Associations of smoking prevalence with individual and area level social cohesion

Connected communities: Perceived neighborhood social cohesion during adolescence and subsequent health and well-being in young adulthood-An outcome-wide longitudinal approach

Does higher perceived neighborhood social cohesion in adolescence lead to better health and well-being 10-12 years later? We evaluated this question using data from a large, prospective, and nationally representative sample of US adolescents (Add Health; N = 10,963), and an outcome-wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological well-being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes. These results were maintained after robust control for a wide range of potential confounders.

Neighborhood Vigilance in Terms of Abstinence Expectancies for Smoking and Severity of Problems When Quitting

Background: Although social determinants of health (SDoH) have increasingly been understood as clinically important factors in the onset, maintenance, and relapse of substance use behavior, little research has evaluated neighborhood vigilance in terms of smoking. Objectives: The present investigation sought to evaluate the role of neighborhood vigilance in terms of smoking abstinence expectancies (i.e., perceived consequences of refraining from smoking, including negative mood, somatic symptoms, harmful consequences, and positive consequences) and severity of problems when trying to quit among adults who smoke. Results: Participants included 93 treatment-seeking people who smoke (45.2 years of age and 29% identified as female). Results: indicated that greater levels of neighborhood vigilance were associated with negative mood and harmful consequences abstinence expectancies. No effect was evident for somatic symptom abstinence expectancies after Bonferroni correction. Conclusions: As expected, neighborhood vigilance was not predictive of positive abstinence expectancies, offering explanatory specificity. Neighborhood vigilance was also associated with more severe problems when trying to quit smoking. The current findings suggest neighborhood vigilance represents an important contextual factor involved in certain negative beliefs about abstinence and challenges in quitting.

Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States

Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.

The association of neighborhood socioeconomic characteristics with cardiovascular health: A quasi-experimental study of refugees to Denmark

Neighborhood socioeconomic disadvantage is associated with cardiovascular health, although it is unclear which specific aspects of neighborhoods matter most. We leveraged a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998, creating variation in exposure to various aspects of neighborhood disadvantage. The cohort was followed through December 2018. Exposures included neighborhood-level family income, educational attainment, unemployment, and welfare transfers measured in the first neighborhood after arrival to Denmark. Outcomes included cardiovascular risk factors (hyperlipidemia, hypertension, diabetes and anxiety/depression) and cardiovascular disease (acute myocardial infarction and ischemic heart disease). Neighborhood-level income and education were most consistently associated with cardiovascular risk factors, whereas welfare transfers were most consistently associated with cardiovascular disease. Addressing these specific aspects of neighborhood disadvantage could therefore lower the risk of poor cardiovascular health among refugees. Future research is warranted to examine if results are generalizable to other immigrant groups, countries or time periods.

The Role of Perceived Neighborhood Cohesion in the Association between Depressive Symptoms and Cigarette Smoking

BACKGROUND

Greater depression has been linked to increased smoking rates. However, the mechanisms underlying this association are not fully understood. It is possible that high perceived neighborhood cohesion may serve as one such mechanism given its associations with decreased depression and smoking. Having increased levels of depression likely impacts one's perceptions of neighborhood cohesion, which could lead to further increases in depression and a need to manage these symptoms via cigarette smoking. As a first test of this theory, the current study examined the effect of neighborhood cohesion on the association between depressive symptoms and smoking frequency and quantity among past 30-day cigarette smokers.

METHODS

Participants were 201 combustible cigarette smokers (Mage = 48.33, SD = 11.64; 63.2% female; 68.2% White) who completed self-report measures as part of a larger study of environmental influences on cardiac health.

RESULTS

Greater depressive symptoms were associated with lower levels of perceived neighborhood cohesion, and there was a significant indirect effect of greater depressive symptoms on heavier smoking through decreased neighborhood cohesion (b = .07, SE = .04, 95% CI [.003, .15]). There was no significant indirect effect for daily smoking.

CONCLUSION

These results suggest that neighborhood cohesion is an important contextual factor that serves as one explanatory mechanism for the well-established relationship between depression and smoking quantity. Thus, there may be utility in implementing interventions focused on increasing neighborhood cohesion as a way to decrease smoking behavior.

Community social environments and cigarette smoking

Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.

Association between neighborhood social cohesion, awareness of chronic diseases, and participation in healthy behaviors in a community cohort

BACKGROUND

Neighborhood social cohesion (NSC) is the network of relationships as well as the shared values and norms of residents in a neighborhood. Higher NSC has been associated with improved cardiovascular health, largely among Whites but not African Americans. In a bi-racial cohort, we aimed to study the association between NSC and chronic disease awareness and engagement in healthy self-management behaviors, two potential mechanisms by which NSC could impact cardiovascular health outcomes.

METHODS

Using the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study (HANDLS), we cross-sectionally examined the association between NSC and awareness of three chronic conditions (diabetes, chronic kidney disease (CKD), and hypertension) and engagement in healthy self-management behaviors including physical activity, healthy eating, and cigarette avoidance.

RESULTS

Study participants (n = 2082) had a mean age of 56.5 years; 38.7% were White and 61.4% African American. Of the participants, 26% had diabetes, 70% had hypertension and 20.2% had CKD. Mean NSC was 3.3 (SD = 0.80) on a scale of 1 (lowest score) to 5 (highest score). There was no significant association between NSC and any chronic disease awareness, overall or by race. However, each higher point in mean NSC score was associated with less cigarette use and healthier eating scores, among Whites (adjusted odds ratio [aOR], 95% confidence interval [CI]: =0.76, 0.61-0.94; beta coefficient [βc]:, 95% CI: 1.75; 0.55-2.97, respectively) but not African Americans (aOR = 0.95, 0.79-1.13; βc: 0.46, - 0.48-1.39, respectively; Pinteraction = 0.08 and 0.06). Among both Whites and African Americans, higher NSC scores were associated with increases in self-reported physical activity (βc: 0.12; 0.08-0.16; Pinteraction = 0.40).

CONCLUSIONS

Community engagement and neighborhood social cohesion may be important targets for promotion of healthy behaviors and cardiovascular disease prevention. More research is needed to understand the different associations of NSC and healthy behaviors by race.

Individual and contextual variables associated with smoking and alcohol consumption during pregnancy

OBJECTIVE

to analyze the association between individual characteristics and housing context with smoking and alcohol consumption during pregnancy.

METHODS

a cross-sectional study with a probabilistic sample of 3,580 pregnant women who underwent prenatal care in the Unified Health System in 2019. The outcomes were firsthand, secondhand smoke and alcohol consumption during pregnancy. Individual characteristics and the living environment were used as exploratory variables.

