Addressing tobacco-related health disparities

The case of young people who use e-cigarettes infrequently: Who is this population? What becomes of them?

BACKGROUND

Emerging data indicate that many adolescents and young adults ("youth") engage in infrequent, or occasional, e-cigarette use. However, little is known about this population as they are often subsumed into the broader "any past-30-day use" category used to define youth "current use." This study aimed to focus on infrequent e-cigarette use by youth, examining its correlates and transitional outcomes.

METHODS

Participants were from a prospective cohort study of youth (aged 15-24 at baseline). Among youth who had used e-cigarettes, we classified "infrequent use" as using e-cigarettes ≤5 days in the last 30 days (n=273) and "frequent use" as using e-cigarettes ≥6 days in the last 30 days (n=278). Descriptive statistics, Markov modeling, and logistic regression were utilized.

RESULTS

By the 12-month follow-up, 76.8% of those using infrequently at baseline remained in the "infrequent use" category, 6.3% reported no recent use, and 16.8% had escalated to the "frequent use" category. Among the youth using infrequently at baseline, those who did (vs. did not) escalate to frequent use by follow-up had higher baseline nicotine dependence and were more likely to have family members who used tobacco.

CONCLUSIONS

Infrequent e-cigarette use is extremely common, and often fairly stable, among young people. Prevention efforts must certainly attempt to reduce escalation and attend to both individual and interpersonal factors (e.g., nicotine dependence, family use). Yet prevention efforts must additionally attend to the case of continued infrequent use, given the high prevalence of people in this category and their regular exposure to e-cigarette harms.

Public health impact of a US menthol cigarette ban on the non-Hispanic black population: a simulation study

INTRODUCTION

With the US Food and Drug Administration recently proposing to implement a ban on menthol cigarettes, it is critical to estimate the potential public health effects of such a ban. With high rates of menthol cigarette use and important smoking-related health disparity implications, the impact of the ban on the non-Hispanic black (NHB) population merits strong consideration.

METHODS

We apply the previously developed Menthol Smoking and Vaping Model to the NHB population. A status quo scenario is developed using NHB-specific population, smoking and vaping initiation, cessation and death rates. Estimates from a recent expert elicitation on behavioural impacts of a menthol cigarette ban on the NHB population are used to develop a menthol ban scenario implemented in 2021. The public health impacts of the menthol ban are estimated as the difference between smoking and vaping attributable deaths (SVADs) and life years lost (LYLs) in the status quo and the menthol ban scenarios from 2021 to 2060.

RESULTS

Under the menthol ban scenario, overall smoking is projected to decline by 35.7% in 2026 and by 25.3% in 2060 relative to the status quo scenario. With these reductions, SVADs are estimated to fall by about 18.5% and LYLs by 22.1%, translating to 255 895 premature deaths averted, and 4.0 million life years gained over a 40-year period.

CONCLUSIONS

A menthol cigarette ban will substantially reduce the smoking-associated health impact on the NHB population, thereby reducing health disparities.

Smoking and progressive retinal nerve fibre layer thinning in glaucoma

BACKGROUND/AIMS

To investigate the relationship between smoking and smoking intensity, and the rate of retinal nerve fibre layer (RNFL) thinning in patients with primary open angle glaucoma (POAG).

METHODS

In this longitudinal study, patients with POAG who had at least 3 years of follow-up with a minimum of 5 visits of optical coherence tomography (OCT) were enrolled. The smoking intensity was calculated as the pack-year at the baseline OCT. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of RNFL thinning over time. Non-linear least-squares estimation with piecewise regression model was used to investigate the cut-off point for the relationship between circumpapillary RNFL thinning and smoking intensity.

RESULTS

A total of 466 eyes of 314 patients were included over the mean (95% CI) follow-up of 6.6 (6.4 to 6.7) years. Of the 314 patients, 121 (39%) had reported any history of smoking. Greater smoking intensity was associated with faster RNFL thinning (-0.06 (95% CI -0.11 to 0.00) µm/year per 10 pack-year higher; p=0.031) after adjusted for confounding factors. RNFL thinning became significantly faster when smoking intensity was >8 pack-year.

CONCLUSIONS

Smoking intensity is associated with faster rates of RNFL thinning. Evaluation of smoking intensity might add information to the assessment of risk of glaucoma progression. Future studies are required to explore if withdrawing smoking as a modifiable risk factor can decrease progression in patients with glaucoma.

A pilot trial of behavioural activation with a contingency management component: Preliminary examination of changes in smoking and alternative rewards among low-income individuals

The heaviest smoking and burden of tobacco-related illness occurs among low-income individuals. Using a behavioural economics framework, this non-randomised pilot study examined the preliminary efficacy of behavioural activation (BA) with a contingency management (CM) component designed to encourage continued use of BA skills and reductions in cigarettes smoked. Eighty-four participants were recruited from a community centre. Data were collected at the start of every other group and at four different follow-up time points. Domains assessed included number of cigarettes smoked, activity level, and environmental rewards (i.e. alternative environmental reinforcers). Over time, cigarette smoking decreased (p < .001), environmental reward increased (p = .03), and reward probability and activity level were associated over time with cigarette smoking (p ≤ .03) above and beyond the effect of nicotine dependence. The continued use of BA skills was associated with greater environmental rewards (p = .04). While further research is needed to replicate this work, results suggest initial evidence for the utility of this intervention in a traditionally underserved community.

Association between cigarette sales in the USA and FDA's announcement of its intention to prohibit menthol as a characterising flavour in cigarettes

INTRODUCTION

On 29 April 2021, the US Food and Drug Administration (FDA) announced its intention to prohibit menthol as a characterising flavour in cigarettes.

METHODS

We assessed the changes in cigarette sales associated with the FDA's announcement using interrupted time series analysis based on monthly retail point-of-sale data on cigarettes from the NielsenIQ Local Trade Area (LTA) data from September 2019 to April 2022. Main outcome variables included LTA-level monthly menthol and non-menthol cigarette sales per 1000-persons.

