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Mantey DS, Montgomery L, Chen B, Omega-Njemnobi O, Harrell MB. Blunt smoking during emerging adulthood: Characterizing transitions in cannabis and cigar co-use among a diverse cohort in Texas. Addict Behav 2024; 156:108062. [PMID: 38805771 DOI: 10.1016/j.addbeh.2024.108062] [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] [Received: 11/02/2023] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021. METHODS We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking. RESULTS At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21-3.84) and Hispanic (HR: 1.72; 95% CI: 1.08-2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16-2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42-0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40-19.45), NHB (HR: 3.14; 95% CI: 1.32-7.46), and Hispanic (HR: 2.99; 95% CI: 1.80-4.97) participants. CONCLUSIONS Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people.
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Affiliation(s)
- Dale S Mantey
- UTHealth, University of Texas School of Public Health, Department of Health Promotion and Behavioral Science, USA; UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA.
| | - LaTrice Montgomery
- University of Cincinnati College of Medicine, Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, USA
| | - Baojiang Chen
- Michael and Susan Dell Center for Healthy Living, USA; UTHealth, University of Texas School of Public Health, Department of Biostatics and Data Science, USA
| | - Onyinye Omega-Njemnobi
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA
| | - Melissa B Harrell
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA
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DuPont-Reyes MJ, Villatoro AP, Chowkwanyun M, Ortiz SE, Tang L. Communication Policy to Reduce Health Disparities: A Cross-Language Content Analysis of YouTube Television Advertising. Am J Prev Med 2024:S0749-3797(24)00173-9. [PMID: 38844149 DOI: 10.1016/j.amepre.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION This study aimed to identify disparate health-related marketing across English- and Spanish-language television networks in New York City, ultimately to inform policy that can counteract disproportionate health-related marketing that provides harmful content to and withholds beneficial information from Latinx populations. METHODS A 2-week composite sample of primetime English-language (National Broadcasting Company and Columbia Broadcasting System) and Spanish-language (Telemundo and Univision) television networks from YouTube television was randomly drawn from September 7, 2022 to September 27, 2022 in New York City. A total of 9,314 health-related television advertisements were identified for systematic media content analysis and coded into categories: alcohol, core or noncore foods/beverages, mental health/tobacco prevention, health insurance, medical centers, and pharmaceuticals. Analyses conducted in 2022-2024 included intercoder reliability and descriptive and rate difference estimates using total advertisement broadcasting time in the full sample and subsamples by language networks on YouTube television. RESULTS Spanish television networks broadcast greater health-adverse advertisements per hour for alcohol (rate difference=4.91; 95% CI=3.96, 5.85) and noncore foods/beverages (rate difference=13.43; 95% CI=11.52, 15.34) and fewer health-beneficial advertisements per hour for mental health/tobacco prevention (rate difference= -0.99; 95% CI= -1.45, -0.54), health insurance (rate difference= -1.00; 95% CI= -1.44, -0.57), medical centers (rate difference= -0.55; 95% CI= -1.23, 0.12), and pharmaceuticals (rate difference= -5.72; 95% CI= -7.32, -4.11) than New York City primetime English television networks. CONCLUSIONS Multilevel policy innovation and implementation are required to mitigate primetime television marketing strategies that contribute to health inequities.
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Affiliation(s)
- Melissa J DuPont-Reyes
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Alice P Villatoro
- Department of Public Health, College of Arts and Sciences, Santa Clara University, Santa Clara, California
| | - Merlin Chowkwanyun
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Selena E Ortiz
- Department of Health Policy and Administration, The PennState College of Health and Human Development, University Park, Pennsylvania
| | - Lu Tang
- Department of Communication and Journalism, College of Arts & Sciences, Texas A&M University, College Station, Texas
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Sanjeevi N. Food insecurity and use of electronic vapor products among high school students. Nutr Health 2024:2601060241258578. [PMID: 38807513 DOI: 10.1177/02601060241258578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Background: Studies have shown that food insecurity is associated with electronic vapor products (EVP) use in adults; however, an understanding of this relationship in adolescents is needed to inform prevention efforts in this age group. Aim: Examine the relationship of food insecurity with EVP use patterns, frequency and source of acquisition in high school students. Methods: This cross-sectional study used Youth Risk Behavior Survey (YRBS) 2019 data from states that incorporated the YRBS' optional food insecurity question. The data included 42,154 high school students with complete information on food insecurity and two EVP-related questions. Responses to EVP-related questions identified "ever users," "current users," "former users," "current dual EVP-cigarette users," and assessed "frequency of EVP use among current users" and "source of EVP acquisition." Logistic regression examined associations of food insecurity with EVP-related outcomes. Results: The proportion of high school students who ever used EVP was 48.3% and the proportion of food-insecure students was about 12%. Food security status significantly differed by race/ethnicity of students, such that the proportion of food insecure students classified as "non-Hispanic White" was lower than the proportion of food secure students classified as "non-Hispanic White." Food insecurity was significantly associated with greater odds of ever EVP use (odds ratio (OR) = 1.75; 95% confidence interval (CI) = (1.55, 1.96)), current EVP use (OR = 2.07; 95% CI = (1.80, 2.37); using never users as reference category) and current dual use of EVP and cigarettes (OR = 2.91; 95% CI = (2.38, 3.55)). Food insecurity also was associated with greater odds of current EVP use (OR = 1.54; 95% CI = (1.28, 1.84)) when former users were used as reference category. In current users, food insecurity was related to greater odds of daily EVP use (OR = 1.40; 95% CI = (1.14, 1.70)) compared to occasional use. Conclusions: Study findings imply that efforts targeting prevention/cessation of EVP use should consider reducing food insecurity in high school students.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutrition and Exercise Physiology, Washington State University - Spokane, Spokane, WA, USA
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Tuson M, Lizama N, Kameron C, Gazey A, Wood L. Vape stores in Western Australia: growth, proximity to schools and socio-economic gradient of density. Aust N Z J Public Health 2024; 48:100118. [PMID: 38296754 DOI: 10.1016/j.anzjph.2023.100118] [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] [Received: 10/06/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To audit the number and location of dedicated e-cigarette retailers ("vape stores") in Western Australian (WA), measure proximity to schools and model the association between vape store density and socio-economic disadvantage. METHODS Vape stores were identified via internet search and geocoded. Proximity to schools was measured. Regression modelling was used to investigate the association between vape store density and socio-economic disadvantage. RESULTS 194 stores were identified, with 88% located within one kilometre of a school. In metropolitan WA, vape store density was nearly seven times higher in the most socio-economically disadvantaged areas than in the least disadvantaged areas (rate ratio 6.9, 95% confidence interval 3.4-15.5). CONCLUSIONS There has been rapid, recent growth in the number of vape stores in WA, with most located within walking distance of schools. In metropolitan WA, vape store density is strongly associated with socio-economic disadvantage, mirroring the pattern observed globally for tobacco outlets. IMPLICATIONS FOR PUBLIC HEALTH This is the first Australian study demonstrating that vape stores are more densely located in socio-economically disadvantaged areas. Vape stores' proximity to schools may increase young people's access and exposure to promotional signage. There is a need to address ready e-cigarette availability through strong regulatory and compliance measures.
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Affiliation(s)
- Matthew Tuson
- Institute for Health Research (IHR), The University of Notre Dame Australia (UNDA), Australia; Centre for Applied Statistics (CAS), School of Physics, Mathematics and Computing, The University of Western Australia (UWA), Australia.
| | - Natalia Lizama
- Cancer Council Western Australia (CCWA), Australia; School of Population Health, Curtin University, Australia
| | | | - Angela Gazey
- Institute for Health Research (IHR), The University of Notre Dame Australia (UNDA), Australia
| | - Lisa Wood
- Institute for Health Research (IHR), The University of Notre Dame Australia (UNDA), Australia
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Streck JM, Potter K, Pachas G, Cather C, Nielsen L, Eden Evins A. Alternative combusted tobacco product and multiple tobacco product use among individuals with serious mental illness enrolled in a large pragmatic randomized controlled trial. Addict Behav 2024; 148:107844. [PMID: 37678006 DOI: 10.1016/j.addbeh.2023.107844] [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: 05/23/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Use of combustible alternative tobacco products (ATPs; e.g., little cigars, loose tobacco, multiple tobacco product types [TPTs]) is increasingly common. Inexpensive, combusted ATPs (e.g little cigars) are predominantly marketed to lower-income communities. Prevalence of combusted ATP use among those with serious mental illness (SMI) is unknown. METHODS We examined rates and correlates of combusted ATP use and association with tobacco abstinence in a secondary analysis of a single-cohort (N = 1007) trial of tobacco-smoking adults with SMI and severe SMI-related functional impairment. The parent study aimed to test a community-health worker-delivered intervention for promoting smoking cessation among adults with SMI. Participants were surveyed at baseline on demographic and smoking characteristics including combusted TPT (cigarettes, cigars/little cigars, loose tobacco), and breath carbon-monoxide (CO). CO-verified 7-day point-prevalence tobacco abstinence was assessed at Year 2. RESULTS At baseline, 59% of participants reported using cigarettes only, 25% multiple (>1) combusted TPTs, 12% cigars/little cigars only, and 4% loose tobacco (e.g., "rollies", pipes) only. Those reporting any ATP use at baseline had higher expired CO concentration and reported using more tobacco products per day than exclusive cigarette users (p's < 0.05). ATP use was not associated with abstinence in adjusted logistic regression models (p's > 0.05). CONCLUSIONS Use of ATPs was associated with use of more tobacco products per day and greater tobacco toxicant exposure than exclusive cigarette use in this population. Future policy efforts work to change preferential taxation policies (e.g., lower taxation for cigar products) and disproportionate marketing of ATPs to lower-income communities.