RESULTS

living in a neighborhood with episodes of violence, without social cohesion and without urban elements that encourage physical activity was associated with smoking. Alcohol consumption during pregnancy was associated with living in environments that do not encourage physical activity. Smoking was also associated with lower income and education.

CONCLUSIONS

individual characteristics and the living environment are associated with smoking, secondhand smoke and alcohol consumption during pregnancy.

Associations of Social Cohesion and Socioeconomic Status with Health Behaviours among Middle-Aged and Older Chinese People

Background: An understanding of factors associated with health behaviours is critical for the design of appropriate health promotion programmes. Important influences of social cohesion, education, and income on people's health behaviours have been recognised in Western countries. However, little is known about these influences in the older Chinese population. Objective: To investigate associations of social cohesion and socioeconomic status (SES) with health behaviours among middle-aged and older adults in China. Methods: We used data from the World Health Organization's Study on Global AGEing and Adult Health. Logistic regression and multivariate linear regression were performed. Results: Participants who reported greater social cohesion were more likely to have adequate vegetable and fruit (VF) consumption, be socially active, and less likely to smoke daily, but were not physically more active; participants with lower education levels were less likely to have adequate VF consumption and be socially active, and more likely to smoke daily; higher incomes were associated with decreased odds of daily smoking, increased odds of adequate VF consumption, increased likelihood to be socially active, but also less likelihood to have sufficient physical activity (PA). Associations of social cohesion and SES with health behaviours (smoking, PA, and VF consumption) differed between men and women. Discussion: Our findings are an essential step toward a fuller understanding of the roles of social cohesion and SES in protecting healthy behaviours among older adults.

Social cohesion, depression, and substance use severity among young men: Cross-sectional and longitudinal analyses from a Swiss cohort

INTRODUCTION

Social cohesion, depression, and problematic substance use are intertwined and poorly understood.This study aimed to examine cross-sectional and longitudinal associations between social cohesion, depression and problematic substance use amongyoung men, age 21-25.

METHODS

We used 2nd wave (t₁, 2012-2014, N = 6020) and 3rd wave (t₂, 2016-2018) data from the on-going Swiss CohortStudy on Substance Use Risk Factors (C-SURF), assessing social cohesion, depression, and severity of alcohol, nicotine and cannabis use during both waves. Structural Equation Models (SEMs) were employed to examine pathways in both waves under the framework of longitudinal analysis.

RESULTS

Social cohesion was directly associated with depression and problem nicotine and cannabis use and indirectly associated with problem alcohol, nicotine and cannabis use through depression at both t1 and t2. Social cohesion exerted direct effects on nicotine use and cannabis use severity, but not on alcohol use severity. Social cohesion had indirect effects on problem use of all three substances, mediated via depression. The predictive direction was from depression to substance use, rather than vice versa.

CONCLUSIONS

Higher social cohesion at an early age appears to protect young males from depression and problematic substance use later in life. However, once problematic substance use is established, the direct effect of social cohesion diminishes and is mediated through personal depression. Therefore, promoting a more cohesiveneighborhood in childhood or adolescenthood could play an important role preventing depression and more severe substance use behaviors.

The effect of local unemployment on health: A longitudinal study of Irish mothers 2001-2011

The relationship between economic conditions and health is mixed, with some evidence from the most recent financial crisis finding a positive effect of periods of unemployment on heath behaviours. This study uses longitudinal data spanning the periods before, during and after the Irish crisis of 2007, to test the impact of economic expansion and contraction on mothers physical and mental health and health behaviours. Three waves of data from the Irish Lifeways Cohort Study for the period 2001-2011, and local area employment rates from the Irish Census, are used to capture the impact of a period of increased unemployment on health before, during and after the Irish recession, independent of individual employment status. The results from fixed effect linear probability models demonstrate that an additional unit of local area unemployment increases the probability of reporting poor self-rated health by 1-1.8 percentage points and of reporting poor mental well-being by 1.4 and 2.7 percentage points depending on the instrument used. There are decreases in the probability of consuming cigarettes by 3.3 percentage points, self-describing as a regular smoker by 2.9 percentage points and obesity by 0.9 percentage points. The probability of engaging in at least 20 minutes of strenuous or moderate exercise per week declines by 7.8 and 8.7 percentage points respectively, while the probability of engaging in at least 20 minutes of mild exercise rises by 10 percentage points. These results are largely consistent with the US literature, which is predominantly based on working men, thus demonstrating the universal impact of economic vulnerability on health.

Housing Conditions, Neighborhood Physical Environment, and Secondhand Smoke Exposure at Home: Evidence from Chinese Rural-to-Urban Migrant Workers

Over the past two decades, health-related issues among rural-to-urban migrant workers in China have been widely discussed and documented by public health scholars. However, little, if any, scholarly attention has been paid to migrant workers’ secondhand smoke (SHS) exposure at home. This study aims to explore the contours of SHS exposure at home and investigate the effects of inadequate housing conditions and poor neighborhood physical environments on such in-home exposure among Chinese migrant workers. A respondent-driven sampling method was employed to interview 1854 rural-to-urban migrant workers from the period June 2017 to June 2018 in Chengdu, China. The results indicate that Chinese migrant workers are at high risk of SHS exposure at home. Migrant workers who live in homes with inadequate conditions, such as substandard housing and crowdedness, are especially at high risk of SHS exposure at home. Moreover, poor neighborhood physical environments are significantly and positively associated with SHS exposure at home. These findings suggest that strategies that can help improve housing conditions and neighborhood physical environments should be developed and promoted to protect rural-to-urban migrant workers from SHS exposure at home.

Do comprehensive school reforms impact the health of early school leavers? Results of a comparative difference-in-difference design

In the current article, we examine whether and how reforms in tracking age affect educational inequalities in health among people between the ages of 25-75 years. Particular attention is paid to the health consequences for early school leavers. The study combines data from the European Social Survey (2002-2016) on 21 countries with country-cohort information on education policies. Moreover, a difference-in-difference design is used, which takes advantage of both the cross-national and cross-temporal variability in the implementation of comprehensive schooling reforms. The results reveal statistically significant, but very small effects of de-tracking policies on people's health. That is, comprehensive education leads to slight improvements in health among people who have attained upper secondary or tertiary education, but these improvements are achieved at the expense of the health of those with the lowest levels of education. Our study should encourage future research to further explore the institutional impact of educational systems on the health of individuals.

Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking

INTRODUCTION

Our objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States.

METHODS

We linked cigarette smoking data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan Area Risk Trends (SMART) data set to 7 social and physical environmental characteristics: county type (metropolitan designation), primary care physician density, income inequality, percentage of the population that was a racial/ethnic minority, violent crime rate, education, and percentage of county residents with low income and no health insurance, all obtained from several county data sets. Spatial regression and hierarchical logistic regression modeling were performed.

RESULTS

Results showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (high school graduate or less) (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties. Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type (based on population size of the of metropolitan area), primary care physician density, and percentage of county residents with low income and no health insurance. At an individual level, results showed that as the density (population) of primary care physicians increased in a county, the odds of being a current smoker decreased (OR, 0.980; P = .02).

CONCLUSION

We found a significant association between adult cigarette smoking and county social and physical environmental factors. These place-based factors, especially social environmental characteristics, may reveal tobacco-related disparities to be considered when developing strategies to reduce tobacco use.

Trends in the incidence and mortality of transitional cell carcinoma of the bladder for the last four decades in the USA: a SEER-based analysis

BACKGROUND

Transitional cell carcinoma (TCC) accounts for around 95% of bladder cancers and is the 4th most common cancer among men and the tenth most common in women, in the US. There is a constant need to clarify current TCC incidence and mortality rates among different population groups for better clinical practice guidelines. We aimed to describe the TCC incidence and incidence-based mortality by demographic and tumor-related characteristics over the last 40 years in the US.

METHODS

We obtained data from the SEER 18 registries to study TCC cases that were diagnosed between the years 1973 and 2014. We calculated incidence rates and incidence-based mortality rates in different demographic and tumor-related characteristics and expressed rates by 100,000 person-years. We then calculated the annual changes in incidence and incidence-based mortality rates and displayed them as annual percent changes (APCs).

RESULTS

There were 182,114 patients with TCC between 1973 and 2014 in the United States. Overall incidence rates of TCC increased 0.16% (95% CI, 0.02-0.30, p = .02) per year over the study period. However, the incidence declined significantly since 2007; (95%CI,-1.89- -0.77, p < .001), except among the elderly and African Americans, which increased significantly over the study period. Overall TCC mortality rates did not change over the study period. However, since 2000 it started to decrease significantly.

CONCLUSION

TCC incidence and incidence-based mortality rates had been showing significant increases over the previous decades. However, significant declines in both incidence and incidence-based mortality rates have been observed over the recent years, except in some patients with certain racial groups. Improved understanding of the etiological and ecological factors of TCC could lead to further declines in incidence and incidence-based mortality rates.

Does Resilience Moderate the Relationship Between Stress and Smoking Status?

BACKGROUND

There is a growing evidence that resilience to stress can promote nonsmoking. However, few studies have undertaken quantitative research to investigate whether resilience, generated by internal and external factors, moderates the impact of stress on the likelihood of smoking.

OBJECTIVE

This study aims to help fill this knowledge gap in relation to smokers and ex-smokers, and those people who have never smoked.

METHODS

A large online cross-sectional survey was administered in Australia (2015-2016) to collect data on demographic variables, levels of internal and external resilience, and stress from current and past smokers (n = 400) and those who have never-smoked (n = 921). Logistic regressions were employed to test our hypotheses.

RESULTS

Most participants were female (82%) and ranged between 18 and 77 years. Higher levels of reported perceived stress and stress-related variables did significantly predict smoking. The combined impact of internal and external resilience factors predicted never-smoking and lessened the relationship between perceived stress and stress-related variables, and the likelihood of smoking.

CONCLUSION

These results are important because they suggest that the social environment should be developed to augment social support and internal properties such as developing "a strong sense of purpose in life" to encourage people not to commence smoking, rather than focus on smoking cessation.

A social-contextual investigation of smoking among rural women: multi-level factors associated with smoking status and considerations for cessation

INTRODUCTION

The social-contextual model of tobacco control and the potential mechanisms of the maintenance or cessation of smoking behavior among disadvantaged women, including rural residents, have yet to be comprehensively studied. The purpose of this study was to determine the association between selected individual, interpersonal, workplace, and neighborhood characteristics and smoking status among women in Appalachia, a US region whose residents experience a disproportionate prevalence of tobacco-related health disparities. These findings may assist in efforts to design and test scientifically valid tobacco control interventions for this and other disadvantaged populations.

METHODS

Women, 18 years of age and older, residing in three rural Ohio Appalachian counties, were recruited using a two-phase address-based sampling methodology for a cross-sectional interview-administered survey between August 2012 and October 2013 (N=408). Multinomial logistic regression was employed to determine associations between select multilevel factors (independent variables) and smoking status (dependent variable). The sample included 82 (20.1%) current smokers, 92 (22.5%) former smokers, and 234 (57.4%) women reporting never smoking (mean age 51.7 years).

RESULTS

In the final multivariable multinomial logistic regression model, controlling for all other significant associations, constructs at multiple social-contextual levels were associated with current versus either former or never smoking. At the individual level, for every additional year in age, the odds of being a former or never smoker increased by 7% and 6% (odds ratio (OR) (95% confidence interval(CI)): 1.07 (1.0-1.11) and 1.06 (1.02-1.09)), respectively, as compared to the odds of being a current smoker. With regard to depression, for each one unit increase in the Center for Epidemiologic Studies Depression Scale score, the odds of being a former or never smoker were 5% and 7% lower (OR(95%CI): 0.95(0.91-0.999) and 0.93(0.88-0.98)), respectively. Five interpersonal factors were associated with smoking status. As the social influence injunctive norm score increased by one unit, indicating perception of smoking to be more acceptable, the odds of being a former or never smoker decreased by 23% and 30%, respectively. For every one unit increase in the social participation score, indicating past-year engagement in one additional activity type, the odds of being a former or never smoker increased by 17% and 36%, respectively. For every 10% increase in the percentage of social ties in the participant's advice network who smoked, the odds of being a former or never smoker were 24% and 28% less, respectively. For every 0.1 unit increase in the E/I index, indicating increasing homophily on smoking in one's social network, the odds of being a former or never smoker were 20% and 24% less, respectively, in the time network, and 18% and 20% less, respectively, in the advice network. At the neighborhood level, for every one unit increase in neighborhood cohesion score, indicating increasing cohesion, the odds of being a former smoker or never smoker were 12% and 14% less, respectively.