RESULTS

Monthly cigarette sales were declining before the FDA's announcement (menthol vs non-menthol: -1.68 (95% CI -1.92, -1.45) vs -3.14 (95% CI -3.33, -2.96) packs per 1000-persons). Monthly menthol cigarette sales increased immediately in May 2021 after the FDA's announcement by 6.44 packs per 1000-persons (95% CI 3.83, 9.05). Analysis stratified by LTA-level racial/ethnic compositions showed that LTAs with a relatively higher proportion of non-Hispanic Black population (>8.94%) experienced higher spike in menthol cigarette sales in May 2021 immediately after the announcement and higher post-announcement 12-month menthol cigarette sales than expected.

CONCLUSIONS

Areas with a relatively higher proportion of non-Hispanic Black population are potentially at risk of experiencing increased burden of menthol cigarette consumption. Targeted community level cessation support in non-Hispanic Black majority areas may help mitigate the growing burden of menthol cigarette smoking and improve health equity. The findings of this study also suggest that FDA's prompt finalisation and enforcement of such ban may help avoid extending the increased burden of menthol cigarette consumptions in non-Hispanic Black majority areas.

Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study

INTRODUCTION

The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs).

METHODS

After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060.

RESULTS

As a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications.

CONCLUSIONS AND RELEVANCE

Our findings strongly support the implementation of a ban on menthol in cigarettes and cigars.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014

INTRODUCTION

Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents.

METHODS

This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance.

RESULTS

Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents.

CONCLUSIONS

There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

Impact of Self-Control and Social Network of Friends on the Amount of Smoking among Out-of-School Youth

The aim of this study is to understand the effects of self-control and social networks of friends on the amount of smoking among out-of-school adolescents. The subjects of this study were 187 out-of-school adolescent smokers from the J-province Youth Counseling Welfare Center as of 2020. Data were collected through self-report questionnaires that contained questions about sociodemographic characteristics, self-control, social networks of friends, and amount of smoking. The dependent variable was smoking amount. Descriptive statistics, χ2 tests, correlation analyses, and regression analysis were performed. The predictors of smoking in OSY (out-of-school youth) were analyzed with respect to self-control and social networks of friends. The significant variables in model 3 were age, living with parents, and average allowance. The smoking rate of friends (β = 0.256) and the degree of penetration of friends smoking (β = 0.341) were significant variables. The higher the percentage of friends smoking and the higher the degree of penetration of smoking among the members of social networks, the higher the amount of smoking.

Short- and Long-Term Cigarette and Tobacco Abstinence Among Daily and Nondaily Older Smokers

INTRODUCTION

There is mixed evidence regarding whether older (vs. younger) smokers are more or less likely to quit smoking. We examined how age is associated with cigarette and all tobacco product abstinence and the potential moderating effects of smoking frequency.

AIMS AND METHODS

Data from a 4-year cohort of the Population Assessment of Tobacco and Health (PATH) study were used, including 7512 smokers at Wave 1 who had smoking status data at Wave 4. Logistic regression models were used to examine the effects of age (18-24, 25-34, 35-44, 45-54, and ≥55 years) on Wave 4, 30-day and 12-month cigarette and all tobacco product abstinence, adjusting for covariates and the interaction between age and cigarette use frequency (nondaily, light daily, and heavy daily).

RESULTS

Older smokers (≥55 years) were more likely to be heavy daily smokers than younger smokers 18-24 and 25-34 years, but were less likely to have a past-year cigarette quit attempt. Younger smokers 45-54 years were less likely to report 12-month cigarette abstinence than older smokers (odds ratio = 0.72 [0.54-0.95]). Younger smokers 18-24 and 45-54 years were less likely to report 12-month tobacco product abstinence than older smokers (odds ratio = 0.65 [0.45-0.93]; odds ratio = 0.73 [0.55-0.96], respectively). Thirty-day cigarette abstinence significantly decreased as age increased for nondaily smokers, significantly increased for heavier daily smokers, but remained similar across age for light daily smokers.

CONCLUSIONS

Older smokers were more likely to report 12-month cigarette and tobacco abstinence than younger smokers 45-54 years old, and the effect of age on abstinence differed by smoking frequency/intensity. Smoking cessation interventions need to be age specific and consider smoking frequency.

IMPLICATIONS

This study shows that although older smokers are more likely to be heavy smokers and less likely to have a quit attempt at baseline, they are more likely to have 12-month cigarette and tobacco abstinence than younger smokers. Furthermore, 30-day cigarette abstinence significantly decreases as age increases for nondaily smokers and significantly increases for heavy daily smokers, suggesting that the effect of cigarette smoking frequency and intensity changes with age. Smoking cessation interventions need to be age specific as well as consider the smoking frequency/intensity of each age group. Younger smokers may need more targeted cessation interventions to successfully quit.

E-cigarette use among Hispanics: Reducing risk or recruiting new tobacco users?

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.

Boosting the Tobacco Control Vaccine: recognizing the role of the retail environment in addressing tobacco use and disparities

Much of the progress in reducing cigarette smoking and tobacco-related morbidity and mortality among youth and adults is attributable to population-level strategies previously described in the context of the Tobacco Control Vaccine. The retail environment is used heavily by the tobacco industry to promote and advertise its products, and variations in exposure to and characteristics of the retail environment exist across demographic groups. It is therefore also an essential environment for further reducing smoking, as well as ameliorating racial, ethnic and socioeconomic tobacco-related disparities. This commentary provides an overview of the importance of incorporating strategies focused on the tobacco retailer environment (availability; pricing and promotion; advertising and display; age of sale; and retail licensure) as part of a comprehensive approach to tobacco prevention and control. To reach tobacco endgame targets, such innovative strategies are a complement to, but not a replacement for, long-standing evidence-based components of the Tobacco Control Vaccine.

Temporal trends in smoking and nicotine dependence in relation to co-occurring substance use in the United States, 2005-2016

BACKGROUND

Despite an overall decline in tobacco use in the United States, secular trends of smoking and nicotine dependence with co-occurring substance use are not well characterized.