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Affiliation(s)
- Joanna M Streck
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Tobacco Research & Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lindsay Nielsen
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
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Audrain-McGovern J, Manikandan D, Koita F, Klapec O, Pickworth WB, Stone MD. Effect of sweet flavouring on the rewarding and reinforcing value of cigarillo use among young adults. Tob Control 2023:tc-2023-058307. [PMID: 38050181 PMCID: PMC11116272 DOI: 10.1136/tc-2023-058307] [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: 07/31/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Cigarillos dominate the US cigar market, and young adults largely drive use. While young adults prefer flavoured to non-flavoured cigarillos, especially those flavoured to taste like fruit or other sweets, the factors that underlie this preference have received little attention. We sought to determine if key indicators of abuse liability, the rewarding and reinforcing effects, are greater for sweet versus non-flavoured cigarillos. METHODS Young adults (18-24 years old) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerised choice task) and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavoured versus non-flavoured cigarillos. General linear regression models were fit with the appropriate family link for each outcome measure. RESULTS Young adults rated sweet-flavoured cigarillos as more rewarding (estimated marginal mean (EMM) =4.52, 95% CI 4.00 to 5.03) than the non-flavoured cigarillo (EMM=3.31, 95% CI 2.80 to 3.83; B=1.20, 95% CI 0.80 to 1.60, p<0.001). The reinforcing value of sweet-flavoured cigarillos, measured by break point, was higher relative to non-flavoured cigarillos (6.34 out of 10), especially among young adults with a preference for flavoured cigarillos (B=1.94, 95% CI 0.71 to 3.18, p=0.003). Young adults took 1.9 times the number of puffs (35.75 vs 19.95) from sweet-flavoured cigarillos compared with non-flavoured cigarillos (Rate Ratio =1.94, 95% CI 1.30 to 2.90, p<0.001). CONCLUSIONS Sweet flavouring increases the abuse liability of cigarillos among young adults as reflected in greater liking, motivation to use and actual use. Banning sweet flavouring in cigarillos may diminish their use in young adults.Trial registration number CT.gov (NCT05092919).
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Affiliation(s)
| | - Divya Manikandan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fodie Koita
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivia Klapec
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Matthew D Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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Sterling KL, Franco N, Lee E, Tang C, Geller A, Mead A, Anderson M, Kong G. The Portrayal of Premium Cigar Selling Propositions in Lifestyle Magazines: A Content Analysis. Nicotine Tob Res 2023; 25:S69-S75. [PMID: 37506232 PMCID: PMC10380182 DOI: 10.1093/ntr/ntad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Although lifestyle magazines are an important marketing tool for premium cigars, little is known about their recent portrayal of the products. We expand on research conducted for the National Academies of Sciences, Engineering, and Medicine's Committee on Patterns of Use and Health Effects of "Premium Cigars" and Priority Research. AIMS AND METHODS A content analysis of magazine covers, articles, and advertisements published in 2021 from Cigar Aficionado and Cigar Snob (five issues each) and Cigar Journal (three issues) assessed magazine themes and mentions of lower harm. Magazine covers (n = 14), advertisements (n = 105), and every fifth article (n = 45) were coded. RESULTS In total, 92% of the magazine covers, 72.4% of advertisements, and 62.2% of articles had premium cigar content. Celebrities (e.g. musicians and actors) appeared on 92.9% of covers. The most common themes in the advertisements and articles were "high quality." Regarding article content, 80% portrayed the premium cigars' quality (e.g. superior materials), and the taste of featured products (e.g. "tones," "aromas," and "notes") was portrayed in 42.4%. While no articles described their health risks, 6.7% described the positive health effects of premium cigar use (e.g. stress relief and clear cognition). Additionally, a digital search of Cigar Snob and Cigar Aficionado for terms related to lower harm (e.g. "organic," "healthy," "clean," "pure," and "natural") found 7.7 mentions of lower-harm words per issue. CONCLUSIONS Our findings indicate that lifestyle magazines are an important marketing strategy that promotes and normalizes premium cigar use as a high-quality product that can have positive health effects for users. IMPLICATIONS Our manuscript characterized the premium cigar companies' use of selling propositions, including promoting the products' features, safety, taste, and flavors, as a part of their advertising promotion practices. Premium cigar companies used digital and print lifestyle magazines as marketing tools to promote and normalize the use of their products by emphasizing their high quality and positive health benefits (e.g. reducing stress). Premium cigars were promoted as a symbol of power and success, featured in advertisements of upscale social events (e.g. exclusive trade shows, social clubs, and lounges), and often juxtaposed with expensive alcohol, food, and other luxurious goods. Future research should assess if exposure to premium cigar content increases consumer appeal and detracts from the products' potential adverse health outcomes.
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Affiliation(s)
- Kymberle Landrum Sterling
- Health Promotion and Behavioral Sciences, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
| | - Nicholas Franco
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Lee
- Health Promotion and Behavioral Sciences, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
| | - Charis Tang
- Martel College, Rice University, Houston, TX, USA
| | - Amy Geller
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Aimee Mead
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Maggie Anderson
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Shevorykin A, Ruglass LM, Freitas-Lemos R, Bauer AG, Baez S, Sheffer CE. Attitudes about Cigarette Smoking, Perceived Consequences of Smoking, and Seeking Assistance with Cessation among Black and White Cigarette Smokers: A Qualitative Study. J Smok Cessat 2023; 2023:9298027. [PMID: 37250113 PMCID: PMC10224791 DOI: 10.1155/2023/9298027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Research has identified significant racial differences in cigarette smoking behavior, associated disease risk, likelihood of cessation, and mortality from smoking-related diseases. The current study assessed, via qualitative narrative analysis, racial differences in participants' motivations for smoking, perceived consequences of smoking, and how participants deal with cravings/withdrawal, as well as thoughts and feelings about quitting, seeking assistance with quitting, and the importance of social support in quitting. Methods Semistructured interviews were conducted with 11 Black and 11 White cigarette smokers. Data were analyzed using the Thematic Networks Analysis process, which entailed coding the data and constructing thematic networks by identifying basic and organizing themes. Results While there were no descriptive racial differences identified in participants' motivation for smoking or perceived consequences of smoking, differences existed between Blacks and Whites in terms of approaches in dealing with smoking cravings and withdrawal, perceived self-efficacy in controlling cravings, preferred methods of learning about and receiving smoking cessation assistance, and overall preference for receiving cessation-related support. Conclusions Further investigation is needed into racial differences in methods to deal with cigarette cravings and withdrawal, preferences for receiving cessation information, and social support for cessation. This research will further develop our understanding of and ability to address factors underlying racial disparities in smoking behavior and cessation, as well as inform the development of future smoking cessation interventions.
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Affiliation(s)
| | - Lesia M. Ruglass
- The City College of New York, City University of New York, USA
- Center for Alcohol and Substance Use Studies, Rutgers University, USA
| | | | | | - Shannyl Baez
- Fralin Biomedical Research Institute at Virginia Tech Carilion, USA
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Cwalina SN, Ihenacho U, Barker J, Smiley SL, Pentz MA, Wipfli H. Advancing racial equity and social justice for Black communities in US tobacco control policy. Tob Control 2023; 32:381-384. [PMID: 34526408 PMCID: PMC8920941 DOI: 10.1136/tobaccocontrol-2021-056704] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022]
Abstract
The US Food and Drug Administration (FDA) applies the Population Health Standard in tobacco product review processes by weighing anticipated health benefits against risks associated with a given commercial tobacco product at the population level. However, systemic racism (ie, discriminatory policies and practices) contributes to an inequitable distribution of tobacco-related health benefits and risks between white and Black/African Americans at the population level. Therefore, Black-centered, antiracist data standards for tobacco product review processes are needed to achieve racial equity and social justice in US tobacco control policy. Regardless of whether FDA implements such data standards, non-industry tobacco scientists should prioritise producing and disseminating Black-centred data relevant to FDA's regulatory authority. We describe how systemic racism contributes to disparities in tobacco-related outcomes and why these disparities are relevant for population-level risk assessments, then discuss four possible options for Black-centred data standards relevant to tobacco product review processes.
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Affiliation(s)
- Sam N Cwalina
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Ugonna Ihenacho
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Joshua Barker
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sabrina L Smiley
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Heather Wipfli
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Jeon J, Cao P, Fleischer NL, Levy DT, Holford TR, Meza R, Tam J. Birth Cohort‒Specific Smoking Patterns by Family Income in the U.S. Am J Prev Med 2023; 64:S32-S41. [PMID: 36653231 PMCID: PMC11186479 DOI: 10.1016/j.amepre.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/09/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION In the U.S., low-income individuals generally smoke more than high-income individuals. However, detailed information about how smoking patterns differ by income, especially differences by birth cohort, is lacking. METHODS Using the National Health Interview Survey 1983-2018 data, individual family income was calculated as a ratio of the federal poverty level. Missing income data from 1983 to 1996 were imputed using sequential regression multivariate imputation. Age‒period‒cohort models with constrained natural splines were used to estimate annual probabilities of smoking initiation and cessation and smoking prevalence and intensity by gender and birth cohort (1900-2000) for 5 income groups: <100%, 100%-199%, 200%-299%, 300%-399%, and ≥400% of the federal poverty level. Analysis was conducted in 2020-2021. RESULTS Across all income groups, smoking prevalence and initiation probabilities are decreasing by birth cohort, whereas cessation probabilities are increasing. However, relative differences between low- and high-income groups are increasing markedly, such that there were greater declines in prevalence among those in high-income groups in more recent cohorts. Smoking initiation probabilities are lowest in the ≥400% federal poverty level group for males across birth cohorts, whereas for females, this income group has the highest initiation probabilities in older cohorts but the lowest in recent cohorts. People living below the federal poverty level have the lowest cessation probabilities across cohorts. CONCLUSIONS Smoking prevalence has been decreasing in all income groups; however, disparities in smoking by family income are widening in recent birth cohorts. Future studies evaluating smoking disparities should account for cohort differences. Intervention strategies should focus on reducing initiation and improving quit success among low-income groups.
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Affiliation(s)
- Jihyoun Jeon
- From the Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
| | - Pianpian Cao
- From the Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Nancy L Fleischer
- From the Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - David T Levy
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- From the Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Scott L, McCausland K, Maycock B, Jancey J. The emergence of e-cigarette retail shops in a regulated tobacco control environment. Health Promot J Austr 2023; 34:185-192. [PMID: 36054267 PMCID: PMC10087173 DOI: 10.1002/hpja.657] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED E-cigarettes are of growing concern. We aimed to determine the location and characteristics of retail shops selling e-cigarette products in Perth, Western Australia. METHODS Two phase study: (i) identifying all e-cigarette retailers in the Greater Capital City Statistical Area of Perth; (ii) audit at the point-of-sale to assess products, promotions and shop characteristics (n = 41). RESULTS Ninety-eight retailers selling e-cigarette products were identified: 43 tobacconists (44%), 21 vape shops (21% - up from one shop in 2017), 14 supermarkets (14%), 12 service stations (12%) and 8 smoke shops (8%). The most common e-cigarette product was non-nicotine e-liquid, available at 38 (93%) stores audited. Most stores sold parts of e-cigarette devices (n = 25, 61%). Front counter displays were the most frequent form of promotion (n = 40, 98%). Vape shops differed from other retailers, having bar-style layouts (n = 15, 71%), lounge areas (n = 7, 33%) and free e-liquid samples (n = 17, 89%). CONCLUSION The availability of e-cigarette products from retail shops and particularly vape shops is increasing. E-cigarette retailers are using traditional promotional techniques including point-of-sale displays to market their products, while vape shops are extending their appeal through bar style, lounge layouts and free trials. IMPLICATIONS FOR PUBLIC HEALTH Understanding the e-cigarette retail store environment is essential for identifying emergent trends, potential regulations and future research. SO WHAT?: The e-cigarette retail market in the Perth is growing, shops using traditional and new promotional techniques to market e-cigarette products. Our findings identify a need for public health surveillance, regulations and legislation.