CONCLUSIONS

These findings indicate that a social-contextual approach to tobacco control may be useful for narrowing a widening trajectory of smoking disparity for rural women. Interpersonal context, in particular, must be considered in the development of culturally targeted cessation interventions for Ohio Appalachian women.

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.

Associations of the Neighborhood Environment With Substance Use: A Cross-sectional Investigation Among Patients in Compulsory Drug Detention Centers in Thailand

Objectives

To identify the associations of characteristics of the neighborhood environment with substance abuse among clients receiving treatment for drug abuse in Thailand.

Methods

A cross-sectional study was conducted of 1128 drug addicts from 28 neighborhoods who were receiving treatment at all 7 compulsory drug detention centers in Thailand. A trained interviewer conducted structured interviews with the subjects about substance use and the perceived neighborhood environment in their community. A multilevel logistic regression model was applied to estimate the effects of the neighborhood environment on substance use.

Results

The majority of participants, 53.8% only used methamphetamine pills, 31.3% used other illicit drugs as well as methamphetamine pills, and 14.9% used an illicit drug other than methamphetamine. Three neighborhood characteristics were associated with substance use. A 1-unit increase in the perceived neighborhood cohesion score was associated with a 15% reduction in methamphetamine pill use and an 11% reduction of the use of both methamphetamine pills and another illicit drug. Conversely, a 1-unit increase in perceived neighborhood crime predicted 19 and 14% increases in the use of methamphetamine pills and the use of both methamphetamine pills and another illicit drug, respectively. In addition, a 1-unit increase in the scores for stigma surrounding addiction corresponded to a 25% increase of the use of methamphetamine pills and a 12% increase in the use of both methamphetamine pills and another illicit drug.

Conclusions

Substance use among drug addicts was influenced by characteristics of the neighborhood environment. Therefore, prevention and intervention strategies should be designed based on a consideration of the impact of neighborhood context on substance use behaviors.

Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis

Introduction. Lyme borreliosis is a multisystem tick-borne disease caused by Borrelia burgdorferi. Neurological manifestations are reported in up to 15 % of adult patients with Lyme disease, while the frequency among children is higher. The most common manifestations are painful radiculopathy, facial nerve paresis and lymphocytic meningitis. Epileptic seizures and cerebral vasculitis with stroke or aneurysms are very rare complications.

Case presentation. We describe a paediatric patient with sensorineural auditory dysfunction, headache, fatigue and epileptic seizures as sequelae of meningoencephalitis/Lyme neuroborreliosis (LNB) caused by B. burgdorferi. Brain magnetic resonance imaging revealed widespread enhancement of the leptomeninges, cranial nerves and artery walls compatible with vasculitis and disturbances in cerebrospinal fluid (CSF) circulation. The patient was treated with ceftriaxone for 2 weeks. Two years later, the patient had an ischemic stroke. Brain magnetic resonance angiography revealed multiple aneurysms, which were not present previously. The largest aneurysm was operated rapidly. The patient was treated with another course of intravenous ceftriaxone for 4 weeks and pulse therapy with corticosteroids. He recovered well.

A community based intervention program to enhance neighborhood cohesion: The Learning Families Project in Hong Kong

BACKGROUND

Neighborhood cohesion, which refers to the extent of the connectedness and solidarity among residents in a community or neighborhood, is an important determinant of human health. To enhance neighborhood cohesion, the "Learning Families Project" was developed with a series of intervention programs in Kwun Tong in Hong Kong, a district with low neighborhood cohesion. This project, based on the social ecological model, provided a platform for neighbors to learn, communicate and interact with each other.

METHODS

This quasi-experimental study included two nearby government subsidized low rent housing estates separated by busy main roads. One served as the intervention (Tsui Ping (South) Estate) and one as the control (Shun Tin Estate) estate. The intervention included promotion, resident training and learning programs, embodied by a series of community activities such as talks, day camp, thematic activities and horticulture class. Baseline (before the programs) and follow-up (one year after the programs) surveys were conducted both in the intervention and control estate to assess the impact of the programs on neighborhood cohesion.

RESULTS

The number of residents who completed both the baseline and follow-up surveys was 502 in the intervention estate and 476 in the control estate. Neighborhood cohesion significantly improved in the intervention group after the programs (Cohen effect size d: 0.15). Compared with the control group, the improvements in closeness of the neighborhood and trust in neighbors were significantly greater in the intervention group (Cohen effect size d: 0.13 and 0.14, respectively).

CONCLUSION

This brief intervention program using a quasi-experimental study design increased neighborhood cohesion in a low rent housing estate.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02851667.

Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study

BACKGROUND

Few studies have focused on the impact of neighborhood social environment on changes in smoking and alcohol use over time among African Americans.

METHOD

Jackson Heart Study participants were recruited from the Jackson, MS metropolitan area from 2000 to 2004. Neighborhood social environment was characterized using census-based neighborhood socio-economic status (NSES) and survey-derived perceptions of neighborhood social cohesion, disorder, and violence. Multinomial logistic regression was used to estimate the associations of neighborhood social environment with prevalence of smoking and alcohol use and with changes in these behaviors over time adjusted for individual sociodemographic characteristics.

RESULTS

Participants (N=3166) resided in 108 census tracts. All neighborhood social environment variables were consistently associated with prevalence of current smoking at baseline (11%) and with persistence of smoking over a median of 8-years follow-up (8%). The odds of being a consistent smoker relative to never smoking was about 30% higher per 1SD higher neighborhood violence (aOR: 1.30, 95% CI: 1.16-1.46) and disorder (aOR: 1.26, 95% CI: 1.08 - 1.47) and at least 16% lower per 1SD higher in neighborhood social cohesion (aOR: 0.84, 95% CI: 0.74-0.95) and NSES (aOR: 0.79, 95% CI: 0.67-0.95). Heavy alcohol use at baseline (17%) and consistent heavy use over the study period (8%) were negatively associated with higher NSES (aOR: 0.85, 95% CI: 0.73-0.99 per 1SD increase in NSES).

CONCLUSION

Favorable neighborhood social environments may reduce unhealthy behaviors among African Americans.

Multilevel analysis of school anti-smoking education and current cigarette use among South African students

INTRODUCTION

South Africa (SA) implemented the Global Youth Tobacco Survey (GYTS) four times between 1999 and 2011. Data from the four surveys indicated that downward trends in cigarette use among students may have stalled. Understanding the effect of school anti-smoking education on current smoking among students within schools and variability across schools may provide important insights into policies aimed at preventing or reducing tobacco use among students. The objective was to assess the student- and school-level effects of students' exposure to school anti-smoking education on current cigarette use among the study population using the most recent wave of GYTS data in SA (2011).

