered by weak leadership and mixed messaging; and (iv) There is a need for innovative policy solutions to promote both demand- and supply-side measures for tobacco control. Tobacco control advocates need to recognize the political economy of tobacco control and generate strong, reliable and scientifically sound evidence to support their arguments. Working for incremental 'wins' in terms of more stringent application of existing legal frameworks can make a substantial difference even in contexts where enhancing tobacco taxes is a challenge. Promoting multisectoral action is critical, at both policy and the ground levels, by expanding ownership and responsibility for tobacco control to sectors beyond health. Finally, the health sector needs to recommit to its role as a champion for tobacco control. Failure to do so would amount to a failure on multiple fronts-public health, economic, fiscal and ethical.
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Affiliation(s)
- Shreelata Rao Seshadri
- Azim Premji University, School of Development, Bikkanahalli Main Road, Sarjapura, Bangalore 562125, India
| | - Radhika Kaulgud
- Azim Premji University, School of Development, Bikkanahalli Main Road, Sarjapura, Bangalore 562125, India
- SOCHARA, Ist Block Koramangala, Bangalore 560034, India
| | - Prabhat Jha
- Center for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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O'Connell M, Kephart L. Local and State Policy Action Taken in the United States to Address the Emergence of E-Cigarettes and Vaping: A Scoping Review of Literature. Health Promot Pract 2020; 23:51-63. [PMID: 33164552 DOI: 10.1177/1524839920963691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In response to rising rates of youth vaping and e-cigarette use, states and localities in the United States have adopted various tobacco control policies and have extended their utility to these emerging products. However, the extent to which these policies have been evaluated for their impact on youth use is unknown. METHOD Two databases (PubMed, Google Scholar) were searched for English language peer-reviewed articles pertaining to electronic cigarette policy evaluation between 2009 and 2020. Primary articles of interest were journal articles that evaluated an e-cigarette policy. Secondary articles of interest were journal articles that identified any e-cigarette policy action without a formal evaluation component, those that evaluated tobacco policy, or those that described e-cigarette behaviors and trends. Tertiary articles included gray literature that provided context for e-cigarette trends and additional policy identification. RESULTS The final sample consisted of 12 relevant articles with an e-cigarette policy evaluation component and 62 relevant articles without such component, and 19 gray literature sources. Findings were synthesized based on policy type: product classification, age restrictions, smoke-free policies, flavor bans, sales restrictions, taxation, packaging, and advertising. CONCLUSION Policies that address access and use of e-cigarettes are common on the federal, state, and local level, are mostly reactionary, and mimic tobacco control efforts. Few policies have been formally evaluated for their effectiveness in reducing or preventing youth vaping. Strengthening the evidence base should be a priority for researchers going forward, given the potential of these policies to intervene on social and environmental conditions that affect youth initiation and uptake.
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Affiliation(s)
| | - Lindsay Kephart
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, MA, USA
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Affiliation(s)
- Kathleen T Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston
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42
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Jassal MS, Oliver-Keyser T, Galiatsatos P, Burdalski C, Addison B, Lewis-Land C, Butz A. Alignment of Medical and Psychosocial Sectors for Promotion of Tobacco Cessation among Residents of Public Housing: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217970. [PMID: 33138330 PMCID: PMC7663453 DOI: 10.3390/ijerph17217970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 01/01/2023]
Abstract
The inequity in cessation resources is at the forefront of the recently enacted US smoking ban in public housing facilities. This pre-post, non-randomized pilot study assessed the feasibility of a smoking cessation program targeting smokers in Baltimore City public housing. The study implemented a four-phased, 10-week, community-based cessation program using a joint academic–housing partnership that provided on-site cessation pharmacotherapy, behavioral counseling, and psychosocial/legal services. The community-led strategy involved: (1) two-week smoking cessation training for lay health workers; (2) screening and recruitment of smokers by housing authority residential leadership; (3) four-week resident-led cessation using evidenced-based strategies along with wraparound support services; (4) formative evaluation of the intervention’s acceptability and implementation. Thirty participants were recruited of which greater than one-half attended the majority of weekly cessation events. Thirty percent were able to achieve biomarker-proven cessation, as measured by a reduction in exhaled CO levels—a percentage comparable to the reported state quitline 30-day cessation rate. Despite weekly joint community–academic led-education of nicotine replacement therapy (NRT) therapies, only two participants regularly and properly used NRT transdermal patches; <20% of participants used NRT gum correctly at their first follow-up visit. Less than one-half utilized psychosocial and legal services by our community-based organization partners. Post-intervention interviews with participants noted broad approval of the ease in accessibility of the cessation intervention, but more diversification in the timing and personalization of offerings of services would have assisted in greater adoptability and participant retention. Though a reduction in smoking behaviors was not broadly observed, we elucidated modifiable social, educational, and physical features that could enhance the likelihood of smoking cessation among public housing residents.