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Affiliation(s)
- Lucy Scott
- Collaboration for Evidence, Research and Impact in Population Health (CERIPH), School of Population Health, Curtin University, Perth, WA, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Population Health (CERIPH), School of Population Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Population Health (CERIPH), School of Population Health, Curtin University, Perth, WA, Australia.,Enable Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Obinwa U, Pasch KE, Jetelina KK, Ranjit N, Perez A, Perry CL, Harrell M. Restricting Tobacco Retail Outlets Around Middle and High Schools as a Way to Reduce Tobacco Marketing Disparities: A Simulation Study. Nicotine Tob Res 2022; 24:1994-2002. [PMID: 35738013 PMCID: PMC9653075 DOI: 10.1093/ntr/ntac150] [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: 06/15/2021] [Revised: 04/05/2022] [Accepted: 06/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Communities with more people of color and economically disadvantaged residents are disproportionately exposed to tobacco marketing from tobacco companies. This study examined if banning tobacco retail outlets (TROs) within 1000 ft of schools would reduce these marketing disparities through a greater reduction in the amount of tobacco advertising around schools in these communities. METHODS Data from objectively audited advertisement data from 106 convenience stores and gas stations around 42 middle and high schools located in the four major metropolitan areas of Texas were linked with schools' enrollment data. ArcGIS (Aeronautical Reconnaissance Coverage Geographic Information System) was used to simulate a 1000-ft ban of tobacco sales around the schools. Independent sample T-tests and Mann-Whitney U tests were used to test mean differences where appropriate. RESULTS Schools with a higher enrollment of Hispanic/Latino (mean = 171.6, SD = 96.9) and economically disadvantaged students (mean = 168.9, SD = 102.3) were surrounded with significantly greater advertising at TROs than schools with lower enrollment of these groups (mean = 82.8, SD = 49.1 and mean = 89.2, SD = 50.6, respectively). A simulated 1000 ft ban of TROs around schools led to greater advertising reduction around schools with a higher enrollment of Hispanic/Latino students (13.3%-29.4% reductions) in comparison to schools with lower Hispanic/Latino student enrollment. However, the more economically disadvantaged schools had a smaller reduction in the number of advertisements (5.9%-21.9% reductions) in comparison to schools with less economically disadvantaged students. CONCLUSION The implementation of a ban of tobacco sales at TROs within 1000 ft of schools is one policy approach to reduce youth exposure to tobacco marketing, particularly among students of color. STUDY IMPLICATION Tobacco retail outlets (TROs) around schools with a higher enrollment of Hispanic/Latino and economically disadvantaged students had significantly more tobacco advertisements in comparison to schools with lower enrollment of these student groups. A simulated ban of TROs within 1000 ft of schools led to greater advertising reduction around schools with a higher enrollment of Hispanic/Latino students. For schools with more economically disadvantaged students, the ban led to a smaller reduction in advertisements in comparison to schools with less economically disadvantaged students. This proposed place-based strategy could be a successful means to reduce tobacco advertising and marketing disparity among communities of color.
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Affiliation(s)
- Udoka Obinwa
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Katelyn K Jetelina
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
| | - Nalini Ranjit
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
| | - Adriana Perez
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
| | - Cheryl L Perry
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
| | - Melissa Harrell
- School of Public Health, University of Texas Health Science Center at Houston, Austin Regional Campus, Austin, TX, USA
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13
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Addo Ntim S, Martin B, Termeh-Zonoozi Y. Review of Use Prevalence, Susceptibility, Advertisement Exposure, and Access to Electronic Nicotine Delivery Systems among Minorities and Low-Income Populations in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13585. [PMID: 36294164 PMCID: PMC9603140 DOI: 10.3390/ijerph192013585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Increased use of electronic nicotine delivery systems (ENDS) and improper disposal after use pose a public health and an environmental justice (EJ) concern if use prevalence is disproportionately high among minorities and people of low socioeconomic status (SES) (broadly termed "EJ populations" for the purposes of this review). This review synthesizes literature on demographic patterns of use prevalence, susceptibility, advertisement exposure, and access to ENDS, and extrapolates environmental tobacco exposure (ETE) from ENDS among EJ populations. Seven electronic databases were searched using ENDS-related terms. We included studies published between 2017 and May 2020 that described ENDS use prevalence, susceptibility to ENDS use, advertisement exposure, and access to ENDS by race, ethnicity, or SES. Data synthesis was based on the assumptions that ETE increases with high use prevalence, susceptibility may influence future use, and advertisement exposure and access may impact demographic differences in use. We identified 32 studies describing use prevalence, susceptibility, advertisement exposure, or access to vape shops and other tobacco retail outlets by race/ethnicity or SES. We found higher prevalence of ENDS use among non-Hispanic Whites and inconclusive use patterns by SES. Patterns of susceptibility to use, advertisement exposure, and access were also mixed, with slightly higher outcomes observed among low SES youth. However, the evidence base on advertisement exposure was limited, with limited generalizability. Our findings indicate low prevalence of ENDS use among EJ populations. While this suggests low potential ETE among these groups, mixed outcomes on susceptibility, advertisement exposure, and access to ENDS among low SES groups may affect future ENDS use and ETE. Educational campaigns that discourage ENDS uptake should target EJ youth. Initiatives aimed at managing vape shop presence in EJ communities and monitoring targeted advertisement are also needed.
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14
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Giovenco DP, Spillane TE, Talbot E, Wackowski OA, Audrain-McGovern J, Ganz O, Delnevo CD. Packaging Characteristics of Top-Selling Cigars in the United States, 2018. Nicotine Tob Res 2022; 24:1678-1683. [PMID: 35287167 PMCID: PMC9575977 DOI: 10.1093/ntr/ntac070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco product packaging is an influential industry marketing tool, but research on cigar packaging characteristics is limited. This study leveraged a pack archive of the top-selling, mass-market cigar products in the US and their corresponding sales data to assess the prevalence of common pack features in the marketplace. METHODS The 50 cigar products with the highest national unit sales in 2018 were identified using Nielsen's Scantrack data. A content analysis captured common packaging features within four domains: physical, textual, graphical, and promotional elements. Descriptive statistics, weighted by each pack's 2018 unit sales, documented the market share of pack characteristics overall and by brand. RESULTS Products in the sample constituted 62% of all convenience store cigar sales in 2018. Black & Mild, the most popular brand, did not display warning labels on its single stick, cellophane-wrapped products, which constituted nearly all of its sales (96.3%). Resealable foil pouches were the most common packaging style across other brands, and were most often sold in predominantly red, green, or silver packaging. Common flavor categories included concept (eg, "Jazz", 32.4%), fruit (15.7%), and sweet (14.5%). Prepricing (eg, "2 for 99 cents") was a popular promotional strategy, appearing on 74% of all packs sold. CONCLUSIONS Cigar packaging features such as small pack sizes, innovative materials, flavor names, bright colors, and cost-saving promotions are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help reduce appeal and potentially curb cigar use. IMPLICATIONS Sales of mass-market cigars in the US have remained strong over the past decade, propelled by lax product regulations. This study demonstrated that cigar packaging features that may enhance consumer appeal, such as small pack sizes, flavor names, sensory descriptors, bright colors, and cost-saving promotions, are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help curb cigar use, reduce youth appeal, and potentially minimize existing disparities in cigar use.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Torra E Spillane
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Eugene Talbot
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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15
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DuPont-Reyes MJ, Hernandez-Munoz JJ, Tang L. TV Advertising, Corporate Power, and Latino Health Disparities. Am J Prev Med 2022; 63:496-504. [PMID: 35680481 DOI: 10.1016/j.amepre.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/08/2022] [Accepted: 04/14/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study identifies mental health, tobacco prevention, alcohol/beer, food/beverage, pharmaceutical, and other health-related advertisements across Spanish- and English-language TV networks owned by the same parent media company in the U.S. as commercial determinants of health disparities for Latino populations and/or viewers of Spanish-language TV. METHODS A 3-week composite sample of Telemundo and National Broadcasting Company prime-time TV owned by the same parent media company was randomly drawn from March 31, 2021 to June 12, 2021 in Houston, Texas. A total of 1,593 health-related advertisements were yielded for systematic content analysis. Analyses included intercoder reliability, descriptive and bivariate analysis, and rate ratio and rate difference calculations. RESULTS Telemundo had significantly more health-adverse and fewer health-beneficial advertisements than National Broadcasting Company. Telemundo broadcasted about 11 more alcohol (95% CI=9.1, 12.5) and 5 more unhealthy/noncore food/beverages (95% CI=2.0, 7.2) advertisements per hour of TV advertisement programming than the National Broadcasting Company. Telemundo also broadcasted about 1 fewer mental health/tobacco prevention (95% CI= -0.9, -0.2), 3 fewer healthy/core food/beverages (95% CI= -1.5, -4.3), and 4 fewer pharmaceutical (95% CI= -2.4, -5.7) advertisements per hour of advertisement programming than the National Broadcasting Company. CONCLUSIONS Overall greater health-adverse and fewer health-beneficial advertisements are broadcasted on Spanish-language than on English-language TV. Unchecked corporate marketing strategies may serve as a commercial determinant of health disparities for Latino populations by Spanish-language TV.