METHODS

An analytic sample of students 13-15 years of age was selected (n=3,068) from the SA GYTS 2011. A taxonomy of two-level logistic regression models was fit to assess the relationship of various tobacco use, control, and exposure predictor variables on current cigarette smoking among the study population.

RESULTS

At the student-level in the full model, secondhand smoke (SHS) exposure, peer smoking, and ownership of a promotional item were significantly associated with higher risk of current smoking. At the school-level in the full model, average exposure to peer smoking was associated with significant increases in the prevalence of current cigarette use, while average family anti-smoking education was significantly associated with decreases in the outcome variable. School anti-smoking education was not a statistically significant predictor at the student- or school-levels.

CONCLUSION

in this study, exposure to school anti-smoking education had no association with current cigarette smoking among the study population. Consistent with previous studies, having peers that smoked was highly associated with a student being a current smoker. Interestingly, at the school-level in the multilevel analysis, schools with higher rates of average family anti-smoking education had lower prevalence of current smoking. This finding has potential implications for tobacco control in SA, particularly if the school-level, family-centered protective effect can be operationalized as a prevention tool in the country's tobacco control program.

Neighborhood social and physical environments and type 2 diabetes mellitus in African Americans: The Jackson Heart Study

Using data from Jackson Heart Study, we investigated the associations of neighborhood social and physical environments with prevalence and incidence of type 2 diabetes mellitus (T2DM) in African Americans (AA). Among non-diabetic participants at baseline (n=3670), 521 (14.2%) developed T2DM during a median follow-up of 7.3 years. Measures of neighborhood social environments, and food and physical activity resources were derived using survey-and GIS-based methods. Prevalence ratios (PR) and Hazard ratios (HR) were estimated using generalized estimating equations and Cox proportional hazards models. Higher neighborhood social cohesion was associated with a 22% lower incidence of T2DM while higher density of unfavorable food stores was associated with a 34% higher incidence of T2DM after adjusting for individual-level risk factors (HR=0.78 [95% CI:0.62, 0.99] and HR=1.34 [1.12, 1.60], respectively). In addition, neighborhood problems was also associated with prevalence of T2DM (PR=1.12 [1.03, 1.21]) independent of individual-level risk factors. Our findings suggest that efforts to strengthen community ties or to attract healthy food retail outlets might be important strategies to consider for prevention of T2DM in AA.

Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis

BACKGROUND

Social features of neighbourhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighbourhood social environment (NSE) with smoking, and the association of specific neighbourhood social factors with change in smoking behaviour over time, has rarely been examined.

METHODS

This study included 5856 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis (2000-2012, average follow-up: 7.8 years). Outcomes included current smoking status and smoking intensity (average number of cigarettes smoked per day among baseline smokers). NSE was assessed as a composite score composed of aesthetic quality, safety and social cohesion scales (derived from neighbourhood surveys). Generalised linear mixed models evaluated the association of baseline NSE (composite score and individual scales) with current smoking (modified Poisson models) and smoking intensity (negative binomial models) cross-sectionally and longitudinally.

RESULTS

Each SD increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR) 0.87 (95% CI 0.78 to 0.98). Neighbourhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR 0.87 (0.78 to 0.97) and aPR 0.87 (0.77 to 0.99), respectively) but the association with social cohesion was weaker or null. No significant associations were observed for smoking intensity among baseline smokers. Baseline NSE was not associated with changes in smoking risk or intensity over time.

CONCLUSIONS

Results suggest that neighbourhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time.

Risky substance use and peer pressure in Swiss young men: Test of moderation effects

BACKGROUND

Peer pressure (PP) toward misconduct is a well-known risk factor for substance use. However, the way it interacts with social factors and the associations of the aspects of PP other than PP toward misconduct have been understudied. This study examined the associations of three aspects of PP with risky substance use and tested whether the associations of PP toward misconduct were moderated by social factors.

METHOD

A representative sample of 5,680 young Swiss males completed a questionnaire assessing risky alcohol, cigarette, and cannabis use, PP toward misconduct, toward peer involvement, and toward peer conformity, as well as social support (SS) and neighbourhood cohesion. Multinomial logistic regression models were used.

RESULTS

PP toward misconduct was positively associated with all substance use outcomes. The PP toward misconduct-risky alcohol use association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement, SS, and neighbourhood cohesion. The PP toward misconduct-risky cannabis use association was stronger in individuals reporting high than in those reporting low levels of SS and neighbourhood cohesion. The PP toward misconduct-smoking association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement.

CONCLUSIONS

The risk for substance use associated with PP toward misconduct varies as a function of social factors. Being well connected with others (high level of PP toward peer involvement and SS), and living in a cohesive neighbourhood may amplify the risk for risky substance use associated with PP toward misconduct.

Community Development Model for Public Health Applications: Overview of a Model to Eliminate Population Disparities

For well over two decades, the public health community has undertaken a broad range of initiatives to identify and eliminate various health-related disparities among populations. The Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health (OSH), for example, has committed resources to help states eliminate population disparities related to tobacco use. These initiatives have enjoyed a degree of success and some measurable decreases in population disparities. However, traditional public health approaches that are overly influenced by reductionist paradigms more content with risk factor assessment of at-risk strata may not be sufficient to produce successful results when applied to more intractable disparities. The elimination of disparities will require a more encompassing and comprehensive approach that addresses both population strata at risk and the communities in which they reside. This article proposes a new, concentrated model to address the elimination of population disparities—a model that focuses on community as the critical unit of analysis and action to achieve success.

Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics

PURPOSE

This study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage.

METHODS

This cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models.

RESULTS

Smoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect.

CONCLUSIONS

Some neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.

Social cohesion and the smoking behaviors of adults living with children

INTRODUCTION

The smoking behavior of adults can negatively impact children through exposure to environmental tobacco smoke and by modeling this unhealthy behavior. Little research has examined the role of the social environment in smoking behaviors of adults living with children. The present study specifically analyzed the relationship between social cohesion and smoking behaviors of adults living with children.

METHODS

Data from the 2009 California Health Interview Survey, a random-digit dial cross-sectional survey of California Adults, were used. Adults living with children reported their levels of social cohesion and smoking behaviors (N=13,978). Logistic regression models were used to predict odds of being a current smoker or living in a household in which smoking was allowed, from social cohesion.

