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Sofianidi A, Karadimou A, Charpidou A, Syrigos KN. The Gap of Health Inequalities Amongst Lung Cancer Patients of Different Socioeconomic Status: A Brief Reference to the Greek Reality. Cancers (Basel) 2024; 16:906. [PMID: 38473268 DOI: 10.3390/cancers16050906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Lung cancer treatment and patient care are constantly improving, but it remains doubtful whether this applies equally to all socioeconomic groups. It is nowadays well established that there are socioeconomic inequalities regarding lung cancer incidence, screening, effective treatment, overall survival, and prognosis. One of the key contributing factors to low socioeconomic status is low education. Low educational level is correlated with several factors, such as smoking habits, bad lifestyle behaviors, lower paid and unhealthier occupations, polluted neighborhoods, and genetic-familial risk, that lead to increased lung cancer incidence. The disparities regarding lung cancer care are further enhanced by stigma. On this basis and inspired by the gap in health equality among the Greek population, the Greek Society of Lung Cancer initiated a campaign, "MIND THE GAP", to help increase awareness and minimize the gap associated with lung cancer, both in Greece and across Europe. The aim of this review is to explore the gap of health inequalities regarding lung cancer incidence and prognosis between patients of different SES and its root of causality. Key pivotal actions towards bridging this gap are reviewed as well.
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Affiliation(s)
- Amalia Sofianidi
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexandra Karadimou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andriani Charpidou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos N Syrigos
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Smoking and diabetes: sex and gender aspects and their impact on vascular diseases. Can J Cardiol 2023; 39:681-692. [PMID: 36702239 DOI: 10.1016/j.cjca.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Smoking and diabetes mellitus (DM) have been identified as two major cardiovascular risk factors for many years. In the field of cardiovascular diseases, considering sex differences, or gender differences, or both has become an essential element in moving toward equitable and quality healthcare. We reviewed the impact of sex or gender on the link between smoking and DM. The risk of type 2 DM (T2DM) due to smoking has been established in both sexes at the same level. As is the case in the general population, the prevalence of smoking in those with DM is higher in men than in women, although the decrease in smoking observed in recent years is more pronounced in men than in women. Regarding chronic DM complications, smoking is an independent risk factor for all-cause mortality, as well as macrovascular and microvascular complications, in both sexes. Nevertheless, in T2DM, the burden of smoking appears to be greater in women than in men for coronary heart disease morbidity, women having a 50% higher risk of fatal coronary event. Women are more dependent to nicotine, cumulate psychosocial barriers to quitting smoking, and are more likely to gain weight, which might make it more difficult for them to quit smoking. Smoking cessation advice and treatments should take into account gender differences to improve the success and long-term maintenance of abstinence in people with and without DM. This might include interventions that address emotions and stress in women or designed to reach specific populations of men.
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3
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Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: Smoking Cessation Disparities. J Am Acad Orthop Surg 2022; 30:1055-1058. [PMID: 35297802 DOI: 10.5435/jaaos-d-21-00875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Currently, 13.7% of the adult American population smokes cigarettes. Although rates of cigarette smoking have decreased over time, those of e-cigarette usage have increased. Smoking rates are highest in American Indians/Alaskan Natives and adults whose highest education level is a General Educational Development certificate, who live in rural American areas, and who have an annual household income of less than $35,000. After arthroplasty, smoking is linked to impaired wound healing, superficial and deep wound infections, and aseptic loosening. Patients who smoke should be strongly encouraged to stop and be supported with smoking cessation programs. Monitoring smoking cessation with cotinine levels may be inaccurate because variations have been noted in race, ethnicity, and sex. Confirmation of cessation as a hard stop to surgery could increase existing healthcare disparities. The role of the surgeon in encouraging patients to stop smoking, at least temporarily, before total joint arthroplasty cannot be overemphasized.
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Cohen-Levy WB, Lans J, Salimy MS, Melnic CM, Bedair HS. The Significance of Race/Ethnicity and Income in Predicting Preoperative Patient-Reported Outcome Measures in Primary Total Joint Arthroplasty. J Arthroplasty 2022; 37:S428-S433. [PMID: 35307241 DOI: 10.1016/j.arth.2022.02.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Utilization of total joint arthroplasty (TJA) by minorities is disproportionately low compared to Whites. Contributing factors include poorer outcomes, lower expectations, and decreased access to care. This study aimed to evaluate if race and income were predictive of preoperative patient-reported outcome measures (PROMs) and the likelihood of achieving the minimal clinically important difference (MCID) following TJA. METHODS We retrospectively reviewed 1,371 patients who underwent primary TJA between January 2018 and March 2021 in a single healthcare system. Preoperative and postoperative PROM scores were collected for Patient-Reported Outcomes Measurement Information System (PROMIS) Mental Health, PROMIS Physical Function (PF10a), and either Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS). Demographic and comorbidity data were included as explanatory variables. Multivariable regression was used to analyze the association between predictive variables and PROM scores. RESULTS Mean preoperative PROM scores were lower for non-Whites compared to Whites. Increased median household income was associated with higher preoperative PROM scores. Non-White race was associated with lower PROMIS Mental Health and KOOS, but not PF10a or HOOS scores. Only non-White race was associated with a decreased likelihood of achieving MCID for PF10a. Neither race nor income was predictive of achieving MCID for KOOS and HOOS. CONCLUSION Non-White race/ethnicity and lower income were associated with lower preoperative PROMs prior to primary TJA. Continued research is necessary to identify the causes of this discrepancy and correct this disparity.
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Affiliation(s)
- Wayne B Cohen-Levy
- Department of Orthopaedic Surgery, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Orthopaedic Surgery, University Hospitals/Cleveland Medical Center, Cleveland, Ohio
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Newton-Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Newton-Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Hawkes S, Pantazis A, Purdie A, Gautam A, Kiwuwa-Muyingo S, Buse K, Tanaka S, Borkotoky K, Sharma S, Verma R. Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men. ECONOMIA POLITICA (BOLOGNA, ITALY) 2022; 39:55-73. [PMID: 35422585 PMCID: PMC8773398 DOI: 10.1007/s40888-021-00254-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/30/2021] [Indexed: 05/31/2023]
Abstract
Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.
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Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, UCL, and Global Health 50/50, 30 Guilford Street, London, WC1N 1EH UK
| | - Athena Pantazis
- Independent Consultant To Global Health 50/50, Maseru, Lesotho
| | - Anna Purdie
- Institute for Global Health, UCL, and Global Health 50/50, 30 Guilford Street, London, WC1N 1EH UK
| | - Abhishek Gautam
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Sylvia Kiwuwa-Muyingo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Kent Buse
- Healthier Societies Programme, The George Institute for Global Health and Global Health 50/50, University of New South Wales, Global Health 50/50, Paris, France
| | - Sonja Tanaka
- Global Health 50/50, 16 A Rue Petit, Paris, France
| | - Kakoli Borkotoky
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Sneha Sharma
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Ravi Verma
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
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Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
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Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
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Arnabal LR. Optimal design of sin taxes in the presence of nontaxable sin goods. HEALTH ECONOMICS 2021; 30:1580-1599. [PMID: 33864322 DOI: 10.1002/hec.4269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
Sin good consumption entails health damage, which is in general not fully perceived by individuals, what results in its overconsumption. One way to tackle this problem is to tax these unhealthy goods. However, not all the individual choices that affect health status can be easily observed and effectively taxed by the government. This paper considers a setting where individuals can consume two types of sin goods that differ in their observability (taxability) by the government. As a benchmark, the first-best taxes for the observable and non-observable sin good are derived, considering homogeneous individuals. In the second-best setting, where observability on sin good consumption is limited, the rule for the taxable sin good is shown to depend on the degree of complementarity or substitutability with the unobservable sin good. Finally, redistributional considerations are incorporated by extending the analysis to a setting where individuals differ in their wealth and in their degree of misperception of the health damage caused by sin good consumption. Policy implications are illustrated considering physical inactivity and illicit drugs as examples of non-taxable sin goods, while alcohol, tobacco, fat and sugar account for the taxable sin goods.