METHODS

We examined self-reported tobacco and other substance use in 22,245 participants age 21-59 in the United States from six waves of the National Health and Nutrition Examination Survey (NHANES). Using Joinpoint regression, we assessed secular trends of smoking and nicotine dependence as a function of co-occurring use of alcohol, prescription opioids, marijuana/hashish, cocaine/heroin/methamphetamine, or other injection drug use. Multivariable logistic regressions were fitted to identify the potential risk factors.

RESULTS

During 2005-2016, the prevalence of current smoking decreased (without co-occurring substance use: 17.0 %-12.7 %; with co-occurring use of one substance: 35.3 % to 24.6 %; with co-occurring use of two or more substances: 53.8 %-42.2 %), and moderate-to-severe nicotine dependence decreased as well (8.0 %-4.2 %, 16.0 %-8.8 %, and 23.9 %-15.7 %, respectively). Smoking and nicotine dependence were more likely in those with co-occurring use of one substance (current smoking: odds ratio [OR] = 2.22, 95 % confidence interval [CI] = 2.01-2.45); nicotine dependence: OR = 1.88, 95 % CI = 1.63-2.17) and in those with co-occurring use of two or more substances (current smoking: OR = 5.25, 95 % CI = 4.63-5.95; nicotine dependence: OR = 3.24, 95 % CI = 2.72-3.87).

CONCLUSIONS

Co-occurring substance use was associated with smaller reductions in tobacco use, over time, and with increased odds of nicotine dependence. This suggests that co-occurring substance users should be regarded as a tobacco-related disparity group and prioritized for tobacco control interventions.

An Expert Elicitation on the Effects of a Ban on Menthol Cigarettes and Cigars in the United States

INTRODUCTION

The US FDA announced its intention to ban menthol in cigarettes. However, information is needed on how a federal ban would affect population health. We conducted an expert elicitation to gauge the impact of a menthol cigarette and cigar ban in the US.

METHODS

We developed and pilot tested a questionnaire that focused on tobacco use transitions of current smokers (age 18-24 menthol, age 35-54 menthol, and age 35-54 non-menthol) and potential menthol smokers (age 12-24). Using a structured expert elicitation, we estimated mean net transitions under a ban from cigarette use to combustible tobacco product, smokeless tobacco, novel nicotine delivery product (NNDPs, such as e-cigarettes) use, or no tobacco use.

RESULTS

Eleven experts provided responses. Of those ages 12-24 who would have initiated menthol cigarette use in the absence of a ban, the experts estimated that 41% would still initiate combustible products under a ban, while 18% would initiate with NNDPs and 39% would not initiate regular tobacco use. Combustible use by menthol smokers ages 35-54 was expected to decline by 20% post-ban relative to pre-ban rates, half switching to NNDPs and half quitting all tobacco use. Menthol smokers ages 18-24 were expected to reduce combustible use by 30%, with 16% switching to NNDPs. Greater reductions in combustible use were estimated for African-Americans across the three age groups. Negligible impacts were expected for current adult non-menthol smokers.

CONCLUSIONS

According to expert opinion, a menthol ban is expected to substantially reduce smoking initiation and combustible tobacco product use among current menthol smokers.

Psychological, Normative, and Environmental Barriers to Tobacco Cessation that Disproportionally Affect Sexual Minority Tobacco Users

INTRODUCTION

Sexual minority populations-particularly gay/lesbian and bisexual women-use tobacco at higher rates than their heterosexual peers. Evidence-based biopsychosocial interventions for tobacco cessation are available; however, research is lacking on the specific barriers to tobacco cessation in these populations. The purpose of this study is to describe the psychological, normative, and environmental barriers to cessation that disproportionally affect sexual minority tobacco users.

METHODS

Data from wave 1 of the Population Assessment of Tobacco and Health were used to explore differences by sexual identity across psychosocial barriers and facilitators of tobacco cessation. The analytic sample consisted of current tobacco users (including cigarettes, e-cigarettes, cigars, cigarillos, pipes, hookah, dissolvable snus, and smokeless products). Psychosocial barriers/facilitators were modeled using logistic regression analyses, controlling for age, race/ethnicity, poverty, education, census region, and urbanicity and were stratified by sex. Models accounted for the complex study design and nonresponse.

RESULTS

Substance use and internalizing/externalizing behavioral problems were more common among gay/bisexual men. Bisexual, but not gay/lesbian, women also had higher odds of these behavioral problems. Bisexual men and women reported less normative pressure to quit than their heterosexual peers (no differences in gay/lesbian tobacco users). Gay men had more environmental barriers to quit, being more likely to receive tobacco promotion materials, and live with another tobacco user.

CONCLUSIONS

Several barriers to tobacco cessation were identified as disproportionally affecting sexual minority groups in this study; however, there were considerable differences between sexual minority men and women, as well as between gay and bisexual participants.

IMPLICATIONS

Several important psychological, normative, and environmental barriers to tobacco cessation were identified that disproportionally affect sexual minorities. There was considerable heterogeneity in the prevalence and relative difference of these barriers across sexual minority subgroups, suggesting that community-based tobacco cessation programs should be responsive to differences in gay and bisexual men and women.

Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans

BACKGROUND AND AIMS

Frequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers.

DESIGN

Mixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived).

SETTING

Academic medical center in Los Angeles, CA, USA.

PARTICIPANTS

African American non-treatment seeking daily cigarette smokers (n = 607, ≥ 10 cig/day).

MEASUREMENTS

At a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured.

FINDINGS

Adjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs = 0.09-0.13; Ps < 0.02). Data were inconclusive for associations between perceived exposure to discrimination and deprivation-induced changes in cravings, urges to smoke for pleasure, positive mood reduction, other symptoms or smoking reinstatement behavior.

CONCLUSIONS

Frequency of perceived exposure to discrimination appears to be modestly associated with increased severity of some deprivation-induced tobacco withdrawal symptoms in African American smokers.

Tobacco Use Patterns among GED Recipients

U.S. General Educational Development diploma (GED) recipients have the highest smoking prevalence of any education level. This paper describes demographic characteristics and tobacco use patterns and examines effect modification and confounding as potential explanations for higher crude prevalence of smoking.