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Affiliation(s)
- Mandeep S. Jassal
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (B.A.); (C.L.-L.); (A.B.)
- Correspondence:
| | | | - Panagis Galiatsatos
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA;
| | - Catherine Burdalski
- Johns Hopkins Bayview Medical Center, Department of Pharmacy, Baltimore, MD 21287, USA;
| | - Bonnie Addison
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (B.A.); (C.L.-L.); (A.B.)
| | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (B.A.); (C.L.-L.); (A.B.)
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (B.A.); (C.L.-L.); (A.B.)
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Wang G, Wu L. Healthy People 2020: Social Determinants of Cigarette Smoking and Electronic Cigarette Smoking among Youth in the United States 2010-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7503. [PMID: 33076356 PMCID: PMC7602660 DOI: 10.3390/ijerph17207503] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine social determinants of cigarette smoking and ever using electronic cigarettes (e-cigarettes) among young adults aged 18 to 25 years in the United States between 2010 and 2018. Using secondary data from National Health Interview Surveys (NHIS) across the 2010, 2014, and 2018 survey years, this study analyzed the prevalence rates of cigarette smoking and ever using e-cigarettes between 2010 and 2018, demographic and socioeconomic disparities in smoking, and the relationship between previous e-cigarette use and current smoking. First, the past decade witnessed a notable decline in conventional cigarette smoking and a sharp increase in e-cigarette use among youth. These trends were consistent regardless of socioeconomic status. Second, demographic and socioeconomic disparities persisted in cigarette smoking. Non-Hispanic white male youth were more likely to become smokers as they grew older. Young people with lower educational attainment, living below the U.S. federal poverty level, and having a poor physical health status had a higher smoking prevalence. Third, previous e-cigarette use was more likely to relate to subsequent cigarette use among young people. To achieve the Healthy People 2020 objectives, tobacco control programs and interventions need to be more specific in higher prevalence groups and service providers should not assume that there is a one-size-fits-all model for youth.
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Affiliation(s)
- Gang Wang
- School of Journalism and Communication, Wuhan University, Wuhan 430072, China;
| | - Liyun Wu
- Ethelyn R. Strong School of Social Work, Norfolk State University, 700 Park Avenue, Norfolk, VA 23504, USA
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Stokes AC, Wilson AE, Lundberg DJ, Xie W, Berry KM, Fetterman JL, Harlow AF, Cozier YC, Barrington-Trimis JL, Sterling KL, Benjamin EJ, Blaha MJ, Hamburg NM, Bhatnagar A, Robertson RM. Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths. Nicotine Tob Res 2020; 23:900-908. [PMID: 32948872 PMCID: PMC8150136 DOI: 10.1093/ntr/ntaa170] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Introduction Understanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities. Methods We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1–4. The sample was a dynamic cohort of cigarette-naïve youth aged 12–17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals. Results Of the 28 788 observations pooled across waves 1–4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21–3.45), cigars (OR, 2.00; 95% CI, 1.42–2.80), or other products (OR, 1.66; 95% CI, 1.28–2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. Conclusions Prior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). Implications Our findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.