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Affiliation(s)
- Luis Rodrigo Arnabal
- Banco Central del Uruguay, Montevideo, Uruguay
- Toulouse School of Economics (TSE), Toulouse, France
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Jafari A, Rajabi A, Gholian-Aval M, Peyman N, Mahdizadeh M, Tehrani H. National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis. Environ Health Prev Med 2021; 26:5. [PMID: 33419408 PMCID: PMC7796590 DOI: 10.1186/s12199-020-00924-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background This systematic and meta-analysis review aimed to provide an updated estimate of the prevalence of ever and current cigarette smoking in women, in geographic areas worldwide, and demonstrate a trend of the prevalence of smoking over time by using a cumulative meta-analysis. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the prevalence of ever and current cigarette smoking in women. We searched PubMed, Web of Science (ISI), Scopus, and Ovid from January 2010 to April 2020. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence of ever and current cigarette smoking in women. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. Results The pooled prevalence of ever and current cigarette smoking in women was 28% and 17%, respectively. The pooled prevalence of ever cigarette smoking in adolescent girls/students of the school, adult women, pregnant women, and women with the disease was 23%, 27%, 32%, and 38%, respectively. The pooled prevalence of ever cigarette smoking in the continents of Oceania, Asia, Europe, America, and Africa was 36%, 14%, 38%, 31%, and 32%, respectively. Conclusions The prevalence of cigarette smoking among women is very high, which is significant in all subgroups of adolescents, adults, and pregnant women. Therefore, it is necessary to design and implement appropriate educational programs for them, especially in schools, to reduce the side effects and prevalence of smoking among women. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-020-00924-y.
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Affiliation(s)
- Alireza Jafari
- Department of Health Education and Health Promotion, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolhalim Rajabi
- Biostatistics and Epidemiology Department, Faculty of Health, Environmental Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Gholian-Aval
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrsadat Mahdizadeh
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Hawkes S, Buse K. COVID-19 and the gendered markets of people and products: explaining inequalities in infections and deaths. REVUE CANADIENNE D'ETUDES DU DEVELOPPEMENT = CANADIAN JOURNAL OF DEVELOPMENT STUDIES 2020; 42:37-54. [PMID: 35475122 PMCID: PMC7612661 DOI: 10.1080/02255189.2020.1824894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 06/01/2023]
Abstract
COVID-19 has exposed and exploited existing inequalities in gender to drive inequities in health outcomes. Evidence illustrates the relationship between occupation, ethnicity and gender to increase risk of infection in some places. Higher death rates are seen among people also suffering from non-communicable diseases - e.g. heart disease and lung disease driven by exposure to harmful patterns of exposure to corporate products (tobacco, alcohol, ultra-processed foods), corporate by-products (e.g. outdoor air pollution) or gendered corporate processes (e.g. gendered occupational risk). The paper argues that institutional gender blindness in the health system means that underlying gender inequalities have not been taken into consideration in policies and programmatic responses to COVID-19.
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Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, University College London, London, UK
| | - Kent Buse
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Buse K, Aftab W, Akhter S, Phuong LB, Chemli H, Dahal M, Feroz A, Hofiani S, Pradhan NA, Anwar I, Skhiri HA, El Ati J, Giang KB, Puri M, Noormal B, Rabbani F, Hawkes S. The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach. Health Policy Plan 2020; 35:503-521. [PMID: 32091080 PMCID: PMC7225567 DOI: 10.1093/heapol/czz175] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.
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Affiliation(s)
- Kent Buse
- UNAIDS, Avenue Appia 20, 1211 Genève, Switzerland
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sadika Akhter
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Linh Bui Phuong
- Center for Population Health Sciences, Hanoi University of Public Health, No. 1A, Duc Thang Street, Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - Haroun Chemli
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007, Tunis, Tunisia
| | - Minakshi Dahal
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sayad Hofiani
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Iqbal Anwar
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Hajer Aounallah Skhiri
- Faculty of Medicine of Tunis, University of Tunis El-Manar, Rue de la Faculte de Medecine, Tunis, Tunisia
- National Health Institute, Ministry of Health, 5/7 Rue El Khartoum, Diplomat, Bloc IV, 10ème étage, le Belvédère 1002 Tunis, Tunisia
| | - Jalila El Ati
- National Institute of Nutrition and Food Technology, SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Kim Bao Giang
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung, Dong da District, Hanoi, Vietnam
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Bashir Noormal
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sarah Hawkes
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH5, UK
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11
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Thirlway F. Explaining the social gradient in smoking and cessation: the peril and promise of social mobility. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:565-578. [PMID: 31769046 PMCID: PMC7079060 DOI: 10.1111/1467-9566.13039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Smoking in high-income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working-class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents.
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Affiliation(s)
- Frances Thirlway
- Department of SociologyWentworth CollegeUniversity of YorkYorkUK
- Anthropology DepartmentDurham UniversityDurhamUK
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12
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Masud H, Oyebode O. Inequalities in smoking prevalence: a missed opportunity for tobacco control in Pakistan. J Public Health (Oxf) 2019; 40:271-278. [PMID: 28505324 DOI: 10.1093/pubmed/fdx044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background Pakistan is one of the highest tobacco consuming countries in South Asia and consumption is increasing. To implement equity orientated tobacco control policies, the most vulnerable groups must be identified. We aimed to identify these groups using the Pakistan Demographic and Health Survey (PDHS) 2012-13. Methods Descriptive statistics, univariate and multivariate analyses were used to explore household and participant characteristics associated with smoking inside the home or tobacco smoking, respectively. Survey weights were used to give nationally representative findings. Results Data for 12 931 households, 3132 men and 13 538 women were examined. About 58.3% of surveyed households were smoke-free, 39.1% were exposed to indoor tobacco smoke every day, 2.6% less frequently. Significantly more rural households were exposed to indoor tobacco smoke than urban households (45.2% versus 34.9%). Of men, 28.3% reported smoking compared with 1.3% of women. Smoking prevalence was higher in older age groups. Increasing wealth was associated with lower smoking prevalence and indoor smoking. For men, but not women, increasing education was associated with reduced smoking. Conclusions Inequalities in smoking behaviour impose harm to those who can least afford the financial and health costs. Future tobacco control policies in Pakistan must be sensitive to gender, geography and socio-economic status.
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Affiliation(s)
- Haleema Masud
- Department of Public Health, Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Cruz TB, Rose SW, Lienemann BA, Byron MJ, Meissner HI, Baezconde-Garbanati L, Huang LL, Carroll DM, Soto C, Unger JB. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature. Tob Induc Dis 2019; 17:68. [PMID: 31582956 PMCID: PMC6770621 DOI: 10.18332/tid/111397] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups. METHODS Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group. RESULTS There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results. CONCLUSIONS We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.