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Affiliation(s)
- Melissa J DuPont-Reyes
- Department of Sociomedical Sciences (SMS), Mailman School of Public Health, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Jose J Hernandez-Munoz
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, College Station, Texas
| | - Lu Tang
- Department of Communication, College of Liberal Arts, Texas A&M University, College Station, Texas
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16
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Assini-Meytin LC, Fix RL, Green KM, Nair R, Letourneau EJ. Adverse Childhood Experiences, Mental Health, and Risk Behaviors in Adulthood: Exploring Sex, Racial, and Ethnic Group Differences in a Nationally Representative Sample. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:833-845. [PMID: 35958728 PMCID: PMC9360354 DOI: 10.1007/s40653-021-00424-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 05/03/2023]
Abstract
This study examined sex, racial, and ethnic differences in the short- and long-term associations between adverse childhood experiences (ACEs), mental health, and risk behaviors in a nationally representative sample. Analysis was based on the National Longitudinal Study of Adolescent to Adult Health, a longitudinal cohort of U.S. adolescents followed in five waves of data collection from adolescence to adulthood. Analysis included design-based regression models to examine the associations between ACEs and proximal and distal outcomes (i.e., depression, suicidal ideation, number of sexual partners, binge drinking, current smoker) assessed in the transition to adulthood (mean age 21; 2001-2002) and adulthood (mean age 38; 2016-2018). Sex, racial, and ethnic interactions were included in regression models to examine effect modification in the association of ACEs, mental health, and risk behaviors. In this analytical sample (N = 9,690), we identified a graded association between ACEs and depression, suicide ideation, and current smoker status at both time points (i.e., mean age 21 and 38). Sex moderated the relationship between ACEs and depression at mean age 21, while race (i.e., American Indian versus White) moderated the relationship between ACEs and number of sexual partners at mean age 38. A greater number of cumulative traumatic experiences in childhood may amplify adverse health outcomes among women and adults of American Indian descent in particular.
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Affiliation(s)
- Luciana C. Assini-Meytin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231 USA
| | - Rebecca L. Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231 USA
| | - Kerry M. Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 2242 Valley Dr, College Park, MD 20742 USA
| | - Reshmi Nair
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231 USA
| | - Elizabeth J. Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231 USA
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17
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Whitsel LP, Johnson J. Addressing social and racial justice in public policy for healthy living. Prog Cardiovasc Dis 2022; 71:37-42. [PMID: 35490866 DOI: 10.1016/j.pcad.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
Long-standing health disparities stemming from the historical, inequitable distribution of wealth, power, and privilege in the United States exist across almost every health indicator and outcome. There is a need for equitable policy, systems, and environment changes that are rooted in an understanding of the historical arc of structural racism across obesity prevention and treatment, ending tobacco and nicotine addiction and increasing access to healthy, affordable foods and physical activity opportunities and infrastructure. This paper explores the influence of structural inequities on the proliferation of health-compromising social conditions, and opportunities to leverage the policymaking process at the local, state, and federal levels to cultivate environments that support healthy living. Policy makers, community change leaders and advocacy organizations, with powerful grassroots voices can catalyze movements, advocacy campaigns and equitable policy change that address race and social justice and support healthy living for all.
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Affiliation(s)
- Laurie P Whitsel
- American Heart Association, Washington, DC, United States of America.
| | - Janay Johnson
- American Heart Association, Washington, DC, United States of America
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18
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Glasser AM, Hinton A, Wermert A, Macisco J, Nemeth JM. Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness - considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors. BMC Public Health 2022; 22:820. [PMID: 35468777 PMCID: PMC9036780 DOI: 10.1186/s12889-022-13244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention. METHODS This study included 96 youth (ages 14-24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana. RESULTS Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one's housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors. CONCLUSIONS Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Alice Hinton
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Joseph Macisco
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
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19
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Shelton RC, Philbin MM, Ramanadhan S. Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity. Annu Rev Public Health 2022; 43:37-57. [PMID: 34936827 PMCID: PMC10580302 DOI: 10.1146/annurev-publhealth-012420-105104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Public health research that addresses chronic disease has historically underutilized and undervalued qualitative methods. This has limited the field's ability to advance (a) a more in-depth understanding of the factors and processes that shape health behaviors, (b) contextualized explanations of interventions' impacts (e.g., why and how something did or did not work for recipients and systems), and (c) opportunities for building and testing theories. We introduce frameworks and methodological approaches common to qualitative research, discuss how and when to apply them in order to advance health equity, and highlight relevant strengths and challenges. We provide an overview of data collection, sampling, and analysis for qualitative research, and we describe research questions that can be addressed by applying qualitative methods across the continuum of chronic disease research. Finally, we offer recommendations to promote the strategic application of rigorous qualitative methods, with an emphasis on priority areas to enhance health equity across the evidence generation continuum.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
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20
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Blank MD, Ozga JE, Romm KF, Douglas A, Alexander L, Doogan NJ, Wilson M, Dino G. Geographic isolation predicts tobacco product use among youth: A latent class analysis. J Rural Health 2022; 38:373-381. [PMID: 33978979 PMCID: PMC8586053 DOI: 10.1111/jrh.12583] [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: 11/27/2022]
Abstract
PURPOSE The purpose of the current study was to evaluate associations between geographic rurality and tobacco use patterns among adolescents. METHODS High school students (N = 566) from north-central Appalachia reported on their lifetime and/or current use of cigarettes, electronic cigarettes (ECIGs), cigars, and smokeless tobacco. Geographic rurality was measured via the Isolation scale, whereby residential ZIP Codes determined the degree to which respondents have access to health-related resources. Latent class analysis (LCA) was used to identify discrete classes of adolescent tobacco users based on their use of tobacco products. Then, associations between participants' geographic rurality and class membership were evaluated using a series of multinomial logistic regressions. FINDINGS LCA classified participants as Nonusers, Current ECIG Users, Cigarette/ECIG Experimenters, and Polytobacco Users. Individuals with higher Isolation scores were more likely to be Polytobacco Users and Cigarette/ECIG Experimenters than Nonusers, and were more likely to be Polytobacco Users than Current ECIG Users. CONCLUSIONS The continuous Isolation scale used in the present study predicted polytobacco use patterns among adolescents in a manner that is consistent with, while simultaneously expanding upon, prior work. Tobacco control practices and policies should be viewed through a lens that considers the unique needs of geographically isolated areas.
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Affiliation(s)
- Melissa D. Blank
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- WV Prevention Research Center, West Virginia University, Morgantown, West Virginia, USA
| | - Jenny E. Ozga
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Katelyn F. Romm
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health, Washington, DC, USA
| | - Ashley Douglas
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Linda Alexander
- Department of Social & Behavioral Sciences, West Virginia University, Morgantown, West Virginia, USA
| | - Nathan J. Doogan
- Government Resources Center, Ohio State University, Columbus, Ohio, USA
| | - Michael Wilson
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Geri Dino
- WV Prevention Research Center, West Virginia University, Morgantown, West Virginia, USA
- Department of Social & Behavioral Sciences, West Virginia University, Morgantown, West Virginia, USA
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21
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Rubenstein D, Pacek LR, McClernon FJ. Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence. Nicotine Tob Res 2022; 24:1208-1217. [PMID: 35137194 PMCID: PMC9278823 DOI: 10.1093/ntr/ntac032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. AIMS AND METHODS In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. RESULTS AND CONCLUSIONS MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. IMPLICATIONS A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.
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Affiliation(s)
- Dana Rubenstein
- Corresponding Author: Dana Rubenstein, BA, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA. Telephone: 919-668-3987; Fax: 919-681-1600; E-mail:
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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22
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Enlow PT, Williford DN, Romm KF, Dino GA, Blank MD, Murray PJ, Banvard CA, Duncan CL. Predicting Adolescent Electronic Cigarette Use: Differences by Never, Ever, and Current Users. J Pediatr Psychol 2022; 47:1-11. [PMID: 34524431 PMCID: PMC9125499 DOI: 10.1093/jpepsy/jsab082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Rising rates of adolescent electronic cigarette (ECIG) use is concerning because it can lead to adverse health outcomes and increased risk behavior. There are known predictors of ever versus never ECIG use, but less are known about risk factors for ever versus current use of ECIGs. Problem behavior theory (PBT) was used to evaluate possible risk factors for different ECIG use status. METHODS Participants were 573 high school students who completed questionnaires measuring ECIG use, as well as constructs within the Social Environment, Perceived Environment, Personality, and Behavior domains of PBT. Multinomial logistic regression was used to evaluate how predictor variables differentiated between participants who reported (a) never use, (b) ever ECIG use, or (c) current ECIG use. RESULTS Adolescents were more likely to endorse ever ECIG use than never use if they reported peer ECIG use, perceived more benefits and fewer costs (e.g., health) of ECIG use, higher extraversion, alcohol and cigarette use (never vs. ever vs. past 30 days), or attended a school with a higher percentage of socioeconomically disadvantaged students. Adolescents were more likely to report current ECIG use than ever ECIG use if they perceived fewer costs of ECIG use or used cannabis in their lifetime (yes/no). CONCLUSIONS PBT variables differentiated between ever ECIG use and never ECIG use. However, these variables did not differentiate between ever and current ECIG use. Identifying unique risk factors for current versus ever ECIG use is important to understanding persistent ECIG use and subsequent targeted prevention and intervention programs.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | - Katelyn F Romm
- Milken Institute of Public Health, George Washington University, Washington, DC, USA
| | - Geri A Dino
- WV Prevention and Research Center, Department of Social and Behavioral Sciences, WVU School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV, USA
- WV Prevention and Research Center, Department of Social and Behavioral Sciences, WVU School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Pamela J Murray
- Department of Pediatrics, Section of Adolescent Medicine, West Virginia University, Morgantown, WV, USA
| | - Christine A Banvard
- Department of Pediatrics, Section of Adolescent Medicine, West Virginia University, Morgantown, WV, USA
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Unger JB, Falcon A. E-cigarette use among Hispanics: Reducing risk or recruiting new tobacco users? Addict Behav 2022; 125:107149. [PMID: 34678711 DOI: 10.1016/j.addbeh.2021.107149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/25/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022]
Abstract
The prevalence of cigarette smoking in the United States has been declining for over 50 years among all racial/ethnic groups. However, this progress could be stalled or even reversed by the increasing popularity of electronic cigarettes (e-cigarettes). Hispanics have experienced tobacco-related health disparities resulting from early age of cigarette smoking initiation and less success in quitting smoking. The effects of e-cigarettes on tobacco-related health disparities among Hispanics have not been well described. The uptake of e-cigarettes among Hispanic youth could lead to a "tipping point" phenomenon, in which Hispanics disproportionately become nicotine-dependent in adolescence and suffer increased tobacco-related disease in adulthood. Hypothetically, if Hispanic adult cigarette smokers switch to e-cigarettes, they could reduce (but not completely eliminate) their health risks. This article summarizes the research on the use of e-cigarettes among Hispanics. We describe the prevalence and patterns of e-cigarette use among Hispanic adolescents and adults compared with non-Hispanic whites. Findings indicate that e-cigarette use is rare among Hispanic adults, but Hispanic adolescents are at risk of experimenting with e-cigarettes at early ages, potentially leading to early nicotine addiction and exacerbating tobacco-related disparities in the future. Health education and policy interventions are needed to prevent e-cigarette use among Hispanic adolescents, while acknowledging that some Hispanic adult cigarette smokers may benefit from switching to e-cigarettes.