METHODS

The study population included adults aged 25 and older in the 2013 National Health Interview Survey. We estimated adjusted prevalence ratios and 95% CIs for smoking and quitting behaviors using weighted multivariable logistic regression.

RESULTS

Among women with a GED, adjusted prevalence of ever use (58.7%) and smoking (32.4%) was 1.50 and 1.52 times the prevalence among high school dropouts (39.1%, 21.3%). Female GED recipients had a significantly higher prevalence of ever smoking compared with dropouts. We found no significant educational differences in smoking prevalence among men or quit behaviors for either sex.

CONCLUSIONS

More research is needed to identify targeted interventions to prevent smoking in this disparate population.

A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network

Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Race, sex, and physician communication about tobacco as predictors of adolescent smoking trajectories in a primarily African American sample

This study identified latent classes of adolescent smoking and examined race, gender, and physician communication (PC) as predictors of class membership. Data were drawn from five waves of a large (N = 3,049), diverse (82.9% African American) study. Several latent classes were identified: nonsmoker, quitter, early-onset escalating smoking, early-onset stable high smoking, late-onset smoking, and declining smoking. Males, Whites, and teens who received PC were more likely to be in classes with more smoking. Our study identified several youth smoking patterns and differences in smoking based on race, gender, and receipt of PC.

Ethnic Differences in Cigarette Use Trajectories and Health, Psychosocial, and Academic Outcomes

PURPOSE

Cigarette smoking among youth is associated with poorer health and psychosocial outcomes. However, few studies address how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence.

METHODS

Youth (n = 2,509) were surveyed eight times from ages 11 to 18. We measured cigarette use, academic and social functioning, mental and physical health, and delinquency. Sequelae of change models controlled for sociodemographic factors, and tested whether intercept and slope for smoking trajectories were associated with outcomes at the end of high school, and examined racial/ethnic differences in outcomes assuming similar smoking trajectories across groups.

RESULTS

Youth were 45% Hispanic, 20% Asian, 20% white, 10% multiethnic, 2% black, and 1% other ethnicities. Higher average probability of smoking and steeper slopes of smoking trajectories were associated with poorer outcomes in multiple domains. Controlling for smoking trajectories, we observed the following disparities (vs. white youth; all p's < .05): black, Hispanic, and multiethnic youth reported lower academic performance; Asian, black, and multiethnic youth reported higher academic unpreparedness; Asian and multiethnic youth reported poorer mental health; Asian, Hispanic, and multiethnic youth reported poorer physical health; and Asian youth reported higher delinquency and poorer social functioning.

CONCLUSIONS

Statistically adjusting for similar smoking trajectories, racial/ethnic minority youth demonstrated poorer outcomes in multiple domains compared with white peers. Smoking may be a particularly robust marker for risk of negative outcomes in racial/ethnic minority youth. Screening for cigarette use and intervening on smoking and associated risk behaviors among minority youth may help reduce disparities in functioning.

A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking

The inverse association between socioeconomic status and smoking is well established, yet the mechanisms that drive this relationship are unclear. We developed and tested four theoretical models of the pathways that link socioeconomic status to current smoking prevalence using a structural equation modeling (SEM) approach. Using data from the 2013 National Health Interview Survey, we selected four indicator variables (poverty ratio, personal earnings, educational attainment, and employment status) that we hypothesize underlie a latent variable, socioeconomic status. We measured direct, indirect, and total effects of socioeconomic status on smoking on four pathways through four latent variables representing social cohesion, financial strain, sleep disturbance, and psychological distress. Results of the model indicated that the probability of being a smoker decreased by 26% of a standard deviation for every one standard deviation increase in socioeconomic status. The direct effects of socioeconomic status on smoking accounted for the majority of the total effects, but the overall model also included significant indirect effects. Of the four mediators, sleep disturbance and psychological distress had the largest total effects on current smoking. We explored the use of structural equation modeling in epidemiology to quantify effects of socioeconomic status on smoking through four social and psychological factors to identify potential targets for interventions. A better understanding of the complex relationship between socioeconomic status and smoking is critical as we continue to reduce the burden of tobacco and eliminate health disparities related to smoking.

Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV

BACKGROUND

Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented.

METHODS

VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use.

RESULTS

Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77).

CONCLUSION

Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.

Improving tobacco dependence treatment outcomes for smokers of lower socioeconomic status: A randomized clinical trial

INTRODUCTION

Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-behavioral treatment for tobacco dependence for diverse lower socioeconomic smokers.

METHODS

Participants were randomized to adapted or standard treatment, received six 1-h group treatment sessions, and were followed for six months. We examined the effectiveness of the adapted treatment to improve treatment outcomes for lower socioeconomic groups.

RESULTS

Participants (n=227) were ethnically, racially, and socioeconomically diverse. The adapted treatment significantly reduced the days to relapse for the two lowest socioeconomic groups: SES1: M=76.6 (SD 72.9) vs. 38.3 (SD 60.1) days to relapse (RR=0.63 95% CI, 0.45, 0.88, p=0.0013); SES2: M=88.2 (SD 67.3) vs. 40.1 (SD 62.6 days to relapse (RR=0.57 95% CI, 0.18, 0.70, p=0.0024). Interactions between socioeconomic status and condition were significant for initial abstinence (OR=1.26, 95% CI 1.09, 1.46, p=0.002), approached significance for 3-month abstinence (OR=0.90, 95% CI 0.80, 1.01, p<0.071), and were not significant for 6-month abstinence (OR=0.99 95% CI 0.88, 1.10, p=0.795). No significant differences in long-term abstinence were observed.

CONCLUSION

Systematic adaption of evidence-based treatment for tobacco dependence can significantly improve initial and short-term treatment outcomes for diverse lower socioeconomic smokers and reduce inequities in days to relapse. Novel methods of providing targeted extended support are needed to improve long-term outcomes.