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Affiliation(s)
- Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, United States.,Center for Health Equity Transformation and Behavioral Science, University of Kentucky College of Medicine, Lexington, United States
| | - Brianna A Lienemann
- Keck School of Medicine, University of Southern California, Los Angeles, United States.,Moores Cancer Center, University of California San Diego, San Diego, United States
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, United States
| | | | - Li-Ling Huang
- Global Health and Health Security, Taipei Medical University, Taipei, Taiwan
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
| | - Claradina Soto
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, United States
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Chido-Amajuoyi OG, Yu RK, Agaku I, Shete S. Exposure to Court-Ordered Tobacco Industry Antismoking Advertisements Among US Adults. JAMA Netw Open 2019; 2:e196935. [PMID: 31298713 PMCID: PMC6628589 DOI: 10.1001/jamanetworkopen.2019.6935] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2006, US District Judge Gladys Kessler ordered tobacco companies to make corrective statements through paid advertisements informing the public of their deceptive practices. This landmark ruling and its subsequent execution represent the first time the tobacco industry sponsored a nationwide corrective advertising campaign against its own products. OBJECTIVE To assess the reach of the court-ordered antismoking advertisements within the US adult population, stratified by demographic characteristics and tobacco use. DESIGN, SETTING, AND PARTICIPANTS This nationally representative, population-based cross-sectional survey of US adults included respondents to the 2018 Health Information National Trends Survey 5, Cycle 2. Respondents were representatives of households selected by equal-probability sampling of the Marketing Systems Group database of addresses that included all nonvacant US residential addresses. Data collection was conducted from January to May 2018, and analysis took place from December 2018 to April 2019. MAIN OUTCOMES AND MEASURES Self-reported exposure to court-ordered antismoking advertisements. RESULTS The overall sample of 3484 respondents included 2054 women (weighted percentage, 50.8%), 1976 non-Hispanic white respondents (weighted percentage, 59.9%), 2952 respondents who lived in urban US areas (weighted percentage, 84.9%), and 450 current smokers (weighted percentage, 15.6%). Estimated exposure to court-ordered antismoking advertisements was 40.6% (95% CI, 37.5%-43.7%) among the full sample and 50.5% (95% CI, 41.4%-59.6%) among current smokers. Exposure was lowest among those aged 18 to 34 years (37.4%; 95% CI, 28.0%-46.8%), those with a high school education or less (34.5%; 95% CI, 29.3%-39.8%), and those with household annual income less than $35 000 (37.5%; 95% CI, 32.0%-42.9%). Among current smokers, Hispanic respondents had lower exposure rates (42.2%; 95% CI, 18.5%-65.9%) than non-Hispanic white respondents (51.7%; 95% CI, 40.4%-63.1%). As the advertising campaign's duration increased, exposure rates increased. Individuals with a high school education or less had lower odds of antismoking advertisement exposure than those with college or postgraduate degrees (adjusted odds ratio, 0.67; 95% CI, 0.48-0.94). Current smokers had higher odds of exposure than never smokers (adjusted odds ratio, 1.81; 95% CI, 1.17-2.80). Among those exposed to antismoking advertisements, 70.5% saw multiple antismoking messages. CONCLUSIONS AND RELEVANCE Approximately 1 of 2 smokers reported exposure to the federal court-ordered antismoking advertisements. However, exposure was relatively lower among several subgroups, including individuals aged 18 to 34 years, only one-third of whom reported exposure. Increasing the duration of antismoking advertisements as well as expanding their coverage to youth-oriented media may increase their potential public health impact.
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Affiliation(s)
| | - Robert K. Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston
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Halawi MJ, Allen DA, Baron S, Savoy L, Williams VJ, Cote MP. Tobacco Smoking Independently Predicts Lower Patient-Reported Outcomes: New Insights on a Forgotten Epidemic. J Arthroplasty 2019; 34:S144-S147. [PMID: 30482415 DOI: 10.1016/j.arth.2018.10.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/14/2018] [Accepted: 10/29/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although smoking is a well-accepted risk factor for surgical complications, the effect of smoking on patient-reported outcomes (PROs) has not been previously investigated. Prompted by an increasingly value-conscious healthcare environment, the purpose of this study is to investigate the association between smoking and PROs in total joint arthroplasty (TJA). METHODS A retrospective review of 713 primary total hip and knee replacements was performed. Two cohorts were compared: (1) current smokers and (2) previous/never smokers at the time of TJA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-12 Physical Composite Summary (SF-12 PCS) and Short Form-12 Mental Composite Summary were assessed preoperatively and again at 6 and 12 months postoperatively. The primary outcomes were the net changes and absolute outcome scores at final follow-up. Postoperative patient satisfaction was also assessed as a secondary outcome. Linear mixed-effects regression analysis was performed. RESULTS There were significant demographic and preoperative health disparities as measured by PROs among smokers. After adjusting for baseline differences, smokers achieved significantly lower improvements in WOMAC (P = .002) and SF-12 PCS (P = .03) compared to nonsmokers. For each unit increase in packs per day smoked, the WOMAC scores increased (worsened) by 7.7 points (P = .003) and SF-12 PCS decreased by 4.8 points (P = .001). At final follow up, nonsmokers had significantly better absolute scores for all outcomes (except for mental health) and were more likely to be satisfied with surgery (89% vs 82%, P = .052). CONCLUSION Tobacco smoking is an independent predictor for lower PROs after TJA and this relationship is dose-dependent. The negative impact of smoking does not appear to be related to impaired psychological health. As we transition to value-based care delivery models, this study provides further evidence that smoking cessation should be strongly recommended as a modifiable risk factor before embarking on elective TJA. Studies are still needed to define the optimal window for smoking cessation.
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Affiliation(s)
- Mohamad J Halawi
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Donald A Allen
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Samuel Baron
- University of Connecticut School of Medicine, Farmington, CT
| | - Larry Savoy
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Vincent J Williams
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
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Moran MB, Heley K, Pierce JP, Niaura R, Strong D, Abrams D. Ethnic and Socioeconomic Disparities in Recalled Exposure to and Self-Reported Impact of Tobacco Marketing and Promotions. HEALTH COMMUNICATION 2019; 34:280-289. [PMID: 29236530 PMCID: PMC6004334 DOI: 10.1080/10410236.2017.1407227] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The role of tobacco marketing in tobacco use, particularly among the vulnerable ethnic and socioeconomic sub-populations is a regulatory priority of the U.S. Food and Drug Administration. There currently exist both ethnic and socioeconomic disparities in the use of tobacco products. Monitoring such inequalities in exposure to tobacco marketing is essential to inform tobacco regulatory policy that may reduce known tobacco-related health disparities. We use data from the Population Assessment of Tobacco and Health (PATH) Wave 1 youth survey to examine (1) recalled exposure to and liking of tobacco marketing for cigarettes, non-large cigars, and e-cigarettes, (2) self-reported exposure to specific tobacco marketing tactics, namely coupons, sweepstakes, and free samples, and (3) self-reported impact of tobacco marketing and promotions on product use. Findings indicate that African Americans and those of lower SES were more likely to recall having seen cigarette and non-large cigar ads. Reported exposure to coupons, sweepstakes and free samples also varied ethnically and socioeconomically. African Americans and those of lower SES were more likely than other respondents to report that marketing and promotions as played a role in their tobacco product use. Better understanding of communication inequalities and their influence on product use is needed to inform tobacco regulatory action that may reduce tobacco company efforts to target vulnerable groups. Tobacco education communication campaigns focusing on disproportionately affected groups could help counter the effects of targeted industry marketing.