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Affiliation(s)
- Jennifer B Unger
- University of Southern California Keck School of Medicine, United States.
| | - Adolph Falcon
- National Alliance for Hispanic Health, United States
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Glasser AM, Onnen N, Craigmile PF, Schwartz E, Roberts ME. Associations between disparities in tobacco retailer density and disparities in tobacco use. Prev Med 2022; 154:106910. [PMID: 34921833 PMCID: PMC8750533 DOI: 10.1016/j.ypmed.2021.106910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/18/2021] [Accepted: 12/12/2021] [Indexed: 01/03/2023]
Abstract
Research has separately established that there are disparities in tobacco use, that greater tobacco retailer density (TRD) is positively associated with tobacco use, and that TRD is greater in high poverty and high racial/ethnic minority neighborhoods. Connecting these topics, this study examined the association between disparities in TRD and disparities in the prevalence of tobacco use among adults and youth. We obtained Ohio data on tobacco use from two statewide adult surveys and two sub-state regional youth surveys (2017-2019). Licensed tobacco retailers in Ohio were geocoded within census tracts. Disparity in TRD within regions across the state was defined as the ratio of TRD in high vs. low poverty (and in high vs. low racial/ethnic minority) census tracts per region. Disparity in cigarette smoking (adults) and any tobacco use (youth) was defined as the ratio of use prevalence among socioeconomically disadvantaged vs. non-disadvantaged (and racial/ethnic minority vs. non-minority) individuals. We estimated Pearson correlation coefficients to assess the linear relationship between the TRD disparity ratios and tobacco use disparity ratios. Poverty-based and race/ethnicity-based TRD disparities were positively associated with smoking disparities among adults. Negative associations between TRD disparities and tobacco use disparities were found among youth. To our knowledge, this is the first analysis directly linking TRD disparities and tobacco use disparities. Different adult and youth findings may be due to trends by age and product preferences. For adults in particular, this analysis suggests a detrimental effect of the tobacco retail environment on disadvantaged populations.
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Affiliation(s)
- Allison M Glasser
- College of Public Health, The Ohio State University, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA.
| | - Nathaniel Onnen
- Department of Statistics, The Ohio State University, Cockins Hall, 958 Neil Ave., Columbus, OH 43210, USA
| | - Peter F Craigmile
- Department of Statistics, The Ohio State University, Cockins Hall, 958 Neil Ave., Columbus, OH 43210, USA
| | - Elli Schwartz
- College of Public Health, The Ohio State University, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA
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Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
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Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
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Leventhal AM, Dai H, Higgins ST. Smoking Cessation Prevalence and Inequalities in the United States: 2014-2019. J Natl Cancer Inst 2021; 114:381-390. [PMID: 34850047 DOI: 10.1093/jnci/djab208] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Smoking is a leading cause of premature death and health inequities in the United States. METHODS We estimated cross-sectional prevalence of smoking cessation indicators among U.S. adult recent smokers (n = 43,602) overall and by sociodemographic subgroups in the Current Population Survey Tobacco Use Supplement 2014-2015 and 2018-2019 timepoints. Respondents reported past-year quit smoking interest, attempts, sustained (successful) cessation for ≥6 months, and use of e-cigarettes or behavioral/pharmacological cessation treatments to quit smoking. RESULTS Past-year quit smoking attempts declined slightly from 2014-2015 (52.9%) to 2018-2019 (51.3%) overall. Quit interest (pooled = 77.1%) and sustained cessation (pooled = 7.5%) did not change across timepoints. Among smokers making past-year quit attempts, 34.4% reported using cessation treatments in 2018-2019 and using e-cigarettes to quit smoking declined from 2014-2015 (33.3%) to 2018-2019 (25.0%). Several non-White (vs. White) racial and ethnic groups had higher prevalence of quit interest and attempts, but lower prevalence of sustained cessation or using e-cigarettes or treatments to quit. Income, education, employment, and metropolitan residence were positively associated with sustained cessation. Sociodemographic inequalities in sustained cessation and most other outcomes did not change across timepoints. CONCLUSIONS Although about half of U.S. adult smokers made past-year quit attempts from 2014-2019, only 7.5% reported sustained cessation and most who made quit attempts did not report using cessation treatments. Sociodemographic inequalities in cessation were pervasive and not entirely correspondent with sociodemographic variation in motivation to quit. Smoking cessation prevalence and inequalities did not improve from 2014-2019. Encouraging quit attempts and equitable access to smoking cessation aids are public health priorities.
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Affiliation(s)
- Adam M Leventhal
- Institute for Addiction Science, University of Southern California, 2001 N Soto Street, 302-C, Los Angeles, CA, 90089, USA.,Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, 302-C, Los Angeles, CA, 90089, USA
| | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4355, USA
| | - Stephen T Higgins
- University of Vermont Center on Behavior and Health, Burlington, VT, 05401-1419, USA.,Department of Psychiatry, University of Vermont Center on Behavior and Health, Burlington, VT, 05401-1419, USA.,Psychological Science, University of Vermont Center on Behavior and Health, Burlington, VT, 05401-1419, USA
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27
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Grilo G, Crespi E, Cohen JE. A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda. Int J Equity Health 2021; 20:238. [PMID: 34717629 PMCID: PMC8557615 DOI: 10.1186/s12939-021-01576-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations. Methods In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction. Results The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods. Conclusions Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.
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Affiliation(s)
- Graziele Grilo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA.
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
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Mallela JL, Fedele DA. Commentary: Understanding Complexities of Adolescent E- cigarette Use to Develop Intervention Strategies. J Pediatr Psychol 2021; 47:12-14. [PMID: 34718679 DOI: 10.1093/jpepsy/jsab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jaya L Mallela
- Department of Clinical & Health Psychology, University of Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, USA
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Kong AY, Delamater PL, Gottfredson NC, Ribisl KM, Baggett CD, Golden SD. Sociodemographic inequities in tobacco retailer density: Do neighboring places matter? Health Place 2021; 71:102653. [PMID: 34461529 PMCID: PMC8490323 DOI: 10.1016/j.healthplace.2021.102653] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
We apply a spatial perspective to measure the extent to which the 2018 U.S. racial, ethnic, and socioeconomic composition of census tracts were each associated with tobacco retailer density within a tract and in its neighboring tracts (n = 71,409). A 10-percentage point increase in the Black population was associated with 0.07 (p < 0.05) more retailers per square mile within a focal tract and 0.35 (p < 0.001) more retailers per square mile in its neighbors on average. A greater percent of Hispanic/Latino residents was associated with more retailers per square mile, both within a focal tract (b = 0.95, p < 0.001) and in its neighbors 0.39 (p < 0.001). Inverse associations were observed for percent white. We also observed inequities by socioeconomic status. The overall magnitude of inequities may be underestimated if the spatial dependence between focal tracts and their neighbors are not taken into consideration. Policymakers should prioritize interconnected geographic areas experiencing high racialized and socioeconomic segregation when designing and implementing policies to reduce retail tobacco product availability.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA.
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Carolina Hall, Chapel Hill, NC, 27599-7435, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA
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Sociodemographic Patterns of Exclusive and Dual Use of ENDS and Menthol/Non-Menthol Cigarettes among US Youth (Ages 15-17) Using Two Nationally Representative Surveys (2013-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157781. [PMID: 34360077 PMCID: PMC8345686 DOI: 10.3390/ijerph18157781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates across years for multiple patterns of current cigarette and ENDS use (i.e., exclusive menthol cigarette, exclusive non-menthol cigarette, exclusive ENDS, dual ENDS and menthol cigarette, and dual ENDS and non-menthol cigarette) by sex, race/ethnicity, parental education level, household income, and homeownership. Overall, both exclusive menthol and non-menthol cigarette use declined from 2013–2017. Exclusive ENDS use increased, particularly among youth who were non-Hispanic White or had a higher socioeconomic status (measured by parental education, household income, and homeownership). Dual use of ENDS with either menthol or non-menthol cigarettes did not change significantly. Monitoring changes in these sociodemographic patterns will help inform future youth tobacco prevention strategies.
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Social Determinants of Cigarette Smoking among American Women during Pregnancy. WOMEN 2021. [DOI: 10.3390/women1030012] [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
Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p < 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p < 0.05) and ethnicity (OR = 2.12, p < 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.
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Smiley SL, Cho J, Blackman KCA, Cruz TB, Pentz MA, Samet JM, Baezconde-Garbanati L. Retail Marketing of Menthol Cigarettes in Los Angeles, California: a Challenge to Health Equity. Prev Chronic Dis 2021; 18:E11. [PMID: 33571082 PMCID: PMC7879965 DOI: 10.5888/pcd18.200144] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Sales of menthol cigarettes continue to increase, accounting for a third of the US cigarette market. Retail marketing of menthol cigarettes is a contributing factor to tobacco-related health disparities. To inform regulation to address associated disparities, we examined retail marketing strategies for menthol cigarettes and their features and characteristics in relation to neighborhood racial/ethnic composition. METHODS We used multilevel regression models to examine associations of neighborhood racial/ethnic composition and store type with menthol cigarette sales outcomes, including availability, exterior advertising, price promotions, and price in a sample of tobacco retailers (N = 673) in Los Angeles County neighborhoods with a median or below-median household income. We also recorded the prices of Newport cigarettes (the highest selling menthol cigarette brand in the United States) and blu disposable menthol e-cigarettes. RESULTS Overall, 94.5% of retailers sold menthol cigarettes, 31.2% displayed menthol cigarette price promotions, and 30.2% displayed at least one menthol cigarette advertisement on their exterior. Adjusting for racial/ethnic zip code cluster and store type, stores located in predominantly African American neighborhoods showed significantly higher odds in the availability of Newport cigarettes than stores in Hispanic neighborhoods (OR = 0.21; 95% CI, 0.09-0.53; P = .001) or non-Hispanic White (OR = 0.12; 95% CI, 0.05-0.31; P < .001) neighborhoods. Stores located in predominantly African American neighborhoods displayed significantly higher odds of having price promotions for menthol cigarettes and storefront advertisements than those in Hispanic neighborhoods (OR = 0.51; 95% CI, 0.30-0.88; P = .02 and OR = 0.25; 95% CI, 0.13-0.48; P < .001, respectively). CONCLUSION In 2016 and 2017, menthol cigarettes were widely available in Los Angeles County across racial/ethnic neighborhoods. We found a disproportionate number of storefront advertisements and price promotions for menthol cigarettes in stores located in predominantly African American neighborhoods along with the lowest advertised pack price. This evidence supports tobacco control policies that restrict menthol cigarette sales in the retail environment.