RESULTS

Overall, 13% of the sample was current smokers and 3.74% lived in households in which smoking was allowed. Logistic regression models showed that each one-unit increase in social cohesion is associated with reduced odds of being a current smoker (AOR=0.92; 95% CI=0.85-0.99) and reduced odds of living in a household in which smoking is allowed (AOR=0.84; 95% CI=0.75-0.93), after controlling for sociodemographic characteristics.

CONCLUSIONS

Among adults living with children, higher social cohesion is associated with a lower likelihood of both being and smoker and living in a home where smoking is allowed. Thus, future research is needed to better understand mechanisms that explain the relationship between social cohesion and smoking-related behavior in order to prevent smoking-related health consequences and smoking initiation among children and adults.

The impact of neighbourhood violence and social cohesion on smoking behaviours among a cohort of smokers in Mexico

BACKGROUND

Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighbourhood-level violence and smoking behaviours in a cohort of Mexican smokers from 2011 to 2012, and whether neighbourhood-level social cohesion modified these relationships.

METHODS

Data were analysed from adult smokers and recent ex-smokers who participated in waves 5 and 6 of the International Tobacco Control Mexico survey. Self-reported neighbourhood violence and social cohesion were asked of wave 6 survey participants (n=2129 current and former smokers, n=150 neighbourhoods). Neighbourhood-level averages for violence and social cohesion (ranges 4-14 and 10-25, respectively) were assigned to individuals. We used generalised estimating equations to determine associations between neighbourhood indicators and individual-level smoking intensity, quit behaviours and relapse.

RESULTS

Higher neighbourhood violence was associated with higher smoking intensity (risk ratio (RR)=1.17, 95% CI 1.02 to 1.33), and fewer quit attempts (RR=0.72, 95% CI 0.61 to 0.85). Neighbourhood violence was not associated with successful quitting or relapse. Higher neighbourhood social cohesion was associated with more quit attempts and more successful quitting. Neighbourhood social cohesion modified the association between neighbourhood violence and smoking intensity: in neighbourhoods with higher social cohesion, as violence increased, smoking intensity decreased and in neighbourhoods with lower social cohesion, as violence increased, so did smoking intensity.

CONCLUSIONS

In the context of recent increased violence in Mexico, smokers living in neighbourhoods with more violence may smoke more cigarettes per day and make fewer quit attempts than their counterparts in less violent neighbourhoods. Neighbourhood social cohesion may buffer the impact of violence on smoking intensity.

The influence of perceived neighborhood disorder on smoking cessation among urban safety net hospital patients

BACKGROUND

Although research has shown that objective neighborhood characteristics are associated with health behaviors including smoking, little is known about the influence of perceived neighborhood characteristics on a smoking cessation attempt.

METHODS

Participants (N=139) enrolled in a Dallas safety-net hospital smoking cessation program were followed from 1 week pre-quit through 4 weeks post-quit. Logistic regression analyses were conducted to evaluate the impact of perceived neighborhood order and disorder on the likelihood of achieving biochemically verified point prevalence and continuous smoking abstinence 4 weeks following a scheduled quit attempt. Analyses were adjusted for demographic characteristics, cigarettes per day, intervention group, and pharmacological treatment.

RESULTS

Participants were primarily non-White (72.7%) and female (56.8%) with a mean age of 52.5 (SD=3.7) years. Most reported an annual household income of ≤$25,000 (86.3%). Logistic regression analyses indicated that greater neighborhood physical (p=.048) and social order (p=.039) were associated with a greater likelihood of achieving point prevalence smoking abstinence at 4 weeks post-quit. Greater perceived physical (p=.035) and social disorder (p=.039) and total neighborhood disorder (p=.014), were associated with a reduced likelihood of achieving point prevalence abstinence. Social disorder (p=.040) was associated with a reduced likelihood of achieving continuous abstinence at 4 weeks post-quit, while social order (p=.020) was associated with an increased likelihood of continuous abstinence.

CONCLUSIONS

Perceptions of neighborhood order and disorder were associated with the likelihood of smoking cessation among socioeconomically disadvantaged smokers making a quit attempt. Findings highlight the need to address perceptions of the neighborhood environment among disadvantaged smokers seeking treatment.

The different effects of neighbourhood and individual social capital on health-compromising behaviours in women during pregnancy: a multi-level analysis

Background

This study assessed clustering of three health-compromising behaviours and explored the association of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of pregnancy (follow-up).

Methods

A longitudinal study was conducted on a representative sample of women recruited in antenatal care units grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status), individual social capital (social support and social networks) and socio-demographic variables were collected at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering was assessed using an observed to expected ratio method. The association of contextual and individual social capital with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models.

Results

Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely associated with low levels of individual social capital. Low individual social capital predicted smoking during whole pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood social capital.

Conclusions

Three health-compromising behaviours are relatively common and cluster in Brazilian women throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social resources should be considered when planning the interventions.

US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings

OBJECTIVES

To examine prospectively the association between US state income inequality and incidence of heart attack.

METHODS

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates.

RESULTS

In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline.

CONCLUSIONS

This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

PURPOSE

The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms.

METHODS

Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee.

RESULTS

Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

A cross-sectional study of geographic differences in health risk factors among young Australian adults: the role of socioeconomic position

Background

It remains unclear why living outside of an urban environment affects aspects of health, particularly whether these differences can be explained by other factors such as socioeconomic position (SEP). The aim of this study was to compare health risk factors between metropolitan and non-metropolitan young Australian adults and examine whether socioeconomic position (SEP) mediates any differences.

Methods

Cross-sectional data came from an Australia-wide sample of 26–36 year-olds (n = 2567). Information on demographic characteristics, smoking, alcohol consumption, diet, physical activity (PA, mins/week) and mental health were collected by questionnaire, BMI from measured height and weight and daily steps using pedometers. Metropolitan versus non-metropolitan residence was classified from addresses. SEP included individual-level (education, occupation) and area-level measures. Prevalence ratios and ratio of means were calculated using log binomial, log multinomial and linear regression techniques.

Results

Non-metropolitan residents were less likely to meet 2 or more dietary guidelines, reported less leisure-time PA and active commuting but more occupational and domestic PA than metropolitan residents. Non-metropolitan women were more likely to smoke and be obese. No differences in mental health were found. After adjusting for SEP, differences remained significant except for leisure-time PA (men and women) and smoking (women).

Conclusions

Living outside metropolitan areas was associated with more risk factors in these young adults. Individual SEP and area-level disadvantage generally did not explain these differences, suggesting that a focus on geographic location as its own social determinant of health, beyond SEP, is warranted.

The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods

The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.