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Affiliation(s)
- Meghan Bridgid Moran
- a Department of Health, Behavior & Society , Johns Hopkins University Bloomberg School of Public Health
| | - Kathryn Heley
- b Department of Health Policy and Management , Johns Hopkins University Bloomberg School of Public Health
| | - John P Pierce
- c Department of Family Medicine & Public Health, UC-San Diego School of Medicine and Division of Population , Moores Cancer Center
| | - Ray Niaura
- d Department of Social and Behavioral Sciences , College of Global Public Health, New York University
| | - David Strong
- c Department of Family Medicine & Public Health, UC-San Diego School of Medicine and Division of Population , Moores Cancer Center
| | - David Abrams
- d Department of Social and Behavioral Sciences , College of Global Public Health, New York University
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Miles DRB, Bilal U, Hutton H, Lau B, Lesko C, Fojo A, McCaul ME, Keruly J, Moore R, Chander G. Tobacco Smoking, Substance Use, and Mental Health Symptoms in People with HIV in an Urban HIV Clinic. J Health Care Poor Underserved 2019; 30:1083-1102. [PMID: 31422990 PMCID: PMC7304241 DOI: 10.1353/hpu.2019.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of tobacco smoking among people with HIV (PWH) ranges from 40% to 70%. Additionally, tobacco smoking is higher among low-income individuals, yet few studies have examined tobacco smoking in low socioeconomic status PWH. Using data from a cohort of PWH receiving care in an urban HIV clinic, we characterized factors associated with current and former smoking and with initiation/re-initiation and cessation of tobacco use. Among a study sample of 1,607 PWH, the prevalence of current smoking was 46.6% among men and 46.0% among women. Current smoking in men and women was associated with Medicaid insurance status, substance use, and panic symptoms. In women, but not men, hazardous alcohol use decreased the likelihood of quitting smoking and increased the risk of initiation/re-initiation. Smoking interventions for low-income, urban PWH may need to be tailored to address mental health and substance use comorbidities.
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Affiliation(s)
- D. R. Bailey Miles
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Community Physicians, Baltimore, MD
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan Lau
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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18
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Bello MS, Khoddam R, Stone MD, Cho J, Yoon Y, Lee JO, Leventhal AM. Poly-product drug use disparities in adolescents of lower socioeconomic status: Emerging trends in nicotine products, marijuana products, and prescription drugs. Behav Res Ther 2018; 115:103-110. [PMID: 30558744 DOI: 10.1016/j.brat.2018.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Greater diversification of nicotine products, marijuana products, and prescription drugs have contributed to increasing trends in adolescent poly-product use-concurrent use of 2 or more drugs-within these drug classes (e.g., nicotine use via e-cigarettes, hookah, cigars). Extant work suggests that poly-product drug use disparities may be disproportionately heightened among youth from lower socioeconomic status (SES) backgrounds, however, it is unknown whether indicators of objective SES or subjective SES differentially increase risk of poly-product use including these newly emerging drugs. This study examined associations of parental education and subjective social status (SSS: perceptions of social standing compared to society [societal SSS] or school [school SSS]) with poly-product use of nicotine products, marijuana products, and prescription drugs among adolescents (N = 2218). Lower parental education and school SSS were associated with increased odds of past or current single, dual, or multiple product use of nicotine, marijuana, and prescription drugs. Findings suggest that risk for poly-product use of emerging drugs are higher for adolescents who endorse lower perceived social standing relative to peers at school and who were from a lower parental SES background.
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Affiliation(s)
- Mariel S Bello
- University of Southern California, Department of Psychology, 3620 South McClintock Avenue, SGM 501, Los Angeles, CA, 90089, USA.
| | - Rubin Khoddam
- University of Southern California, Department of Psychology, 3620 South McClintock Avenue, SGM 501, Los Angeles, CA, 90089, USA.
| | - Matthew D Stone
- University of California, San Diego School of Medicine, Department of Family Medicine and Public Health, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Junhan Cho
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, 2001 North Soto Street, 3rd Floor, Los Angeles, CA, 90032-9045, USA.
| | - Yoewon Yoon
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA, 90089, USA.
| | - Jungeun Olivia Lee
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA, 90089, USA.
| | - Adam M Leventhal
- University of Southern California, Department of Psychology, 3620 South McClintock Avenue, SGM 501, Los Angeles, CA, 90089, USA; University of California, San Diego School of Medicine, Department of Family Medicine and Public Health, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
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Kasza KA, Coleman B, Sharma E, Conway KP, Cummings KM, Goniewicz ML, Niaura RS, Lambert EY, Schneller LM, Feirman SP, Donaldson EA, Cheng YC, Murphy I, Pearson JL, Trinidad DR, Bansal-Travers M, Elton-Marshall T, Gundersen DA, Stanton CA, Abrams DB, Fong GT, Borek N, Compton WM, Hyland AJ. Correlates of Transitions in Tobacco Product Use by U.S. Adult Tobacco Users between 2013⁻2014 and 2014⁻2015: Findings from the PATH Study Wave 1 and Wave 2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2556. [PMID: 30441875 PMCID: PMC6266124 DOI: 10.3390/ijerph15112556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/16/2022]
Abstract
More than half of adult tobacco users in the United States (U.S.) transitioned in tobacco product use between 2013⁻2014 and 2014⁻2015. We examine how characteristics of adult tobacco users in the U.S. relate to transitions in tobacco product use. Population Assessment of Tobacco and Health (PATH) Study data were analyzed from 12,862 adult current tobacco users who participated in Wave 1 (W1, 2013⁻2014) and Wave 2 (W2, 2014⁻2015). Three types of transitions were examined-(1) adding tobacco product(s); (2) switching to non-cigarette tobacco product(s); and (3) discontinuing all tobacco use-among those currently using: (1) any tobacco product; (2) cigarettes only (i.e., exclusive cigarette); and (3) cigarettes plus another tobacco product(s) (i.e., poly-cigarette). Multinomial logistic regression analyses determined relative risk of type of transition versus no transition as a function of demographic and tobacco use characteristics. Transitions in tobacco product use among adult tobacco users were common overall, but varied among different demographic groups, including by age, sex, sexual orientation, race/ethnicity, educational attainment, and poverty level. Further, cigarette smokers with higher dependence scores were more likely to add product(s) and less likely to discontinue tobacco use compared to those with low dependence scores. That high nicotine dependence is a barrier to discontinuing tobacco use adds evidence to support policy to lower nicotine content of cigarettes and to evaluate new products for their potential to reduce cigarette use.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | | | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Elizabeth Y Lambert
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Shari P Feirman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Yu-Ching Cheng
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Iilun Murphy
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, La Jolla, CA 92093, USA.
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON M5T 1R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada.
- Ontario Tobacco Research Unit, Toronto, ON M5S 2S1, Canada.
| | - Daniel A Gundersen
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers, Somerset, NJ 08873, USA.
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
| | | | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada.