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Affiliation(s)
- Sabrina L Smiley
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Soto Street Building, 2001 N Soto St, 2nd Flr, 214, Los Angeles, CA 90032-3628.
| | - Junhan Cho
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kacie C A Blackman
- Department of Health Sciences, Health Equity Research and Education Center, California State University, Northridge, California
| | - Tess Boley Cruz
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mary Ann Pentz
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Lourdes Baezconde-Garbanati
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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Agaku IT, Egbe CO, Ayo-Yusuf OA. Geospatial spread of e-cigarette vape shops in South Africa and the relationship with tobacco product use among adults. Health Place 2021; 68:102507. [PMID: 33486331 DOI: 10.1016/j.healthplace.2021.102507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
We estimated the spatial distribution of e-cigarette vape shops in South Africa and measured associations with tobacco use among adults. We linked geocoordinates of identified vape shops to internet protocol addresses of individual participants in the 2018 Health 24 survey (n = 18,208). We used logistic regression to measure the associations between proximity to vape shops and tobacco-related behaviors. In total, we identified 240 vape shops; 49.6% of these were within a 5 km radius of a higher educational institution. Proximity to vape shops was associated with ever e-cigarette use among young adults aged 18-29 years (AOR = 1.33, 95%CI = 1.16-1.54). Efforts to regulate e-cigarette marketing can benefit public health.
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Affiliation(s)
- Israel T Agaku
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Kong AY, Queen TL, Golden SD, Ribisl KM. Neighborhood Disparities in the Availability, Advertising, Promotion, and Youth Appeal of Little Cigars and Cigarillos, United States, 2015. Nicotine Tob Res 2020; 22:2170-2177. [PMID: 31917833 PMCID: PMC7733061 DOI: 10.1093/ntr/ntaa005] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Between 2012 and 2016, sales of cigars increased by 29% in the United States. In small local studies, greater little cigar and cigarillo (LCC) availability and marketing has been documented in neighborhoods with a greater proportion of Hispanic or Latino and black residents, and near schools. This national study of cigarette retailers assesses whether LCC availability and marketing at the point of sale is associated with neighborhood racial, ethnic, income, and percent youth demographics. METHODS In 2015, we collected LCC availability and marketing data through retailer audits of a nationally representative sample of 2128 cigarette retailers. Using 2011-2015 American Community Survey census tract estimates, we modeled associations of neighborhood demographics (in quartiles) with availability of LCC-flavored products, and presence of exterior advertisements, youth marketing, and promotions. RESULTS Nearly 90% of retailers sold LCCs, 83.0% sold flavored LCCs, and 30.9% had youth marketing. Controlling for retailer type and other neighborhood characteristics, neighborhoods with the highest proportion of black residents had significantly higher odds of flavored LCC availability (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.52, 3.30); exterior advertisements (AOR = 2.84, 95% CI = 1.94, 4.16); price promotions (AOR = 1.62; 95% CI = 1.07-2.45), and youth appeal (AOR = 1.49, 95% CI 1.08-2.08) compared to the lowest. Disparities in flavored LCC availability, exterior advertising, and youth appeal were also present for lower income neighborhoods. CONCLUSION Neighborhoods with a greater proportion of black or lower income residents have greater flavored LCCs availability and LCC marketing. Without stronger LCC regulation, residents of these neighborhoods may be at a greater risk of LCC use. IMPLICATIONS LCCs are harmful combustible tobacco products that are less regulated than cigarettes (eg, lower taxation, cheaper outlay due to small package sizes, availability of flavors), which makes them an affordable and appealing product to youth. This study documents greater availability, advertising, and marketing of LCCs in neighborhoods with a higher proportion of black or lower-income residents, potentially putting these populations at a greater risk of using or switching to these products in the face of increasing cigarette regulations. These findings underscore the need for local, state, and federal LCC regulatory action.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Moss SL, Keyes KM. Commentary on Foxon & Selya (2020): Social gradients in long-term health consequences of cigarette use-will adolescent e-cigarette use follow the same trajectory? Addiction 2020; 115:2379-2381. [PMID: 33047826 PMCID: PMC9125695 DOI: 10.1111/add.15268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
As exclusive e-cigarette use increases and combustible cigarette use declines among American youth, tracking and reporting social, racial, and economic disparities as they emerge will increasingly be an important surveillance activity. E-cigarette harm evaluation should also look beyond the immediate physical harms, and include social and financial harms as well.
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Affiliation(s)
- Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Giovenco DP, Spillane TE, Baig SA, Dumas SE, Dongchung TY, Sanderson M, Sisti JS, Farley SM, Jasek JP, Seligson AL. Demographic and psychological moderators of the relationship between neighborhood cigarette advertising and current smoking in New York City. Health Place 2020; 66:102441. [PMID: 32947186 PMCID: PMC7686046 DOI: 10.1016/j.healthplace.2020.102441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tobacco advertising in retailers influences smoking, but little research has examined how this relationship differs among population subgroups. This study merged data on neighborhood cigarette advertising with geocoded survey data to assess the association between advertising prevalence and current smoking among New York City (NYC) residents, and whether demographic and psychological characteristics moderate this relationship. METHODS Audit data from a stratified, random sample of 796 NYC tobacco retailers generated neighborhood prevalence estimates of cigarette advertising, which were linked with unweighted 2017 NYC Community Health Survey data (n = 7837 adult respondents with residential geocodes). Multilevel regression estimated adjusted odds ratios (aOR) of current smoking by level of neighborhood cigarette advertising (quartiles). Interactions assessed differences in this relationship by demographic characteristics and current depression (analyses conducted in 2019). RESULTS There was no main effect of advertising on smoking status or significant interactions with demographic variables, but current depression was an effect modifier (p = 0.045). Cigarette advertising was associated with current smoking among those with current depression (p = 0.023), not those without (p = 0.920). Specifically, respondents with depression who resided in neighborhoods in the highest quartile for cigarette advertising prevalence had higher odds of current smoking, compared to those living in the lowest advertising quartile [aOR: 1.72 (1.04, 2.86)]. CONCLUSION Retail cigarette advertising may serve as an environmental cue to smoke among adults with depression. Efforts to restrict or counteract this practice, such as the development of community-level public health interventions and counter-marketing programs, may particularly benefit those with depression and, perhaps, other mental health disorders.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
| | - Torra E Spillane
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
| | - Sabeeh A Baig
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
| | - Sarah E Dumas
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Tenzin Yangchen Dongchung
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Mike Sanderson
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Julia S Sisti
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Shannon M Farley
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - John P Jasek
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Amber Levanon Seligson
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
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D'Angelo H, Rose SW, Golden SD, Queen T, Ribisl KM. E-cigarette availability, price promotions and marketing at the point-of sale in the contiguous United States (2014-2015): National estimates and multilevel correlates. Prev Med Rep 2020; 19:101152. [PMID: 32670780 PMCID: PMC7338777 DOI: 10.1016/j.pmedr.2020.101152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/18/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023] Open
Abstract
Electronic cigarette (e-cigarette) sales and use have increased rapidly, yet point-of-sale e-cigarette availability and marketing is understudied. We estimated changes in e-cigarette availability and marketing among tobacco retailers in the U.S., and associations with neighborhood characteristics. A national sample of tobacco retailers in the Contiguous U.S. was audited in 2014 and 2015 (n = 1,905 and n = 2,126, respectively) to observe e-cigarette availability and marketing (signs, ads, displays and promotions) and generate national prevalence estimates. Store, neighborhood and state level correlates of 2015 e-cigarette availability, price promotions and exterior advertising were analyzed using multilevel mixed-effects generalized linear models. E-cigarettes were sold at 72.0% of retailers in 2014 and at 79.2% in 2015. Price promotions increased from 11.9% to 20.2% of retailers. Among retailers that did not previously sell e-cigarettes in 2012, availability in 2015 was greater for retailers in neighborhoods with the highest proportion of Black residents (vs. lowest). E-cigarette price promotions were more prevalent in neighborhoods with more Hispanic residents, while exterior e-cigarette marketing was more prevalent in neighborhoods with more Black residents. State smoking prevalence was positively associated with e-cigarette availability, promotions and advertising. E-cigarette point-of-sale availability and marketing increased between 2014 and 2015 and expanded to neighborhoods with a higher proportion of Black residents between 2012 and 2015. Retailers located within states with high smoking prevalence appear to be targeted by e-cigarette marketing. As e-cigarettes become the target of more regulations, understanding changes in the e-cigarette retail environment is critical to inform potential policies regulating their sale and marketing.