The differential impact of state tobacco control policies on cessation treatment utilization across established tobacco disparities groups

Tobacco control policies are effective in promoting quit attempts and increase the likelihood that smokers use evidence-based cessation treatments (e.g., nicotine replacement therapies (NRT), non-NRT medications, behavioral treatment, and/or quitlines). However, what is less clear is how these policies might differentially impact different groups of smokers, perhaps in some cases even widening disparities in the use of evidence-based tobacco dependence treatments. This paper examined how different state-level tobacco control policies impact the use of evidence-based cessation treatments by race/ethnicity, gender, socio-economic status (SES), age, and smoking history. Participants included 9110 adult smokers reporting a past-year quit attempt within the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Lasso regression modeling was used to identify a subset of interactions between tobacco policies and individual smoker characteristics that predicted use of evidence-based cessation treatment. Significant interactions were fitted via participant-weighted generalized linear models to determine effect sizes and relations to each cessation treatment outcome. Results highlighted that various state level tobacco control policies differentially impacted the reported use of both prescription and non-prescription stop smoking medications by race/ethnicity, age, and SES. The relationship between state level tobacco control policies and the use of behavioral treatments and quitlines did not differ by smoker characteristics. In sum, tobacco control policies differentially impact the use of FDA approved stop smoking medications across different race/ethnicity, age, and SES groups. Understanding such effects can help to target interventions to ensure equal access to evidence-based tobacco dependence treatments.

Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial

BACKGROUND

The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes.

METHODS/DESIGN

Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences.

DISCUSSION

Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01928719 . Registered on 21 August 2013.

Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients

Background

Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers.

Methods/design

This trial uses a randomized, two-group design in which caregiver-smokers of children 0–17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child’s illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control “5–2–1-0” counseling that focuses on improving the child’s health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed.

Discussion

This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers’ tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

Trial registration

ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4278-8) contains supplementary material, which is available to authorized users.

Effectiveness of a Culturally-Tailored Smoking Cessation Intervention for Arab-American Men

To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack—a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking ”very much”. For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = −6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population.

Understanding Tobacco Use Onset Among African Americans

INTRODUCTION

Compared to the majority of non-Hispanic white ("white") cigarette smokers, many African American smokers demonstrate a later age of initiation. The goal of the present study was to examine African American late-onset smoking (ie, regular smoking beginning at age 18 or later) and determine whether late-onset (vs. early-onset) smoking is protective in terms of quit rates and health outcomes.

METHODS

We used data from the National Survey of Midlife Development in the United States (MIDUS) because the wide age range of participants (20-75 at baseline) allowed the examination of smoking cessation and mortality incidence across the lifespan.

RESULTS

Consistent with previous research, results indicated a later average age of smoking onset among African Americans, compared to whites. Disentangling effects of race from age-of-onset, we found that the cessation rate among late-onset African American smokers was 33%, whereas rates for early-onset African American smokers and early- and late-onset white smokers ranged from 52% to 57%. Finally, results showed that among white, low-socioeconomic status (SES) smokers, the hazard rate for mortality was greater among early- versus late-onset smokers; in contrast, among African American smokers (both low- and high-SES) hazard rates for mortality did not significantly differ among early- versus late-onset smokers.

CONCLUSIONS

Although late (vs. early) smoking onset may be protective for whites, the present results suggest that late-onset may not be similarly protective for African Americans. Tobacco programs and regulatory policies focused on prevention should expand their perspective to include later ages of initiation, in order to avoid widening tobacco-related health disparities.

IMPLICATIONS

This study indicates that late-onset smoking is not only the norm among African American adult smokers, but that late- versus early-onset smoking (ie, delaying onset) does not appear to afford any benefits for African Americans in terms of cessation or mortality. These results suggest that prevention and intervention efforts need to consider individual groups (not just overall averages) and that tobacco control efforts need to be targeted beyond the teenage years. Tobacco programs and regulatory policies focused on prevention should expand their perspective to include later ages of initiation, to avoid widening tobacco-related health disparities.

Tobacco-Related Health Disparities Across the Cancer Care Continuum

BACKGROUND

Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups.

METHODS

We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities.

RESULTS

Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established.

CONCLUSIONS

To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.

Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes

BACKGROUND

Many smokers admitted for chronic obstructive pulmonary disease (COPD) are not given smoking cessation medications at discharge. The reasons behind this are unclear, and may reflect an interplay of patient characteristics, health disparities, and the receipt of inpatient tobacco control processes.

OBJECTIVES

We aimed to assess potential disparities in treatment for tobacco use following discharge for COPD, examined in the context of inpatient tobacco control processes.

PARTICIPANTS

Smokers aged ≥ 40 years, admitted for treatment of a COPD exacerbation within the VA Veterans Integrated Service Network 20, identified using ICD-9 discharge codes and admission diagnoses from 2005-2012.

MAIN MEASURES

The outcome was any tobacco cessation medication dispensed within 48 hours of discharge. We assessed potential predictors administratively up to 1 year prior to admission. We created the final logistic regression model using manual model building, clustered by site. Variables with p < 0.2 in biviariate models were considered for inclusion in the final model.

RESULTS

We identified 1511 subjects. 16.9 % were dispensed a medication at discharge. In the adjusted model, several predictors were associated with decreased odds of receiving medications: older age (OR per year older 0.96, 95 % CI 0.95-0.98), black race (OR 0.34, 95 % CI 0.12-0.97), higher comorbidity score (OR 0.89, 95 % CI 0.82-0.96), history of psychosis (OR 0.40, 95 % CI 0.31-0.52), hypertension (OR 0.75, 95 % CI 0.62-0.90), and treatment with steroids in the past year (OR 0.80, 95 % CI 0.70-0.90). Inpatient tobacco control processes were associated with increased odds of receiving medications: documented brief counseling at discharge (OR 3.08, 95 % CI 2.02-4.68) and receipt of smoking cessation medications while inpatient (OR 5.95, 95 % CI 3.19-11.10).

CONCLUSIONS

Few patients were treated with tobacco cessation medications at discharge. We found evidence for disparities in treatment, but also potentially beneficial effects of inpatient tobacco control measures. Further focus should be on using novel processes of care to improve provision of medications and decrease the observed disparities.