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
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Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1859-1922. [PMID: 30415748 PMCID: PMC6252083 DOI: 10.1016/s0140-6736(18)32335-3] [Citation(s) in RCA: 1868] [Impact Index Per Article: 311.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. METHODS We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. FINDINGS Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). INTERPRETATION With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. FUNDING Bill & Melinda Gates Foundation.
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Le D, D'Souza G, Atnafou R, Matson PA, Jones MR, Moran MB. "It Felt Like I Was Smoking Nothing:" Examining E-cigarette Perception and Discontinuation among Young Adults. HEALTH BEHAVIOR AND POLICY REVIEW 2018; 5:50-55. [PMID: 32490029 PMCID: PMC7266136 DOI: 10.14485/hbpr.5.6.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this study, we sought to understand why young adults from urban low-income regions discontinue using e-cigarettes. METHODS We recruited 97 tobacco users aged 18-26 years from Baltimore, Maryland to participate in 17 focus groups. Qualitative data were analyzed using framework analysis. RESULTS Being less satisfying than combustible tobacco, perceived cumulating costs, and negative physical effects were expressed as top reasons for never using or discontinuing the use of e-cigarettes. CONCLUSION Understanding why young adults discontinue e-cigarette use is critical to inform e-cigarette intervention efforts and public policy. If e-cigarettes are to be promoted as harm reduction devices for combustible tobacco users, it will be important to ensure that they are affordable, satisfying, and formulated to minimize negative physical effects.
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Affiliation(s)
- Daisy Le
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Miranda R Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Antin TMJ, Hunt G, Sanders E. The "here and now" of youth: the meanings of smoking for sexual and gender minority youth. Harm Reduct J 2018; 15:30. [PMID: 29855377 PMCID: PMC5984472 DOI: 10.1186/s12954-018-0236-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives. METHODS This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense. RESULTS Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health. CONCLUSIONS These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.
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Affiliation(s)
- Tamar M. J. Antin
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Geoffrey Hunt
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Emile Sanders
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
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Drope J, Liber AC, Cahn Z, Stoklosa M, Kennedy R, Douglas CE, Henson R, Drope J. Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA Cancer J Clin 2018; 68:106-115. [PMID: 29384589 DOI: 10.3322/caac.21444] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/16/2022] Open
Abstract
The continuing high prevalence of cigarette smoking among specific subpopulations, many of them vulnerable, is one of the most pressing challenges facing the tobacco control community. These populations include individuals in lower education and/or socioeconomic groups; from certain racial/ethnic groups; in the lesbian, gay, bisexual, and transgender community; with mental illness; and in the military, particularly among those in the lowest pay grades. Although traditional tobacco control measures are having positive health effects for most groups, the effects are not sufficient for others. More attention to and support for promising novel interventions, in addition to new attempts at reaching these populations through conventional interventions that have proven to be effective, are crucial going forward to find new ways to address these disparities. CA Cancer J Clin 2018;68:106-115. © 2018 American Cancer Society.
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Affiliation(s)
- Jeffrey Drope
- Vice President, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Alex C Liber
- Data Analyst, Economic and Health Policy Research Program, American Cancer Society, Atlanta, GA
| | - Zachary Cahn
- Director, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Michal Stoklosa
- Senior Economist, Taxation and Health, Economic and Health Policy Research Program, American Cancer Society, Atlanta, GA
| | - Rosemary Kennedy
- Program Consultant, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Clifford E Douglas
- Vice President for Tobacco Control and Director, Center for Tobacco Control, American Cancer Society, Atlanta, GA
| | - Rosemarie Henson
- Senior Vice President for Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Jacqui Drope
- Managing Director, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
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Kong G, Kuguru KE, Krishnan-Sarin S. Gender Differences in U.S. Adolescent E-Cigarette Use. CURRENT ADDICTION REPORTS 2017; 4:422-430. [PMID: 29545987 DOI: 10.1007/s40429-017-0176-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose of Review This study aims to review the recent (2012-2017) available gender difference data on e-cigarette use among adolescents. Recent Findings E-cigarettes are the most commonly used tobacco product among adolescents, and recent study findings showed that e-cigarette use can lead to cigarette smoking. However, gender differences in e-cigarette use among adolescents are relatively unknown. Summary We used the search terms "adolescents" and "e-cigarettes" on PubMed and identified 652 articles. Of these, 16 articles (2.5%) examined gender differences in adolescent e-cigarette use. Boys appear to have greater use of e-cigarettes, but girls may be at increased risk if e-cigarettes are targeted to them, as it has been for cigarettes. Data on gender differences are limited, and future research should continue to examine gender differences in e-cigarette use. Trends in use rates could evolve with new regulations and innovations in e-cigarette marketing and product features.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
| | - Karissa E Kuguru
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
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Bars, Nightclubs, and Cancer Prevention: New Approaches to Reduce Young Adult Cigarette Smoking. Am J Prev Med 2017; 53:S78-S85. [PMID: 28818250 PMCID: PMC5835447 DOI: 10.1016/j.amepre.2017.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/07/2017] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Tobacco contributes to multiple cancers, and it is largely preventable. As overall smoking prevalence in California declines, smoking has become concentrated among high-risk groups. Targeting social/cultural groups (i.e., "peer crowds") that share common values, aspirations, and activities in social venues like bars and nightclubs may reach high-risk young adult smokers. Lack of population data on young adult peer crowds limits the ability to assess the potential reach of such interventions. METHODS This multimodal population-based household survey included young adults residing in San Francisco and Alameda counties. Data were collected in 2014 and analyzed in 2016. Multivariable logistic regressions assessed smoking by sociodemographic factors, attitudes, self-rated health, peer crowd affiliation, and bar/nightclub attendance. RESULTS Smoking prevalence was 15.1% overall; 35.3% of respondents sometimes or frequently attended bars. In controlled analyses, bar attendance (AOR=2.13, 95% CI=1.00, 4.53) and binge drinking (AOR=3.17, 95% CI=1.59, 6.32) were associated with greater odds of smoking, as was affiliation with "Hip Hop" (AOR=4.32, 95% CI=1.48, 12.67) and "Country" (AOR=3.13, 95% CI=1.21, 8.09) peer crowds. Multivariable models controlling for demographics estimated a high probability of smoking among bar patrons affiliating with Hip Hop (47%) and Country (52%) peer crowds. CONCLUSIONS Bar attendance and affiliation with certain peer crowds confers significantly higher smoking risk. Interventions targeting Hip Hop and Country peer crowds could efficiently reach smokers, and peer crowd-tailored interventions have been associated with decreased smoking and binge drinking. Targeted interventions in bars and nightclubs may be an efficient way to address these cancer risks.