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Affiliation(s)
- Heather D'Angelo
- School of Medicine and Public Health, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Shyanika W. Rose
- College of Medicine, Department of Behavioral Science, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Shelley D. Golden
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Tara Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kurt M. Ribisl
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Berg CJ, Schleicher NC, Johnson TO, Barker DC, Getachew B, Weber A, Park AJ, Patterson A, Dorvil S, Fairman RT, Meyers C, Henriksen L. Vape shop identification, density and place characteristics in six metropolitan areas across the US. Prev Med Rep 2020; 19:101137. [PMID: 32566458 PMCID: PMC7298674 DOI: 10.1016/j.pmedr.2020.101137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Vaping is increasingly prevalent and controversial. Vape shops and convenience stores are common but distinct sources of vaping products, and where they locate may reflect likely target markets. This study examined the density and neighborhood demographics of vape shops and convenience stores in six metropolitan statistical areas (MSAs): Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle. We identified 459 vape shops using Yelp and Google application programming interfaces and 10,777 convenience stores using ReferenceUSA and Dun & Bradstreet. Retailers were geocoded to census tracts (n = 4,442), and logistic regressions were conducted using as predictors percent non-White, percent youth (5-17 years or 5-20 years), and median household income from the American Community Survey, 2013-2017. Per 10,000 young adults, vape shop density ranged from 0.6 (Boston, San Diego) to 1.7 (Oklahoma City), and convenience store density ranged from 12.6 (San Diego) to 26.3 (Oklahoma City). Logistic regressions indicated that vape shops more likely resided in tracts with lower percentages of youth in Boston, but higher percentages of youth in Atlanta, as well as with lower incomes in Boston and Seattle. Convenience stores more likely resided in tracts with lower percentages of non-Whites in Atlanta and Boston; lower incomes in Atlanta, Boston, San Diego, and Seattle; and higher percentages of youth in Atlanta, Boston, and Minneapolis. These common retail sources of vaping products differentially locate in relation to neighborhood sociodemographics across MSAs. Findings suggest that, in some MSAs, vape shops and convenience stores may target youth and lower income populations.
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Affiliation(s)
- Carla J. Berg
- Department of Preventive and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Nina C. Schleicher
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3300 Hillview Ave, Suite 120, Palo Alto, CA 94304, USA
| | - Trent O. Johnson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3300 Hillview Ave, Suite 120, Palo Alto, CA 94304, USA
| | - Dianne C. Barker
- Barker Bi-Coastal Health Consultants, Inc., 20 Ellery Rd, Newport, RI 02840, USA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amber Weber
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy J. Park
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Akilah Patterson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Dorvil
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert T. Fairman
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Christina Meyers
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3300 Hillview Ave, Suite 120, Palo Alto, CA 94304, USA
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Jeong M, Kurti MK, Hrywna M, Ackerman C, Delnevo CD. Changes in Tobacco Product Advertising at Point of Sale: 2015-2018. Pediatrics 2020; 145:peds.2019-1861. [PMID: 32439814 PMCID: PMC7263045 DOI: 10.1542/peds.2019-1861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Tobacco point-of-sale advertising, particularly in retailers surrounding schools, is associated with youth tobacco use and must be monitored. This study examines how the point-of-sale environment surrounding youth changed over time with regard to diverse tobacco products. METHODS Each spring from 2015 to 2018, research staff visited the same tobacco retailers (n = 141) within a half-mile of New Jersey high schools. For cigarettes, cigars, electronic cigarettes, and smokeless tobacco, advertisement presence, volume, and share of advertising voice (SAV) were measured for both the exterior and interior of the store. Analyses examined changes over time by product, controlling for store type and poverty. RESULTS Over time, exterior cigarette advertisements declined in presence (61% to 49%) and SAV (50% to 40%), whereas interior advertisements maintained stable presence, volume, and SAV. In contrast, cigar advertisements increased in presence (exterior 11% to 23%; interior 19% to 30%) and volume (exterior mean 0.2 to 0.5; interior 0.3 to 0.8). For electronic cigarettes, exterior and interior advertising presence, volume, and SAV decreased from 2015 to 2017 but increased in 2018. Smokeless tobacco advertising was infrequent and stayed consistent except in volume in the interior of stores (mean 0.2 to 0.3). When there were any differences by store type, chain convenience stores had the most exterior and interior advertising for all products. CONCLUSIONS The longitudinal changes observed for each product's advertising reflect national youth use rates of the corresponding products. The point-of-sale environment around schools may be influencing youth tobacco use and must be monitored and regulated.
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Affiliation(s)
- Michelle Jeong
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; and .,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Marin K. Kurti
- Rutgers Center for Tobacco Studies, New Brunswick,
New Jersey; and,Department of Health Behavior, Society, and Policy,
Rutgers School of Public Health, Piscataway, New Jersey
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, New Brunswick,
New Jersey; and,Department of Health Behavior, Society, and Policy,
Rutgers School of Public Health, Piscataway, New Jersey
| | | | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick,
New Jersey; and,Department of Health Behavior, Society, and Policy,
Rutgers School of Public Health, Piscataway, New Jersey
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Assari S, Mistry R, Caldwell CH, Bazargan M. Protective Effects of Parental Education Against Youth Cigarette Smoking: Diminished Returns of Blacks and Hispanics. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:63-71. [PMID: 32547284 PMCID: PMC7250177 DOI: 10.2147/ahmt.s238441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022]
Abstract
Background High parental educational attainment is protective against youth health risk behaviors such as tobacco use. According to the Marginalization-related Diminished Returns (MDRs) theory, however, higher parental education is less protective for marginalized groups relative to non-Hispanic Whites. Objective To explore race/ethnic differences in the effects of parental educational attainment on cigarette smoking in a national sample of American adolescents. Methods In a cross-sectional study, we used baseline data of 10,878 American youth who had participated in the Population Assessment of Tobacco and Health (PATH 2013). The independent variable was parental educational attainment. The dependent variables were lifetime cigarette smoking, current (past 30-day) cigarette moking, and daily cigarette smoking. Youth age, youth gender, and parental marital status were the covariates. Race/ethnicity was the moderating variable. Logistic regression model was used for data analysis. Results Overall, a higher parental educational attainment was associated with a lower lifetime cigarette smoking, current (past 30-day) cigarette smoking, and daily cigarette smoking. Parental educational attainment showed significant interaction with race/ethnicity suggesting smaller protective effects of parental educational attainment on youth tobacco outcomes for Black and Hispanic than for non-Hispanic White youth. Conclusion For American youth, race/ethnicity limits the health gains that are expected to follow parental educational attainment. While high parental educational attainment is protective against smoking overall, non-Hispanic Whites (the most socially privileged group) gain most and Blacks and Hispanics (the least socially privileged groups) gain least from such resource. In addition to addressing low SES, researchers and policymakers should identify and address mechanisms by which high SES minority youth remain at risk of tobacco use.
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Affiliation(s)
- Shervin Assari
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Mohsen Bazargan
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, 90095, USA
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Assari S, Chalian H, Bazargan M. Social Determinants of Hookah Smoking in the United States. ACTA ACUST UNITED AC 2020; 4:21-27. [PMID: 32285045 DOI: 10.29245/2578-2959/2020/1.1185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Educational attainment and income are two socioeconomic status indicators with strong protective effects against cigarette smoking. Marginalization-related Diminished Returns, however, refer to less than expected protective effects of socioeconomic status indicators for the members of the racial and ethnic minority groups, particularly Blacks and Hispanics, compared to non-Hispanic Whites. Aim Borrowing data from a nationally representative study in the US, this study tested whether racial and ethnic differences exist in the effects of educational attainment and poverty status on cigarette smoking of American adults. Methods This cross-sectional study entered 28,329 adult participants of the Population Assessment of Tobacco and Health (PATH; 2013). Both educational attainment and poverty status were the independent variables. The dependent variable was current hookah smoking. Age, gender, and region were the covariates. Race and ethnicity were the effect modifiers (moderators). Results Overall, individuals with higher educational attainment were more likely to smoke a hookah. Individuals who lived out of poverty, however, had lower odds of current hookah smoking. Race and ethnicity both showed statistical interactions with both socioeconomic indicators suggesting that Blacks and Hispanics with high educational attainment and those who live out of poverty have disproportionately high odds of hookah smoking, compared to non-Hispanic Whites with high socioeconomic status. Conclusions In the United States, middle-class racial and ethnic minority people remain at higher risk of smoking hookah. As a result, we should expect a high tobacco burden in middle-class Black and Hispanic adults. We suggest that policymakers should not take an over-simplistic way and reduce the problem of race/ethnic inequalities in tobacco use to gaps in socioeconomic status between groups. Marginalization-related diminished returns generate tobacco disparities in higher socioeconomic status levels. Middle-class racial and ethnic minority people need extra support to stay healthy.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Hamid Chalian
- Department of Radiology, Department of Radiology, Duke University Medical Center, Durham, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA.,Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Begay C, Soto C, Baezconde-Garbanati L, Barahona R, Rodriguez YL, Unger JB, Smiley SL. Cigarette and E-Cigarette Retail Marketing on and Near California Tribal Lands. Health Promot Pract 2020; 21:18S-26S. [PMID: 31908191 DOI: 10.1177/1524839919883254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. Method. Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. Results. All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). Discussion. To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.