Satisfaction with physical and social surroundings and the habit of smoking cigarettes in the metropolitan area of Belo Horizonte, Brazil

The objective of this study was to examine the association between individual satisfaction with social and physical surroundings and the habit of smoking cigarettes. Data from the Health Survey of Adults from the metropolitan area of Belo Horizonte, Minas Gerais, Brazil, were used. Based on a probability sample, participants (n = 12,299) were selected among residents aged 20 years old or more. The response variable was the smoking habit and the explanatory variable of interest was the neighborhood perception. Potential confounding variables included demographic characteristics, health behaviors and other indicators of socioeconomic position. The prevalence of current smokers, former smokers and never smokers were 20.8, 14.1 and 65.1%, respectively; 74.4 and 25.5% of the participants were categorized as being more satisfied and less satisfied with the neighborhood, respectively. Compared to those who never smoked, former smokers (adjusted odds ratio = 1.40, 95% confidence interval 1.20 - 1.62) and current smokers (adjusted odds ratio = 1.17, 95% confidence interval 1.03 - 1.34) were less satisfied with the neighborhood compared to those who never smoked. The results of this study indicate there is an independent association between the smoking habit and a less satisfying neighborhood perception in the metropolitan region of Belo Horizonte, which does not depend on individual characteristics, traditionally reported as being associated with smoking.

The relation between social cohesion and smoking cessation among Black smokers, and the potential role of psychosocial mediators

BACKGROUND

Social cohesion, the self-reported trust and connectedness between neighbors, may affect health behaviors via psychosocial mechanisms.

PURPOSE

Relations between individual perceptions of social cohesion and smoking cessation were examined among 397 Black treatment-seeking smokers.

METHODS

Continuation ratio logit models examined the relation of social cohesion and biochemically verified continuous smoking abstinence through 6 months post-quit. Indirect effects were examined in single mediator models using a nonparametric bootstrapping procedure. All analyses controlled for sociodemographics, tobacco dependence, and treatment.

RESULTS

The total effect of social cohesion on continuous abstinence was non-significant (β = 0.05, p = 0.10). However, social cohesion was associated with social support, positive affect, negative affect, and stress, which, in turn, were each associated with abstinence in adjusted models (ps < 0.05).

CONCLUSIONS

Results suggest that social cohesion may facilitate smoking cessation among Black smokers through desirable effects on psychosocial mechanisms that can result from living in a community with strong interpersonal connections.

The effects of social structure and social capital on changes in smoking status from 8th to 9th grade: results of the Child and Adolescent Behaviors in Long-term Evolution (CABLE) study

OBJECTIVE

Social structure and social capital are important variables for public health strategies seeking to prevent smoking among adolescents. The purpose of this study was to examine the relationships between social structure, social capital and changes in smoking status from the 8th to 9th grade in Taiwan.

METHODS

Data were obtained from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project. The study analyzed a final sample of 1937 students (50.7% female).

RESULTS

Each layer of social structure was associated with a particular form of social capital. Students whose parents were married and living together had higher family social capital. After controlling for background variables, the social structure variable of friends who smoke was significantly associated with changes in smoking status. Students reporting more school attachment were less likely to start smoking. Students with higher parental supervision was associated with less chance of being a consistent smoker, whereas participation of social organization outside of school was associated with continued smoking. Attending school club was associated with higher probability of smoking cessation.

CONCLUSION

Smoking prevention and intervention strategies aimed at junior high school students should be tailored to the particular form of social capital important for each type of smoking status.

Cigarette smoking prevalence in US counties: 1996-2012

BACKGROUND

Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action.

METHODS

We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011.

RESULTS

Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile.

CONCLUSIONS

County-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.

Validation of French and German versions of a Perceived Neighborhood Social Cohesion Questionnaire among young Swiss males, and its relationship with substance use

This study main purpose was the validation of both French and German versions of a Perceived Neighborhood Social Cohesion Questionnaire. The sample group comprised 5065 Swiss men from the “Cohort Study on Substance Use Risk Factors.” Multigroup Confirmatory factor analysis showed that a three-factor model fits the data well, which substantiates the generalizability of Perceived Neighborhood Social Cohesion Questionnaire factor structure, regardless of the language. The Perceived Neighborhood Social Cohesion Questionnaire demonstrated excellent homogeneity ( α = 95) and split-half reliability ( r = .96). The Perceived Neighborhood Social Cohesion Questionnaire was sensitive to community size and participants’ financial situation, confirming that it also measures real social conditions. Finally, weak but frequent correlations between Perceived Neighborhood Social Cohesion Questionnaire and alcohol, cigarette, and cannabis dependence were measured.

Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors

This study uses the 2008 economic crisis in Iceland to identify the effects of a macroeconomic downturn on a range of health behaviors. We use longitudinal survey data that include pre- and post-reports from the same individuals on a range of health-compromising and health-promoting behaviors. We find that the crisis led to large and significant reductions in health-compromising behaviors (such as smoking, drinking alcohol or soft drinks, and eating sweets) and certain health-promoting behaviors (consumption of fruits and vegetables), but to increases in other health-promoting behaviors (consumption of fish oil and recommended sleep). The magnitudes of effects for smoking are somewhat larger than what has been found in past research in other contexts, while those for alcohol, fruits, and vegetables are in line with estimates from other studies. Changes in work hours, real income, financial assets, mortgage debt, and mental health, together, explain the effects of the crisis on some behaviors (such as consumption of sweets and fast food), while the effects of the crisis on most other behaviors appear to have operated largely through price increases.

Objective and perceived neighborhood characteristics and tobacco use among young adults

BACKGROUND

In the US, past month tobacco use is higher among young adults aged 18-25 years than among any other age group. Neighborhood disorder may be a malleable environmental determinant of tobacco use among young adults; its correlation with tobacco use is understudied. The purpose of this study is to examine whether perceived and objectively measured neighborhood factors are associated with tobacco use among young adults in Baltimore City.

METHODS

This cross-sectional study of predominately African American young adults (n=359) used logistic regression models via generalized estimating equations (GEE) to estimate the association of perceived and objective neighborhood disorder with past month tobacco use, adjusting for race, age, sex, income, and other substance use. Two measures of perceived neighborhood environment - neighborhood drug involvement, and neighborhood social cohesion - were derived from the Neighborhood Environment Scale (NES). Objective neighborhood disorder was measured via trained field raters using the Neighborhood Inventory for Environmental Typology (NIfETy) instrument.