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Kien VD, Jat TR, Giang KB, Hai PT, Huyen DTT, Khue LN, Lam NT, Nga PTQ, Quan NT, Van Minh H. Trends in socioeconomic inequalities among adult male hardcore smokers in Vietnam: 2010-2015. Int J Equity Health 2017; 16:126. [PMID: 28705253 PMCID: PMC5513204 DOI: 10.1186/s12939-017-0623-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/06/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite male smokers being dominant in Vietnam, scarce evidence on trends in socioeconomics inequalities among the hardcore male smokers is available in the country. In this study, we aimed at assessing the trends in socioeconomics inequalities among the hardcore smokers in adult male population in Vietnam over a five-year period from 2010 to 2015. METHODS We used data from two rounds of the Vietnam Global Adult Tobacco Survey (GATS) conducted in 2010 and 2015. We included only men aged 25 years and above in the analysis. We measured socioeconomic inequalities among hardcore smokers by calculating the concentration index. We conducted multiple logistic regression analysis to identify factors associated with hardcore smoking among men aged 25 years and above. RESULTS The results of this study showed that the prevalence of male hardcore smokers aged 25 years and above in Vietnam was 9.5% in 2010 which increased to 13.1% in 2015. The prevalence of male hardcore smokers declined in the richest group from the 2010 level whereas it increased in the middle, poor and poorest groups. All values of weighted concentration indices indicated that the prevalence of male hardcore smokers occurred more among the poor men in Vietnam in both 2010 and 2015. The socioeconomic inequalities in hardcore smokers increased during 2010 and 2015. Residence in urban areas was significantly associated with higher adult male hardcore smoking in our study. Belonging to the age groups between 40 and 59 years, attaining primary and lower education, being self-employed, belonging to the poorest household group, smoking being allowed at home and no rule for smoking at home were associated with higher risk of being hardcore smoker among adult males in Vietnam. CONCLUSIONS We found increased trends in socioeconomic inequalities in hardcore smoking among the study population. Our study results indicate that existing smoking secession and tobacco control policy and interventions need to be modified or new policies and interventions should be introduced with the perspective of addressing socioeconomic inequalities to have the desired impact. We recommend implementing specific targeted interventions for vulnerable population groups for better results.
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Affiliation(s)
- Vu Duy Kien
- Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam
| | | | - Kim Bao Giang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Phan Thi Hai
- Vietnam Steering Committee on Smoking and Health (VINACOSH), Hanoi, Vietnam
| | - Doan Thi Thu Huyen
- Vietnam Steering Committee on Smoking and Health (VINACOSH), Hanoi, Vietnam
| | - Luong Ngoc Khue
- Vietnam Steering Committee on Smoking and Health (VINACOSH), Hanoi, Vietnam
| | - Nguyen Tuan Lam
- World Health Organization Office in Viet Nam, Hanoi, Vietnam
| | | | | | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam
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Krauss MJ, Sowles SJ, Sehi A, Spitznagel EL, Berg CJ, Bierut LJ, Cavazos-Rehg PA. Marijuana advertising exposure among current marijuana users in the U.S. Drug Alcohol Depend 2017; 174:192-200. [PMID: 28365173 PMCID: PMC5436304 DOI: 10.1016/j.drugalcdep.2017.01.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about marijuana advertising exposure among users in the U.S. We examined the prevalence of advertising exposure among young adult marijuana users through traditional and new media, and identified characteristics associated with seeking advertisements. METHODS We conducted a cross-sectional survey of 18-34 year-old past-month marijuana users in the U.S. using a pre-existing online panel (N=742). The survey queried about passively viewing and actively seeking marijuana advertisements in the past month, sources of advertisements, and marijuana use characteristics. RESULTS Over half of participants were exposed to marijuana advertising in the past month (28% passively observed advertisements, 26% actively sought advertisements). Common sources for observing advertisements were digital media (i.e., social media, online, text/emails; 77%). Similarly, those actively seeking advertisements often used Internet search engines (65%) and social media (53%). Seeking advertisements was more common among those who used medically (41% medical only, 36% medical and recreational) than recreational users (18%), who used concentrates or edibles (44% and 43%) compared to those who did not (20% and 19%), and who used multiple times per day (33%) compared to those who did not (19%) (all p<0.01). CONCLUSIONS Exposure to marijuana advertising among users is common, especially via digital media, and is associated with medical use, heavier use, and use of novel products with higher THC concentrations (i.e., concentrates) or longer intoxication duration (i.e., edibles). As the U.S. marijuana policy landscape changes, it will be important to examine potential causal associations between advertising exposure and continuation or frequency/quantity of use.
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Affiliation(s)
- Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Auriann Sehi
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Edward L Spitznagel
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, USA.
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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Salvi D, Nagarkar A. A qualitative study exploring women's journeys to becoming smokers in the social context of urban India. Women Health 2017; 58:466-482. [PMID: 28328385 DOI: 10.1080/03630242.2017.1310171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In India, the prevalence of smoking among women is increasing, and the reasons behind this are unclear. We aimed to study the factors leading to initiation and maintenance of the smoking habit in women in Pune, India. Twenty-seven urban women smokers, ranging from 21 to 60 years of age (31.96 ± 10.70 years), were interviewed between September 2015 and February 2016. The in-depth interviews consisted of questions on pre-decided categories, including initiation, motivation to continue smoking, and risk perception. Thematic analysis revealed that peer pressure, curiosity, fascination, experimentation, and belonging to a group were factors that led to initiation, while lack of alternatives for stress relief, work environments, and lack of leisure time activities provided circumstances to continue smoking. Participants recognized a sense of liberation and independence from smoking cigarettes and perceived health risks as minor and distant. These findings can be used to develop or modify interventions to prevent and control smoking among urban Indian women.
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Affiliation(s)
- Devashri Salvi
- a Interdisciplinary School of Health Sciences , Savitribai Phule Pune University , Pune , Maharashtra , India
| | - Aarti Nagarkar
- a Interdisciplinary School of Health Sciences , Savitribai Phule Pune University , Pune , Maharashtra , India
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Shuja M, Sarrafzadegan N, Roohafza HR, Sadeghi M, Ghafari M, Mohammadian M, Mohammadian Hafshejani A. Factors Associated with Cigarette Smoking in Central Parts of Iran. Asian Pac J Cancer Prev 2017; 18:647-653. [PMID: 28440970 PMCID: PMC5464479 DOI: 10.22034/apjcp.2017.18.3.647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: This study aims to assess factors associated with cigarette smoking in central parts of Iran. Materials and methods: We used the data of the post intervention phase of Isfahan Healthy Heart Program (IHHP) that was conducted in 2007. Logistic regression was used for calculating crude and adjusted Odds Ratios (OR). The group with the least prevalence of smoking was considered as the Reference Group (RG) and the OR for other parts of the variable was calculated based on the RG and reported with a confidence interval of 95%. Findings: Generally, 9513 individuals participated in the study, of which 13.5% were smokers (26.2% of men and 0.8% of women). The OR for cigarette smoking in men compared with women in (RG) was 13.89 (95% Confidence Interval (CI) 7.44–24.82). Among rural areas, compared with urban areas in (RG), the OR was 0.98 (95% CI 0.82–1.15); and among elementary education level compared to illiterate individuals the OR was 4.37 (95% CI 1.68–10.76). The OR in individuals in the age group 35–44, compared with the age group of 65 and older in (RG) was 2.49 (95% CI 1.81–3.45). The place most used for cigarette smoking was streets (72.1%); and the main reason for starting or continuing cigarette smoking, according to smokers’ opinions, was pleasure and fun. Conclusion: The highest number of smokers was in 35-44 years men, in rural areas, with elementary education level; so, they are the ones who need more attention through implementation of educational programs for awareness, improved attitudes and practices, and smoking cessation programs.