Adolescent social networks: general and smoking-specific characteristics associated with smoking

OBJECTIVE

Converging lines of research suggest that adolescents' smoking behaviors are strongly influenced by the characteristics of their social network and the social processes their network facilitates. The primary goal of this study was to conduct a detailed comparison of the social networks of adolescent smokers and nonsmokers to determine what aspects relate the most to smoking status. A secondary goal was to conduct within-group analyses to examine relationships between key measures of behavior-specific social support and (a) smoking susceptibility among nonsmokers, and (b) readiness to quit smoking among smokers.

METHOD

A matched sample of 190 adolescent smokers and nonsmokers (Mage = 16.8 years; 51% female) completed a questionnaire in which they nominated and reported on up to 10 important people in their lives. This measure allowed us to examine adolescents' overall networks (both peers and family) and to investigate numerous aspects, including general network characteristics (e.g., size of network, average contact with network members), social support (e.g., importance of people in the network), and the pervasiveness of smoking in the network (e.g., percentage of smoking peers).

RESULTS

The pervasiveness of smoking in adolescents' social network was the strongest distinguisher of smokers versus nonsmokers. In addition, behavior-specific social support was strongly associated with susceptibility to initiate smoking among nonsmokers and readiness to quit among smokers.

CONCLUSIONS

This research offers insight into potential targets for prevention and early intervention by demonstrating how social networks can both promote and attenuate risk for smoking.

What predicts early smoking milestones?

OBJECTIVE

As many cigarette smokers begin experimenting before age 16, prevention efforts require a comprehensive understanding of smoking predictors during adolescence. Research has made many advances in understanding the predictors of smoking initiation, yet more precision is still needed to determine whether the patterns of prediction differ across early smoking milestones. The purpose of this study was to use a sample of young adolescents to examine the predictors of two key milestones in smoking initiation: first puff and first cigarette.

METHOD

Data came from an ongoing, prospective project examining psychosocial factors related to adolescent substance use. At Time 1 (T1), the sample was 1,023 Rhode Island middle school students (ages 10-15 years; M = 12.2). T1 measures included empirically supported risk and protective factors, as well as current smoking. Follow-up surveys assessed smoking behavior over the ensuing year (T2 smoking).

RESULTS

Cigarette availability was the most robust predictor of smoking milestones, increasing the likelihood of both first puff and first cigarette in cross-sectional and prospective analyses. Multivariable analyses also showed specificity, where some factors were only associated with one time point (e.g., age and T1 puff and cigarette), whereas others were only associated with one milestone (e.g., parental monitoring and whole cigarette at both time points).

CONCLUSIONS

This study found different patterns of predictors for two early smoking milestones. Such findings are the first to suggest that puff and whole cigarette are distinct smoking milestones and reaffirm arguments that researchers should distinguish the various stages of smoking initiation when examining the broader period of onset/initiation.

Mental Health, Racial Discrimination, and Tobacco Use Differences Across Rural-Urban California

OBJECTIVE

Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use.

METHODS

Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status.

RESULTS

Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender (P < .05).

CONCLUSION

Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities.

Parental Support, Mental Health, and Alcohol and Marijuana Use in National and High-Risk African-American Adolescent Samples

African-American adolescents experience disproportionate rates of negative consequences of substance use despite using substances at average or below-average rates. Due to underrepresentation of African-American adolescents in etiological literature, risk and protective processes associated with their substance use require further study. This study examines the role of parental support in adolescents' conduct problems (CPs), depressive symptoms (DSs), and alcohol and marijuana use in a national sample and a high-risk sample of African-American adolescents. In both samples, parental support was inversely related to adolescent CPs, DSs, and alcohol and marijuana use. CPs, but not DSs, partially mediated the relation of parental support to substance use. Results were consistent across the national and high-risk samples, suggesting that the protective effect of parental support applies to African-American adolescents from a range of demographic backgrounds.

Physician Advice to Adolescents About Smoking: Who Gets Advised and Who Benefits Most?

PURPOSE

The Clinical Practice Guidelines instruct physicians to ask their patients about smoking and to advise against tobacco use. Physicians are urged especially to attend to racial minorities and teens because of these groups' increased susceptibility to smoking. Research on race and physician advice against smoking has produced contradictory findings. The purpose of this study is to clarify the relationships between physician communication about tobacco, race, and smoking among adolescents.

METHODS

This cross-sectional retrospective study explored (1) racial differences in rates of receiving physician communication and (2) whether the relationship between physician communication and smoking among adolescents was moderated by race. Multiple measures of smoking status were used (e.g., intentions to quit, quit attempts, quits, relapse status). We used a large (N = 5,154), predominately African-American (82.9%) sample of 11th graders.

RESULTS

Regular smokers were more likely to be screened about smoking. African Americans were more frequently advised against tobacco than Caucasians. Among African Americans, nonsmokers were most likely to be both screened and advised; among Caucasians, regular were most likely to be screened and advised. Overall, physician intervention was associated with greater benefits for young African Americans, including fewer intentions to smoke, greater likelihood of quitting, and less relapse.

CONCLUSIONS

Physician communication about smoking may hold particular promise for African-American teens, reducing health disparities because of racial differences in smoking-related mortality and morbidity. Physicians should be encouraged to screen and advise all young people about tobacco, regardless of race or smoking status.