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Affiliation(s)
- Andrew C Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anna E Wilson
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Kaitlyn M Berry
- Department of Epidemiology, University of Minnesota, Minneapolis, MN
| | - Jessica L Fetterman
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Alyssa F Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Kymberle L Sterling
- School of Public Health, University of Texas Health Sciences Center, Dallas, TX
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Michael J Blaha
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Naomi M Hamburg
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, University of Louisville, Louisville, KY
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Kingsbury JH, D'Silva J, O'Gara E, Parks MJ, Boyle RG. How Much Progress Have We Made? Trends in Disparities in Tobacco Use. Prev Chronic Dis 2020; 17:E107. [PMID: 32945768 PMCID: PMC7553206 DOI: 10.5888/pcd17.200090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reducing tobacco-related health disparities has been a public health priority for more than 2 decades, yet disparities in cigarette use have remained steady or worsened. Less is known about how disparities in other tobacco products have changed over time. Our study examined trends in cigarette and other tobacco product use in Minnesota with the goal of informing efforts aimed at reducing disparities. METHODS We examined tobacco use disparities as a function of education, income, and race across the Minnesota Adult Tobacco Survey results in 2010 (N = 7,057), 2014 (N = 9,304), and 2018 (N = 6,055). Tobacco use was captured by assessing past 30-day use of 4 tobacco products: cigarettes, cigars, e-cigarettes, and smokeless tobacco, plus combustibles (ie, cigarettes and/or cigars) and any tobacco (ie, use of any of the 4 products). RESULTS At each wave, those with lower income and education reported greater use of cigarettes, combustibles, and any tobacco than those with higher income and education. Black respondents were more likely to report cigar and combustibles use than White respondents in 2018, whereas White respondents were more likely to report smokeless tobacco use in 2014. We saw no significant wave-by-demographic interactions, suggesting that the magnitude of the disparity remained unchanged over time for any tobacco product. CONCLUSION Substantial disparities in tobacco use remain across education, income, and race, even in a state such as Minnesota with a strong tobacco control program. Additional efforts are needed to close disparity gaps and reach endgame tobacco use targets for all subpopulations.
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Affiliation(s)
- J H Kingsbury
- Minnesota Department of Health, 85 7th Place East, St. Paul, MN 55101.
| | - J D'Silva
- ClearWay Minnesota, Bloomington, Minnesota
| | - E O'Gara
- ClearWay Minnesota, Bloomington, Minnesota
| | - M J Parks
- Minnesota Department of Health, St. Paul, Minnesota
| | - R G Boyle
- University of California, Office of the President, Oakland, California
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Exploring Associations between Susceptibility to the Use of Electronic Nicotine Delivery Systems and E-Cigarette Use among School-Going Adolescents in Rural Appalachia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145133. [PMID: 32708622 PMCID: PMC7399914 DOI: 10.3390/ijerph17145133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
Electronic nicotine delivery systems (ENDS) use, including e-cigarettes, has surpassed the use of conventional tobacco products. Emerging research suggests that susceptibility to e-cigarette use is associated with actual use among adolescents. However, few studies exist involving adolescents in high-risk, rural, socioeconomically distressed environments. This study examines susceptibility to and subsequent usage in school-going adolescents in a rural distressed county in Appalachian Tennessee using data from an online survey (N = 399). Relying on bivariate analyses and logistic regression, this study finds that while 30.6% of adolescents are ever e-cigarette users, 15.5% are current users. Approximately one in three adolescents are susceptible to e-cigarettes use, and susceptibility is associated with lower odds of being a current e-cigarette user (OR = 0.03; CI: 0.01–0.12; p < 0.00). The age of tobacco use initiation was significantly associated with decreased current use of e-cigarettes (OR = 0.89; CI: 0.83–0.0.97; p < 0.01). Overall, the results of this exploratory study suggest the need for larger studies to identify unique and generalizable factors that predispose adolescents in this high-risk rural, socioeconomically disadvantaged region to ENDS use. Nevertheless, this study offers insight into e-cigarette usage among U.S adolescents in rural, socioeconomically disadvantaged environments and provides a foundation for a closer examination of this vulnerable population.