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Affiliation(s)
- Mujtaba Shuja
- Researcher, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Paskett ED. The New Vital Sign: Where Do You Live? Cancer Epidemiol Biomarkers Prev 2017; 25:581-2. [PMID: 27196090 DOI: 10.1158/1055-9965.epi-16-0146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
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Simon P, Camenga DR, Kong G, Connell CM, Morean ME, Cavallo DA, Krishnan-Sarin S. Youth E-cigarette, Blunt, and Other Tobacco Use Profiles: Does SES Matter? TOB REGUL SCI 2017; 3:115-127. [PMID: 29082301 PMCID: PMC5654631 DOI: 10.18001/trs.3.1.12] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined the associations between socioeconomic status (SES) and adolescent polytobacco use profiles (including e-cigarettes and blunts). METHODS Adolescents (N = 1932) completed surveys conducted in 2014 in 3 Connecticut high schools. Within a Latent Class Analysis (LCA) framework, logistic regressions examined associations between SES and polytobacco use profiles comprising never, ever, and current e-cigarette, blunt, cigarette, cigar, cigarillo, hookah, and smokeless tobacco use. RESULTS We identified 5 classes: (1) current polytobacco users; (2) ever polytobacco users; (3) current e-cigarette, blunt, and cigarette users; (4) ever e-cigarette and blunt users; and (5) never users. Low SES, relative to high SES, was associated with greater likelihood of being: (1) an ever polytobacco user; (2) a current e-cigarette, blunt, and cigarette user; and (3) an ever e-cigarette and blunt user, relative to a never user. CONCLUSIONS Low SES is associated with membership in distinct polytobacco use latent classes. Regulatory initiatives that focus exclusively on cigarette use may miss the opportunity to influence adolescent use of other products, which may be especially relevant to low-income individuals. Future research should examine whether targeting a broader range of products reduces SES-related tobacco use disparities.
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Affiliation(s)
- Patricia Simon
- Yale School of Medicine, Department of Psychiatry & The Consultation Center, New Haven, CT
| | - Deepa R Camenga
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | - Grace Kong
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Christian M Connell
- Yale School of Medicine, Department of Psychiatry & The Consultation Center, New Haven, CT
| | | | - Dana A Cavallo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
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Affiliation(s)
| | - Sarah Moody-Thomas
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA, USA
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Vasiljevic D, Mihailovic N, Radovanovic S. Socioeconomic Patterns of Tobacco Use–An Example from the Balkans. Front Pharmacol 2016; 7:372. [PMID: 27807419 PMCID: PMC5069418 DOI: 10.3389/fphar.2016.00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Dragan Vasiljevic
- Department of Hygiene and Human Ecology, Faculty of Medical Sciences, University of Kragujevac and Institute of Public Health KragujevacKragujevac, Serbia
- *Correspondence: Dragan Vasiljevic
| | - Natasa Mihailovic
- Center for Informatics and Biostatistics, Institute of Public Health KragujevacKragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac and Institute of Public Health KragujevacKragujevac, Serbia
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Sinha DN, Suliankatchi RA, Amarchand R, Krishnan A. Prevalence and Sociodemographic Determinants of Any Tobacco Use and Dual Use in Six Countries of the WHO South-East Asia Region: Findings From the Demographic and Health Surveys. Nicotine Tob Res 2016; 18:750-6. [PMID: 26729735 DOI: 10.1093/ntr/ntv286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/23/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Tobacco control is an important strategy to reduce the disease burden caused by several noncommunicable diseases. An in-depth understanding of the sociodemographic variations in tobacco use is an important step in achieving effective tobacco control. AIMS We aimed to estimate the age-standardized prevalence of any tobacco use and dual tobacco use and determine their association with sociodemographic variables in six countries (Bangladesh, Indonesia, India, Maldives, Nepal, and Timor Leste) of the WHO South-East Asia Region. METHODS The main outcome variables "any tobacco use" and "current dual use" were created from the latest available Demographic and Health Surveys data for each country. The prevalence estimates were weighted using sample weights and age standardized using the WHO standard population. Associations between the sociodemographic variables and tobacco use were calculated by performing multivariable logistic regression analysis. Analyses were performed in Stata 12 using "svyset" and "svy" commands. RESULTS The highest prevalence of any tobacco use among men was in Indonesia (76.4%) and among women in Nepal (15.7%). Also, Nepal had the highest prevalence of dual tobacco use in both men (17.9%) and women (1.5%). With regard to sociodemographic determinants, despite the inter-country variations, any and dual tobacco use were significantly associated with age, higher education, greater wealth, rural residence, and ever-married marital status. The poor and uneducated had a higher odds ratio for these practices. CONCLUSION Prevalence of dual tobacco use and its underlying socioeconomic disparities should be taken into account for the planning of tobacco control activities in the region. IMPLICATIONS The dual tobacco use phenomenon is being increasingly recognized as a distinct entity in the fight against tobacco addiction. When compared with single product users, dual users have a greater risk of developing tobacco related diseases and are less likely to quit their habits. However, this phenomenon has not been studied adequately in the South-East Asia region. In this context, this study has provided a detailed and comprehensive view of dual tobacco use and its sociodemographic determinants in six countries of the region. This study recommends that tobacco control interventions should be targeted specifically at the disadvantaged sections of the society, such as the poor and the uneducated, who are more likely to engage in "dual" as well as "any" tobacco use. This study could prove as an important reference and tool for policy making in the South-East Asia region.
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Affiliation(s)
- Dhirendra N Sinha
- Tobacco Free Initiative Unit, World Health Organization, Regional Office for South-East Asia, New Delhi, India;
| | - Rizwan A Suliankatchi
- Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Cunradi CB, Moore RS, Battle RS, Yerger VB. Smoking, Work Stress, and Barriers to Participation in HMO Smoking Cessation Treatment Among Transit Workers: Focus Group Results. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2015. [DOI: 10.1080/15555240.2015.1027823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Li X, Holahan CK, Holahan CJ. Sociodemographic and Psychological Characteristics of Very Light Smoking Among Women in Emerging Adulthood, National Survey of Drug Use and Health, 2011. Prev Chronic Dis 2015; 12:E111. [PMID: 26182146 PMCID: PMC4509100 DOI: 10.5888/pcd12.140547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Although smoking prevalence and average cigarette consumption have declined, very light smoking (5 or fewer cigarettes per day) has increased. Very light smoking is common among young adult women. This study examines the differences between the sociodemographic and psychosocial factors associated with women in emerging adulthood who are very light smokers and similar women who are at other smoking levels. Methods The sample consisted of 9,789 women aged 18 to 25 years who took part in the 2011 National Survey on Drug Use and Health in the United States. Variables were sociodemographic factors, psychological adjustment, substance misuse, smoking attitudes, daily smoking, age at smoking initiation, and nicotine dependence. Analyses used were χ2 and multinomial logistic regression. Results Almost a fifth of participants and about three-fifths of smokers were very light smokers (no more than 5 cigarettes per day). Very light smokers were relatively more likely than other smokers to be young (aged 18 to 20), to be from a minority group, and to have some college education. They also were less likely to be married. The characteristics of very light smokers (poor psychological adjustment and tendency to misuse other substances) were similar to the characteristics of other smokers. However, very light smokers were more likely than other smokers to recognize high risks in smoking, less likely to report nicotine dependence, and more likely to be nondaily smokers. Conclusion Prevention programs targeting women in emerging adulthood need to recognize the prevalence of very light smoking in this population. Although comorbid psychological disorders and substance use present challenges, very light smokers’ perception of higher smoking risks and lower nicotine dependence compared with that of other smokers provide intervention opportunities.