RESULTS

Sex modified the relationship between perceived neighborhood drug involvement and past month tobacco use, and the association was significant among women only (aOR=1.49; 95% CI=1.19-1.88). Perceptions of neighborhood social cohesion (aOR=0.97; 95% CI=0.83-1.13), and objective neighborhood disorder (aOR=1.17; 95% CI=0.98-1.38) were not significantly associated with past month tobacco use.

CONCLUSION

Understanding the correlation between perceived and objective neighborhood disorder, and their independent association with tobacco use can potentially lead to environmentally based interventions aimed at reducing tobacco use among young adults who live in urban environments.

Social cohesion and self-rated health: The moderating effect of neighborhood physical disorder

Using data from the Los Angeles Family and Neighborhood Survey and its companion datasets, we examined how neighborhood disorder, perceived danger and both individually perceived and contextually measured neighborhood social cohesion are associated with self-rated health. Results indicate that neighborhood disorder is negatively associated with health and the relationship is explained by perceived cohesion and danger, which are both also significant predictors of health. Further, individually perceived cohesion emerges as a more important explanation of self-rated health than neighborhood-level social cohesion. Finally, neighborhood disorder and perceived cohesion interact to influence health, such that cohesion is especially beneficial when residents live in neighborhoods characterized by low to moderate disorder; once disorder is at high levels, cohesion no longer offers protection against poor health. We interpret our findings as they relate to prior research on neighborhoods, psychosocial processes, and health, and discuss their implications for intervention efforts that address disorder in urban communities.

Developing Behavioral Theory With the Systematic Integration of Community Social Capital Concepts

Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory. Fifty-three studies tested associations between community social capital concepts and physical activity (38 studies), smoking (19 studies), and diet (2 studies). Trustworthiness of community members was consistently associated with more health-promoting and less disease-promoting behaviors in 19 studies. Neighborly reciprocity showed mixed results in 10 studies. Reporting a good sense of community was associated with more physical activity in only 5 of 16 studies. Neighborhood collective efficacy, which includes social cohesion and informal social control, was inconsistently associated with behaviors in 22 studies. Behavioral social norms were associated with smoking and physical activity in 2 of 6 studies, and neighborhood modeling of physical activity was associated with increased activity in 12 of 17 studies, with 1 opposing result. This review identifies several community social capital-related concepts that are, at times, associated with both health-promoting and disease-promoting behaviors and often have no associations. Theory explains these findings by describing the relationships and interactions among these concepts. Using these findings, this article proposes a conceptual framework that integrates community social capital concepts into existing behavioral theory. Iterative empirically based theory development is needed to address these concepts, which affect behaviors. These results can also inform theoretically based community-based and socially tailored interventions.

The intergenerational transmission of smoking in adulthood: a 25-year study of maternal and offspring maladaptive attributes

While smoking is a major cause of mortality and morbidity, and maternal smoking is a risk factor for smoking among their offspring, the mechanisms involved in the intergenerational transmission of smoking are not well understood. This study examines the pathways from maternal and adolescent child factors, and the parent-child relationship, to smoking among the adult offspring, approximately 25 years later. Data for the present analysis were based on time waves 2 (T2; 1983) and 7 (T7; 2007-2009) of an on-going study of a community sample of mothers and their children. Offspring and mother X¯ ages were 14.1 and 40.0 years, respectively, at T2, and 36.6 and 65.0 years, respectively, at T7. At T2, trained interviewers administered individual structured interviews. Psychosocial questionnaires were self-administered at T7. Structural equation modeling (SEM) was used to analyze the interrelationships among maternal and offspring attributes (T2 and T7). SEM results indicated a satisfactory model fit (RMSEA=0.052; CFI=0.91; SRMR=0.057), and confirmed hypothesized pathways. One pathway linked maternal maladaptive attributes (T2) to the mother-adolescent child attachment relationship (T2), which was associated with the offspring's maladaptive attributes over time (T2 to T7), which then predicted the adult offspring's smoking (T7). Other pathways highlighted the stability of maternal smoking, the continuity of maladaptive attributes, and less offspring educational attainment as predictors of offspring smoking at T7. Findings suggest the importance of early interventions to treat maternal smoking, maternal and offspring maladaptive attributes, and the mother-child relationship in order to reduce risk factors for the intergenerational transmission of smoking behavior. Interventions which enhance educational success should also prove effective in reducing smoking.

Inequalities in intentions to quit smoking in Serbia: data from 2006 National Health Survey

OBJECTIVES

The prevalence of smoking is very high in Serbia. A wide range of tobacco control measures and activities have been undertaken to encourage smoking cessation, but it is not known whether smokers in Serbia are willing to quit, and if inequalities exist between them. This study analysed intentions to quit smoking, using the Stages of Change Model, among a population of current and/or former adult smokers in Serbia, and compared socio-economic and demographic characteristics.

STUDY DESIGN

Cross-sectional study on a nationally representative population sample, using data from the 2006 National Health Survey. The sample consisted of 5905 current or former daily smokers.

METHODS

Logistical regression analysis was used to identify associations between socio-economic and demographic characteristics of former/current smokers, and their stage of change in terms of smoking (precontemplation, contemplation, preparation, action, maintenance and termination).

RESULTS

More than one-fifth (22%) of current smokers did not intend to quit smoking (precontemplation stage). Women were twice as likely to contemplate quitting compared with men [odds ratio (OR) 2.08, 95% confidence interval (CI) 1.68-2.58]. However, women were less successful in quitting smoking (termination stage) than men (OR 0.64, 95% CI 0.52-0.79). In addition to gender, educational inequalities in intentions to quit smoking were identified; less-educated individuals were less willing to quit smoking (preparation and action stages) regardless of their socio-economic status or chronic disease status.

CONCLUSION

Tobacco control interventions should be sensitive to gender and educational inequalities in quitting smoking.

Neighborhood vigilance, health locus of control, and smoking abstinence

OBJECTIVES

To examine whether health locus of control mediated relations of self-reported neighborhood vigilance and biochemically verified, continuous short-term smoking abstinence among 200 smokers enrolled in a cohort study.

METHODS

A nonparametric bootstrapping procedure was used to assess mediation.

RESULTS

Health locus of control-chance mediated relations between neighborhood vigilance and smoking abstinence in analyses adjusted for sociodemographics and tobacco dependence (p < .05). Greater vigilance was associated with greater attributions that health was affected by chance, which was associated with a lower likelihood of smoking abstinence.

CONCLUSIONS

Results suggest that neighborhood perceptions influence residents' attributions for health outcomes, which can affect smoking abstinence.