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Lima DR, Carvalho CFC, Guimarães-Pereira BBS, Loreto AR, Frallonardo FP, Ismael F, Andrade AGD, Castaldelli-Maia JM. Abstinence and retention outcomes in a smoking cessation program among individuals with co-morbid substance use and mental disorders. J Psychiatr Res 2020; 125:121-128. [PMID: 32272242 DOI: 10.1016/j.jpsychires.2020.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Tobacco use is the leading cause of preventable death in the world. Although cigarette smoking prevalence has decreased, there are still disparities in morbidity and mortality experienced by individuals with substance use and/or mental disorders when compared to general population. The aim of this study was to compare treatment outcomes between three subgroups of smokers: individuals with substance use disorder (SUD-only), individuals with mental disorder without substance use disorders (MD-only), and individuals with co-morbid substance use and mental disorder (SUD + MD). Data of 498 smokers enrolled in a 6-week smoking cessation program in Brazil were analyzed. Sociodemographic, medical and tobacco use information were collected at baseline. Treatment included group cognitive behavioral therapy (CBT) and pharmacotherapy. The primary outcome was defined as "self-report 4-week quitter" (SR4WQ), a standardized measure to assess treatment success. Retention to treatment was also investigated. Associations between groups were analyzed using unadjusted and adjusted logistic regression models. The results showed that SUD + MD had worse outcomes when compared to the other two groups. After adjusting for level of smoking dependence and the use of medication, abstinence and retention to treatment of SUD-only became equivalent to SUD + MD. Because tobacco and other substance addictions share similar mechanisms, having history of SUD might impair successful results of conventional smoking programs. There is a need to further investigate specific variables associated with treatment success for a more resistant subgroup of individuals in mental health and perhaps to invest in more intensive actions, such as the use of combined pharmacotherapy and adapted CBT approaches.
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Affiliation(s)
- Danielle Ruiz Lima
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil.
| | - Carlos Felipe Cavalcanti Carvalho
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Bruna Beatriz Sales Guimarães-Pereira
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Aline Rodrigues Loreto
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Fernanda Piotto Frallonardo
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Flávia Ismael
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Arthur Guerra de Andrade
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - João Mauricio Castaldelli-Maia
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
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Edwards SK, Dean J, Power J, Baker P, Gartner C. Understanding the Prevalence of Smoking Among People Living with HIV (PLHIV) in Australia and Factors Associated with Smoking and Quitting. AIDS Behav 2020; 24:1056-1063. [PMID: 31115754 DOI: 10.1007/s10461-019-02535-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding contributors to smoking and quitting cigarettes is important to developing effective cessation programs and addressing smoking related morbidity and mortality among people living with HIV (PLHIV). Using data from a large cross-sectional study of Australian PLHIV we provide a smoking prevalence estimate and explore the relationship between socio-demographic variables and smoking status. We also explore the relationship between HIV diagnosis and antiretroviral therapy (ART) initiation and quitting smoking. Of the 1011 respondents included in the analysis, 30.6% were current smokers. The strongest predictor of smoking was regular cannabis use (AOR 6.2, 95% CI 3.6-10.8) while the strongest predictor of being a past smoker was receiving ART (AOR 2.4, 95% CI 1.2-4.7). Quitting also increased around the time of diagnosis and ART initiation, highlighting the potential for these events to be optimal times to address smoking among PLHIV.
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Affiliation(s)
- Stephanie K Edwards
- School of Public Health, The University of Queensland, Cnr Wyndham Street and Herston Road, Herston, Brisbane, QLD, 4006, Australia.