The Sociopharmacology of Tobacco Addiction: Implications for Understanding Health Disparities

Efforts to reduce the public health burden of tobacco use have not equally benefited all members of society, leading to disparities in tobacco use as a function of ethnicity/race, socioeconomic position, physical/behavioral comorbidity, and other factors. Although multilevel transdisciplinary models are needed to comprehensively understand sources of tobacco-related health disparities (TRHD), the incorporation of psychopharmacology into TRHD research is rare. Similarly, psychopharmacology researchers have often overlooked the societal context in which tobacco is consumed. In an effort to facilitate transdisciplinary research agendas for studying TRHD and the psychopharmacology of tobacco use, this article introduces a novel paradigm, called "sociopharmacology." Sociopharmacology is a platform for investigating how contextual factors amplify psychopharmacological determinants of smoking to disproportionately enhance vulnerability to smoking in populations subject to TRHD. The overall goal of sociopharmacology is to identify proximal person-level psychopharmacological mechanisms that channel distal societal-level influences on TRHD. In this article I describe: (1) sociopharmacology's overarching methodology and theoretical framework; (2) example models that apply sociopharmacology to understand mechanisms underlying TRHD; (3) how sociopharmacological approaches may enhance the public health impact of basic research on the psychopharmacology of tobacco use; and (4) how understanding sociopharmacological mechanisms of TRHD might ultimately translate into interventions that reduce TRHD.

Tobacco Denormalization as a Public Health Strategy: Implications for Sexual and Gender Minorities

Although the population-level success of tobacco denormalization is widely accepted, it remains unclear whether these strategies alleviate health inequities for sexual and gender minorities. The high risk of smoking among sexual and gender minorities together with research that documents a relationship between stigma-related processes and smoking prevalence for these groups raises questions about whether tobacco-related stigma intensifies the disadvantages associated with the stigmas of other social identities. We have not adequately considered how tobacco-related stigma overlaps with other social identity stigmas. Given concerns about the intensification of inequality, this type of inquiry has important implications for understanding both the effectiveness and limitations of tobacco denormalization strategies for sexual and gender minorities and identifying those tobacco prevention, treatment, and public health policies that work to ameliorate health inequities.

A pilot study of what African American maternal caregivers and their adolescent daughters talk about when asked to discuss tobacco together

Parents play a critical role in shaping their children's substance use behaviors, yet few studies have examined the messages that caregivers give their adolescents about tobacco. In this study, we identify tobacco-related messages discussed by African American maternal caregivers and their adolescent daughters. Twenty-five African American maternal caregivers and their adolescent daughters participated in a video-taped discussion about tobacco. Discussions were transcribed and coded thematically. Seven themes emerged, which were grouped into tobacco-messages and communication strategies. Messages included health risks, non-health-related reasons to stop smoking, reasons people smoke, and tobacco products and marijuana. Strategies caregivers used to communicate their tobacco-related messages included sharing personal or their families' experience with smoking, using humor, and role-playing. Finally, embedded within all of the themes, participants expressed their disapproval of tobacco use, whether it was directed at their own use, their adolescents' use, a family members' use, or peers' use. African American maternal caregivers and their daughters openly talk about a variety of tobacco-related topics, and caregivers are open to sharing their own and their families' experience with substance use. Findings also suggest that having caregivers and their adolescents participate in discussions tasks could be potentially beneficial in facilitating discussions and could identify areas in which caregivers could use help in discussing sensitive topics.

Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute's Community Networks Program

INTRODUCTION

In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework.

METHODS

We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework.

RESULTS

Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP.

CONCLUSIONS

The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.

A smoking cessation intervention for low-income smokers in the ED

BACKGROUND

There is a high prevalence of smoking among caregivers who bring their children to the pediatric emergency department (PED) and even higher rates of tobacco smoke exposure (TSE) and related morbidity among their children. The PED visit presents an opportunity to intervene with caregivers, but it is unknown whether they are more likely to quit if their child has a TSE-related illness. We sought to examine a PED-based smoking cessation intervention and compare outcomes based on children's TSE-related illness.

METHODS

A single-arm, prospective trial, with baseline, 3, and 6 month assessments was used in this study. Caregivers whose child had either a TSE-related (n=100) or non-TSE-related illness (n=100) were given a brief intervention consisting of counseling, referral to the Quitline, and free nicotine replacement therapy.

RESULTS

Participants were 91.5% female, 50.5% African American, 100% Medicaid recipients, 30.8 years old, child age mean of 5.5 years, 90% highly nicotine dependent, and 60.3% and 75.8% allowed smoking in the home and car, respectively. At follow-up (65% retention), 80% reported quit attempts at 3 months and 89% between 3 and 6 months. There were significant decreases in number of cigarettes smoked, time to first cigarette, and smoking in the home and car. Quit rates were 12.2% at 3 months, 14.6% at 6 months, and 7.3% at both time points (50% biochemically confirmed). There were no significant differences in outcomes based on children's illness.

CONCLUSIONS

A brief PED-based smoking cessation intervention resulted in quit attempts and successful quits. However, the presence of a TSE-related illness did not result in different cessation outcomes.

Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers

BACKGROUND

Tobacco-related heath inequalities are a major public health concern, with smoking being more prevalent among lower socioeconomic groups. The aim of this study is to investigate the mechanisms leading to socioeconomic inequalities in smoking among 15-year-old adolescents by examining the mediating role of psychosocial factors in the peer group, family and school environment.

METHODS

Data were derived from the international WHO-collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, including 52 907 15-year-old students from 35 European and North American countries. Socioeconomic position was measured by the Family Affluence Scale. Multilevel logistic regression models were conducted to examine the contribution of family, school and peer factors in explaining the association between family affluence and weekly smoking.

RESULTS

Across countries, adolescents from low affluent families had an increased risk of weekly smoking (OR(boys) 1.14, confidence interval (CI) 1.05-1.23; OR(girls) 1.36, CI 1.26-1.46) compared with adolescents from high affluent families. Family and school factors mediated the association between family affluence and smoking to a high extent up to 100% (boys) and 81% (girls) in joint analyses. The most important single factors were family structure, relationships with parents, academic achievement and school satisfaction. Peer factors did not mediate the association between family affluence and adolescent smoking.

CONCLUSION

The association between socioeconomic status and adolescent weekly smoking can largely be explained by an unequal distribution of family- and school-related factors. Focusing on the parent-adolescent relationship and adolescent school achievement can help to better understand inequalities in adolescent smoking behaviour.

With others or alone? Adolescent individual differences in the context of smoking lapses

OBJECTIVE

Although a great deal of adolescent smoking research has investigated predictors of initiation, much less has focused on predictors of lapsing during a quit attempt. In particular, the role of social context may deserve greater attention in models of adolescent smoking cessation. Therefore, the present investigation aimed to use ecological momentary assessment (EMA) to examine individual differences in social lapsing--the extent to which lapses occur around others versus when alone.