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Affiliation(s)
- Cynthia Begay
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Rosa Barahona
- University of Southern California, Los Angeles, CA, USA
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Assari S. Association of Educational Attainment and Race/Ethnicity With Exposure to Tobacco Advertisement Among US Young Adults. JAMA Netw Open 2020; 3:e1919393. [PMID: 31951271 PMCID: PMC6991260 DOI: 10.1001/jamanetworkopen.2019.19393] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/21/2019] [Indexed: 12/23/2022] Open
Abstract
Importance Associations of educational attainment with improved health outcomes have been found to be weaker among racial/ethnic minority groups compared with those among the racial/ethnic majority group. Recent research has also documented higher than expected prevalence of smoking in highly educated African American and Hispanic adults. Objective To compare the association of educational attainment with exposure to tobacco advertisements among racial/ethnic groups of US young adults. Design, Setting, and Participants This cross-sectional study included data from 6700 young adults who participated in wave 1 of the Population Assessment of Tobacco and Health Study, a nationally representative survey of US adults in 2013. Educational attainment was classified as less than high school diploma, high school graduate, or college graduate. Analysis was conducted between September 20 and October 4, 2019. Main Outcomes and Measures The independent variable was educational attainment (less than high school diploma, high school graduate, and college graduate). The dependent variable was any exposure to tobacco advertisements in the past 12 months. Race/ethnicity, age, sex, poverty status, unemployment, and region were the covariates. Binary logistic and Poisson regression were used to analyze the data. Results The study included 6700 participants (3366 [50.2%] men) between ages 18 and 24 years. Most participants were non-Hispanic (5257 participants [78.9%]) and white (5394 participants [80.5%]), while 1443 participants (21.5%) were Hispanic. Educational levels included 1167 participants (17.4%) with less than a high school diploma, 4812 participants (71.8%) who were high school graduates, and 4812 participants (10.8%) who were college graduates. A total of 4728 participants (70.6%) reported exposure to tobacco advertisements in the past 12 months. Exposure to tobacco advertising was reported by 383 participants (53.1%) who were college graduates, 3453 participants (71.8%) who were high school graduates, and 892 participants (76.4%) with less than high school educational attainment. In regression analysis, high school graduation (odds ratio, 0.79; 95% CI, 0.68-0.92) and college graduation (odds ratio, 0.46; 95% CI, 0.39-0.54) were associated with lower odds of exposure to tobacco advertisements compared with young adults with lower educational attainment. Compared with non-Hispanic participants, high school education had a weaker protective association for tobacco advertisement exposure among Hispanic participants (odds ratio, 1.44; 95% CI, 1.03-2.01; P = .03), suggesting that the association of high school graduation with lower exposure to tobacco advertisement is weaker among Hispanic young adults than non-Hispanic young adults. Conclusions and Relevance This study found that high school graduation had a weaker inverse association with tobacco advertisement exposure among Hispanic than non-Hispanic young adults. Future research should explore the role of targeted marketing strategies of the tobacco industry that largely advertise tobacco in areas with high concentrations of racial/ethnic minority groups. Future research should also evaluate the efficacy of more restrictive marketing policies on racial/ethnic disparities in tobacco use.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
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Rosario C, Harris KE. Tobacco Advertisements: What Messages Are They Sending in African American Communities? Health Promot Pract 2020; 21:54S-60S. [DOI: 10.1177/1524839919882390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Racial disparities in tobacco-related death and disease persist. Despite evidence of disparities in exposure to tobacco retailers and point-of-sale advertising, little is known about the extent to which tobacco advertisements within African American communities use three prominent messaging strategies: reassure use is safe despite health risks, redirect attention from health risks to other product features, or incite bravery to use despite health risks. Using a multistage design, we examined tobacco advertisements at 24 retail stores listed on Countertools.org StoreMapper within 15 census tracts where roughly 74% of the population was African American. After confirming interrater reliability, trained data collectors assessed messaging strategy (reassurance, misdirection of attention, or inducement to bravery) usage in ads (n = 165) for various brands (e.g., Newport, Swisher Sweets, Blu) and whether strategies varied by product type (e.g., cigarettes, nonlarge cigar, e-cigarettes). Chi-square analysis of 165 advertisements revealed that the misdirection of attention strategy was used more often than reassurance or inducement to bravery. Tobacco advertisement messaging strategies also varied by product type, with misdirection of attention used more frequently in cigarette and nonlarge cigar advertisements and reassurance used more frequently in e-cigarette advertisements. Cigarette and nonlarge cigar advertisement messages prey on African American communities by redirecting their focus from consequences toward favorable product attributes. Additionally, reassurance messaging may misconstrue risks associated with e-cigarettes; therefore, we should vigilantly monitor e-cigarette trends among this population. Countering misleading messages and advocating policies regarding advertisement content and density within African American communities could help reduce health disparities.
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Assari S, Bazargan M. Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2019; 7:105-110. [PMID: 31772950 PMCID: PMC6879009 DOI: 10.15171/ijtmgh.2019.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Although educational attainment is protective against health risk behaviors such as smoking, Minorities' Diminished Returns theory posits that these protective effects are smaller for ethnic minority than the majority groups. Aims compare the effects of educational attainment on smoking status of American Indian Alaska Native (AIAN) and White adults. Methods Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21114 individuals entered our analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator. Results Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that was suggestive that the protective effects of educational attainment against smoking is smaller for AIAN than Whites. Conclusions In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites. The result is additional risk of smoking in highly educated AIANs. To reduce ethnic disparities I tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA.,Department of Family Medicine, UCLA, Los Angeles, USA
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Assari S, Bazargan M. Education Level and Cigarette Smoking: Diminished Returns of Lesbian, Gay and Bisexual Individuals. Behav Sci (Basel) 2019; 9:bs9100103. [PMID: 31554198 PMCID: PMC6826997 DOI: 10.3390/bs9100103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/13/2019] [Accepted: 09/21/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Education level is one of the strongest protective factors against high-risk behaviors such as cigarette smoking. Minorities' Diminished Returns (MDRs), however, suggest that the protective effects of education level tend to be weaker for racial and ethnic minority groups relative to non-Hispanic White people. Only two previous studies have shown that MDRs may also apply to lesbian, gay, and bisexual (LGB) individuals; however, these studies have focused on outcomes other than tobacco use. Aims: To compare LGB and non-LGB American adults for the effects of education level on cigarette-smoking status. Methods: Population Assessment of Tobacco and Health (PATH; 2013) entered 31,480 American adults who were either non-LGB (n = 29,303, 93.1%) or LGB (n = 2,177; 6.9%). The independent variable was education level. The dependent variable was current established cigarette smoking. Race, ethnicity, age, gender, poverty status, employment, and region were the covariates. LGB status was the moderator. Results: Overall, individuals with higher education level (odds ratio (OR) = 0.69) had lower odds of current established smoking. We found a significant interaction between LGB status and education level suggesting that the protective effect of education level on smoking status is systemically smaller for LGB people than non-LGB individuals (OR for interaction = 1.19). Conclusions: Similar to the patterns that are shown for racial and ethnic minorities, MDRs can be observed for the effects of education level among sexual minorities. In the United States, highly educated LGB adults remain at high risk of smoking cigarettes, a risk which is disproportionate to their education level. In other terms, high education level better helps non-LGB than LGB individuals to avoid cigarette smoking. The result is a relatively high burden of tobacco use in highly educated LGB individuals.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
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Giovenco DP, Spillane TE, Delnevo CD. Predictive Validity of Tobacco Product Advertising and Retail Availability. TOB REGUL SCI 2019; 5:440-446. [PMID: 31824986 PMCID: PMC6904106 DOI: 10.18001/trs.5.5.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Measurement properties of key constructs used in tobacco retailer audit studies are infrequently examined. We used diagnostic testing metrics to assess the predictive validity of product advertising and availability. METHODS In 2017, we documented tobacco product advertising and availability in a sample of New York City and New Jersey retailers (N = 987). We calculated positive predictive values (PPV, ie, probability of availability given advertising is present) and sensitivity scores (ie, probability of advertising given product is available) for cigarettes, cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS). RESULTS Advertising presence was an imprecise indicator of availability for ENDS (PPV: 82.3%) and smokeless tobacco (PPV: 88.2%), particularly in non-chain convenience stores. Cigars were least likely to be advertised, if available (sensitivity: 27.8%), compared to other product types (sensitivity range: 43.8% - 57.9%). CONCLUSIONS The suboptimal predictive validity of advertising for certain products suggests that this measure does not necessarily reflect product accessibility in communities. Moreover, differences in sensitivity scores suggest that some product classes rely on strategies other than physical ads to recruit and retain consumers. A better understanding of these constructs and their influence on behavior can help inform more effective retail-based regulatory approaches.
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Affiliation(s)
- Daniel P Giovenco
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | - Torra E Spillane
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | - Cristine D Delnevo
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ
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Kurti MK, Schroth KRJ, Delnevo C. A discarded cigar package survey in New York City: indicators of non-compliance with local flavoured tobacco restrictions. Tob Control 2019; 29:585-587. [PMID: 31462577 DOI: 10.1136/tobaccocontrol-2019-055035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2009, New York City (NYC) restricted the sale of flavoured tobacco products. We assessed product availability as a proxy for potential non-compliance by analysing discarded cigar, cigarillo and blunt wrap packages in New York City. METHODS A discarded cigar package survey was conducted in 2016, in a stratified random sample of 94 block groups in NYC resulting in the collection of 886 discarded cigar packages. Each package was coded for brand name, flavour description (explicit and implicit) and size. FINDINGS Overall, 19.2% of the cigar packages were explicitly flavoured. An additional 9.4% of the packages reflected implicit flavours. Explicit flavoured cigar packages were at increased odds of being found in Staten Island (adjusted OR (AOR)=3.96, 95% CI=1.66 to 9.46), in packaging size of two or three (AOR=8.49, 95% CI=4.24 to 17.02) or four or more (AOR=4.26, 95% CI=1.95 to 9.30). CONCLUSION Nearly one out of three cigar packages were flavoured products suggesting a problematic level of non-compliance and continued availability. Potential non-compliance is likely fueled by licensed wholesalers and retailers who continue to sell restricted flavoured products. Some retailers may be unaware that implicitly named cigars are typically flavoured and are, therefore, illegal. This lack of awareness of implicit flavoured cigars may be exacerbated by NYC's lack of education or enforcement specific to implicitly flavoured tobacco products.
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Affiliation(s)
- Marin K Kurti
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Kevin R J Schroth
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Cristine Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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Assari S, Bazargan M. Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities' Diminished Returns in the National Health Interview Survey (NHIS). ACTA ACUST UNITED AC 2019; 3. [PMID: 31404444 DOI: 10.32892/jmri.179] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background One of the mechanisms by which high educational attainment promotes populations' health is through reducing exposure to environmental risk factors such as second-hand smoke. Minorities' Diminished Returns theory, however, posits that the protective effect of educational attainment may be smaller for racial and ethnic minority individuals particularly Blacks and Hispanics compared to Whites. Aims To explore racial and ethnic differences in the association between educational attainment and second-hand smoke exposure at work in a national sample of American adults. Methods Data came from the National Health Interview Survey (NHIS 2015), a cross-sectional study that included 15,726 employed adults. The independent variable was educational attainment, the dependent variables were any and daily second-hand smoke exposure at workplace, age and gender were covariates, and race and ethnicity were the moderators. Results Overall, higher educational attainment was associated with lower odds of any and daily second-hand smoke exposure at work. Race and ethnicity both interacted with educational attainment suggesting that the protective effects of educational attainment on reducing the odds of any and daily second-hand smoke exposure at work are systemically smaller for Blacks and Hispanics than Whites. Conclusions In the United States, race and ethnicity bound the health gains that follow educational attainment. While educational attainment helps individuals avoid environmental risk factors such as second-hand smoke, this is more valid for Whites than Blacks and Hispanics. The result is additional risk of cancer and tobacco related disease in highly educated Blacks and Hispanics. The results are important given racial and ethnic minorities are the largest growing section of the US population. We should not assume that educational attainment is similarly protective across all racial and ethnic groups. In this context, educational attainment may increase, rather than reduce, health disparities.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Maynard OM. Addressing Health Disparities With Tobacco Policy Research. Nicotine Tob Res 2019; 21:853-854. [PMID: 31050741 DOI: 10.1093/ntr/ntz061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Olivia M Maynard
- School of Psychological Science, University of Bristol, Bristol, UK
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