| | - Judith Dean
- School of Public Health, The University of Queensland, Cnr Wyndham Street and Herston Road, Herston, Brisbane, QLD, 4006, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Peter Baker
- School of Public Health, The University of Queensland, Cnr Wyndham Street and Herston Road, Herston, Brisbane, QLD, 4006, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Cnr Wyndham Street and Herston Road, Herston, Brisbane, QLD, 4006, Australia
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Prochaska JJ, Gates EF, Davis KC, Gutierrez K, Prutzman Y, Rodes R. The 2016 Tips From Former Smokers® Campaign: Associations With Quit Intentions and Quit Attempts Among Smokers With and Without Mental Health Conditions. Nicotine Tob Res 2020; 21:576-583. [PMID: 30496491 DOI: 10.1093/ntr/nty241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/07/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION People living with mental health conditions (MH+) are more likely to smoke cigarettes than people without mental health conditions (MH-) and to experience tobacco-related disparities. The Tips From Former Smokers® (Tips®) campaign is a proven population-level strategy for motivating smokers to quit. In 2016, Tips included ads featuring Rebecca, a former smoker with depression. We evaluated self-reported frequency of exposure to the Rebecca and other Tips ads in association with quit intentions and quit attempts among MH+ and MH- smokers. METHODS Intentions to quit and past 6-month quit attempts lasting at least 24 hours were reported from a two-wave longitudinal online survey conducted before and after the 2016 Tips campaign with a nationally representative sample of US adult cigarette smokers with (MH+, N = 777) and without (MH-, N = 1806) lifetime mental health conditions. RESULTS In 2016, among MH+ respondents, greater exposure to the Rebecca ads was significantly associated with increased odds of intending to quit in the next 30 days (adjusted odds ratio [AOR] = 1.40, p < .05) and with reporting a quit attempt in the past 6 months (AOR = 1.25, p < .05). Among MH- respondents, greater exposure to the other Tips ads was associated with increased odds of making a quit attempt (AOR = 1.19, p < .05). CONCLUSIONS Exposure to the Rebecca ads was associated with a greater likelihood of intentions to quit and quit attempts among MH+ smokers; whereas, exposure to the other (non-mental-health-related) Tips ads was associated with a greater likelihood of quit attempts among MH- smokers. IMPLICATIONS National media campaigns are an important population-level strategy for reaching specific population groups who are experiencing tobacco-related disparities. The findings support the inclusion of ads featuring people living with mental health conditions in national tobacco education media campaigns, such as Tips.
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Affiliation(s)
| | - Emily F Gates
- Department of Measurement, Evaluation, Statistics, & Assessment, Boston College, Chestnut Hill, MA
| | - Kevin C Davis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | | | - Yvonne Prutzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Robert Rodes
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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50
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Henley SJ, Thomas CC, Lewis DR, Ward EM, Islami F, Wu M, Weir HK, Scott S, Sherman RL, Ma J, Kohler BA, Cronin K, Jemal A, Benard VB, Richardson LC. Annual report to the nation on the status of cancer, part II: Progress toward Healthy People 2020 objectives for 4 common cancers. Cancer 2020; 126:2250-2266. [PMID: 32162329 DOI: 10.1002/cncr.32801] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention, the American Cancer Society, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to provide annual updates on cancer occurrence and trends in the United States and to address a special topic of interest. Part I of this report focuses on national cancer statistics, and part 2 characterizes progress in achieving select Healthy People 2020 cancer objectives. METHODS For this report, the authors selected objectives-including death rates, cancer screening, and major risk factors-related to 4 common cancers (lung, colorectal, female breast, and prostate). Baseline values, recent values, and the percentage change from baseline to recent values were examined overall and by select sociodemographic characteristics. Data from national surveillance systems were obtained from the Healthy People 2020 website. RESULTS Targets for death rates were met overall and in most sociodemographic groups, but not among males, blacks, or individuals in rural areas, although these groups did experience larger decreases in rates compared with other groups. During 2007 through 2017, cancer death rates decreased 15% overall, ranging from -4% (rural) to -22% (metropolitan). Targets for breast and colorectal cancer screening were not yet met overall or in any sociodemographic groups except those with the highest educational attainment, whereas lung cancer screening was generally low (<10%). Targets were not yet met overall for cigarette smoking, recent smoking cessation, excessive alcohol use, or obesity but were met for secondhand smoke exposure and physical activity. Some sociodemographic groups did not meet targets or had less improvement than others toward reaching objectives. CONCLUSIONS Monitoring trends in cancer risk factors, screening test use, and mortality can help assess the progress made toward decreasing the cancer burden in the United States. Although many interventions to reduce cancer risk factors and promote healthy behaviors are proven to work, they may not be equitably applied or work well in every community. Implementing cancer prevention and control interventions that are sustainable, focused, and culturally appropriate may boost success in communities with the greatest need, ensuring that all Americans can access a path to long, healthy, cancer-free lives.
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Affiliation(s)
- S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryll C Thomas
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise Riedel Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth M Ward
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Manxia Wu
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Scott
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Kathleen Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Vicki B Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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