METHODS

Analyses focused on 179 adolescent smokers (aged 14-18 years) engaged in an unassisted quit attempt. There were 2 general EMA assessment intervals: prequit (1 week) and postquit (2 weeks). Participants reported every time that they smoked a cigarette and at random, nonsmoking times; in each assessment, participants responded to questions about their current environment, behaviors, and psychological state. A 3-month follow-up assessed longer-term smoking-related outcomes.

RESULTS

Consistent with other adolescent research, the overall rate of lapsing was very high (93%). Social lapsing rates were likewise high (among those who lapsed, 73% reported their first lapse was social), but they also varied continuously across individuals. We computed a social lapsing coefficient for each youth and found that it related to smoking factors at baseline (e.g., lower smoking intensity and dependence) and follow-up (e.g., lower cotinine levels).

CONCLUSIONS

These results suggest that higher rates of social lapsing are associated with being a lighter, less dependent smoker and having better eventual cessation prospects. Findings provide evidence that accounting for variability in social lapsing may improve theory and treatment.

Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

Smoking Trajectories Among Monoracial and Biracial Black Adolescents and Young Adults

INTRODUCTION

Cigarette smoking trajectories were assessed among monorace Blacks, Black-American Indians, Black-Asians, Black-Hispanics, and Black-Whites.

METHOD

We used a subsample of nationally representative data obtained from the National Longitudinal Study of Adolescent Health (Add Health). The sample consisted of adolescents who were in Grades 7 - 12 in 1994, and followed across four waves of data collection into adulthood. Wave 4 data were collected in 2007-2008 when most respondents were between 24 and 32 years old. Respondents could report more than one race/ethnicity. Poisson regression was used to analyze the data.

RESULTS

We found distinct smoking trajectories among monorace and biracial/ethnic Blacks, with all groups eventually equaling or surpassing trajectories of Whites. The age of cross-over varied by gender for some subgroups, with Black-American Indian males catching up earlier than Black-American Indian females. Black-White females smoked on more days than monorace Black females until age 26 and also smoked more than Black-White males between ages 11 and 29 years. Black-Hispanic males smoked on more days than Black-Hispanic females from ages 11 to 14. The results of the interaction tests also indicated different smoking trajectories across SES levels among White, Black, and Black-White respondents.

CONCLUSION

Significant heterogeneity was observed regarding smoking trajectories between monoracel and biracial/ethnic Blacks. Knowledge of cigarette smoking patterns among monorace and biracial/ethnic Black youth and young adults extends our understanding of the etiology of tobacco use and may inform interventions.

Nicotine addiction in light smoking African American mothers

Although African Americans (AA) smoke fewer average cigarettes per day (CPD) than European Americans (EA), they carry a disproportionate tobacco related morbidity and mortality burden.

OBJECTIVE

To evaluate ethnic differences in markers of nicotine addiction, including rates of lifetime nicotine dependence (ND) symptoms, current smoking and smoking during pregnancy across different levels of peak lifetime cigarette consumption.

METHODS

Data from 237 EA (N=118) and AA (N=119) mothers participating in the Missouri Family Study (2003-2005), an ethnically diverse family study of offspring outcomes in high and low risk families, were used to contrast prevalence of ND symptoms and other smoking behaviors between EA and AA women at low (1-10 CPD), moderate (11-19 CPD), and high (≥ 20 CPD) levels of lifetime peak daily cigarette consumption.

RESULTS

Compared with EA smokers, AAs had lower lifetime prevalence of DSM-IV ND (68% v. 54%, p<.05), consumed fewer CPD during their heaviest lifetime consumption (18% EA v. 58% AA smoked ≤ 10 CPD, p<.0001), but did not differ in overall rates of smoking during pregnancy or current smoking. However, stratifying by categories of peak lifetime daily cigarette use, AA mothers who smoked ≤ 10 CPD reported greater lifetime ND symptoms and current smoking than their EA counterparts. In addition, nearly two-thirds of AA mothers in this smoking category smoked during pregnancy and 30% smoked throughout an entire pregnancy. The respective prevalence estimates in EA mothers were 38% and 0%.

CONCLUSIONS

Stratifying the sample into categories of lifetime peak daily cigarette use revealed significant ethnic/racial differences in smoking prevalence during pregnancy that were obscured in overall analysis. Substantial public health risks warranting clinical attention exist among light smokers, particularly AA women.

Research priorities for Article 14--demand reduction measures concerning tobacco dependence and cessation

INTRODUCTION

Tobacco dependence treatment (TDT) interventions are often seen as expensive with little impact on the prevalence of tobacco use. However, activities that promote the cessation of tobacco use and support abstinence have an important role in any comprehensive tobacco control program and as such are recognized within Article 14 (A14) of the Framework Convention on Tobacco Control.

OBJECTIVES

To review current evidence for TDT and recommend research priorities that will contribute to more people being helped to stop tobacco use.

METHODS

We used the recommendations within the A14 guidelines to guide a review of current evidence and best practice for promotion of tobacco cessation and TDT, identify gaps, and propose research priorities.

RESULTS

We identified nine areas for future research (a) understanding current tobacco use and the effect of policy on behavior, (b) promoting cessation of tobacco use, (c) implementation of TDT guidelines, (d) increasing training capacity, (e) enhancing population-based TDT interventions, (f) treatment for different types of tobacco use, (g) supply of low-cost pharmaceutical devices/ products, (h) investigation use of nonpharmaceutical devices/ products, and (i) refinement of current TDTs. Specific research topics are suggested within each of these areas and recognize the differences needed between high- and low-/middle-income countries.

CONCLUSIONS

Research should be prioritized toward examining interventions that (a) promote cessation of tobacco use, (b) assist health care workers provide better help to smokers (e.g., through implementation of guidelines and training), (c) enhance population-based TDT interventions, and (d) assist people to cease the use of other tobacco products.