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Affiliation(s)
- Xiaoyin Li
- University of Texas at Austin, Austin, Texas
| | - Carole K Holahan
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX 78712.
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Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review. Tob Induc Dis 2015; 13:11. [PMID: 25908932 PMCID: PMC4407357 DOI: 10.1186/s12971-015-0036-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/28/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the 'smoking epidemic' in the countries of origin and host countries of the immigrants. METHODS We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made. RESULTS We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men. CONCLUSION Immigrants' countries of origin and host countries have reached different stages of the 'smoking epidemic' where, in addition, smoking among women lags behind that in men. Immigrants might 'move' between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the 'imported' high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation.
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Pförtner TK, Moor I, Rathmann K, Hublet A, Molcho M, Kunst AE, Richter M. The association between family affluence and smoking among 15-year-old adolescents in 33 European countries, Israel and Canada: the role of national wealth. Addiction 2015; 110:162-73. [PMID: 25220260 DOI: 10.1111/add.12741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/27/2013] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Abstract
AIMS To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS The difference in smoking prevalence between rich and poor is greater in more affluent countries.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Medical Faculty, University of Cologne, Cologne, Germany
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Abstract
INTRODUCTION The prominence of socioeconomic and ethnic disparities in tobacco use has led to increased policy attention on smoking inequalities in many countries. In 2008 the UK Department of Health held a consultation on the future of tobacco control, including a focus on reducing socioeconomic inequalities in smoking, to which tobacco companies made written submissions. These organisations have historically opposed regulation, favouring a depiction of smoking that emphasises individual choice and downplays broader influences such as industry activities. METHODS We undertook thematic analysis of submissions from tobacco manufacturers and allied organisations, with particular focus on industry engagement with health inequalities. RESULTS Alongside well-established arguments (including defence of individual liberty and challenges to scientific evidence), industry actors adopted and misrepresented the language of health inequalities and the social determinants of health in order to oppose specific tobacco control interventions including tobacco taxation, denormalisation of smoking and cessation support. While industry submissions generally opposed state regulation of the tobacco market, tobacco companies argued for increased government investment in harm reduction products and in countering illicit trade. CONCLUSIONS Tobacco companies co-opted and misrepresented a social determinants model of health to argue against government regulation of the tobacco market. By drawing on this model, tobacco companies are misappropriating a powerful public health discourse in an attempt to create a false dichotomy between reducing inequalities and regulating of the tobacco market. Such tactics highlight the need for ongoing monitoring of industry attempts to undermine tobacco control policy, particularly with reference to harm reduction.
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Affiliation(s)
| | - Sarah Hill
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, Midlothian, UK
| | - Jeff Collin
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, Midlothian, UK
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Brown-Johnson CG, England LJ, Glantz SA, Ling PM. Tobacco industry marketing to low socioeconomic status women in the U.S.A. Tob Control 2014; 23:e139-46. [PMID: 24449249 PMCID: PMC4105326 DOI: 10.1136/tobaccocontrol-2013-051224] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Describe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the U.S.A. METHODS Analysis of previously secret tobacco industry documents. RESULTS Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, 'discount-susceptible' older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands. CONCLUSIONS Tobacco companies used numerous marketing strategies to reach low SES females in the U.S.A. for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women.
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Affiliation(s)
- Cati G. Brown-Johnson
- Center for Tobacco Control Research and Education University of California, San Francisco 350 Parnassus Ave. suite 366 San Francisco, California 94143-1390 USA
| | - Lucinda J. England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, GA
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education University of California, San Francisco 350 Parnassus Ave. suite 366 San Francisco, California 94143-1390 USA
- Division of Cardiology, Department of Medicine, Philip R Lee Institute for Health Policy Studies University of California, San Francisco 350 Parnassus Ave. suite 366 San Francisco, California 94143-1390 USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education University of California, San Francisco 350 Parnassus Ave. suite 366 San Francisco, California 94143-1390 USA
- Division of General Internal Medicine, Department of Medicine University of California, San Francisco 350 Parnassus Ave. suite 366 San Francisco, California 94143-1390 USA
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Hefler M, Chapman S. Disadvantaged youth and smoking in mature tobacco control contexts: a systematic review and synthesis of qualitative research. Tob Control 2014; 24:429-35. [PMID: 25326217 DOI: 10.1136/tobaccocontrol-2014-051756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/03/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To review qualitative research and synthesise findings about socioeconomically disadvantaged and socially marginalised adolescents and young adults in mature tobacco control contexts. DATA SOURCES Searches of PubMed and MEDLINE, additional purposive searches in Google Scholar, PsycINFO, grey literature, specialist journals and reference lists for English language articles published after 2000. Search terms were qualitative, youth or adolescent or young adult, smoking/tobacco and vulnerable populations or disadvantage or socioeconomic inequality. The most recent update of the search was undertaken in January 2014. STUDY SELECTION Twenty articles, reporting on 17 studies, from 902 initial records were included. Inclusion criteria were: qualitative study undertaken in a country in the final stage of the tobacco epidemic and with comprehensive tobacco control measures in place, participants were youth who were socioeconomically disadvantaged or members of an identified subgroup with higher smoking prevalence and/or resided in a geographical area of low socioeconomic status. The target age range was 10-24. DATA EXTRACTION Data were independently extracted by one author, summarised and reviewed, compared and re-reviewed at multiple time points. DATA SYNTHESIS The majority of studies were from the UK, with the remainder from the USA, Australia and New Zealand. The review used a thematic analysis approach, and started with an open question: 'what does qualitative research tell us about disadvantaged young people and smoking?' The synthesis provides insights into the social context of smoking for marginalised and disadvantaged young people, group affiliation and identity, the role of smoking in social capital and sources of cigarettes. CONCLUSIONS Surprisingly few qualitative studies focused exclusively on smoking and disadvantaged young people were found. Future qualitative studies on the intersection between specific psychosocial characteristics associated with disadvantage and increased smoking risk would be of use to inform approaches to reduce socioeconomic differentials in smoking prevalence.
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Affiliation(s)
- Marita Hefler
- A27-School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Chapman
- A27-School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Courtney RJ, Bradford D, Martire KA, Bonevski B, Borland R, Doran C, Hall W, Farrell M, Siahpush M, Sanson-Fisher R, West R, Mattick RP. A randomized clinical trial of a financial education intervention with nicotine replacement therapy (NRT) for low socio-economic status Australian smokers: a study protocol. Addiction 2014; 109:1602-11. [PMID: 25040447 DOI: 10.1111/add.12669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/04/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Reducing smoking prevalence among smokers from low socio-economic status (SES) is a preventative health priority. Financial stress (e.g. shortage of money or inability to pay bills) may be a major barrier to quitting smoking. This study evaluates the efficacy of a financial education and support programme coupled with pharmacotherapy at improving cessation rates at 8-month follow-up among Australian low SES smokers (people receiving a government pension or allowance). DESIGN A two-group parallel block randomized (ratio 1 : 1) open-label clinical trial (RCT) with allocation concealment will be conducted. Allocation will be concealed to interviewers at data collection-points. SETTING The study will be conducted primarily by telephone with baseline, follow-up interviews and telephone-based support sessions. Nicotine replacement therapy (NRT) delivery will be mail-based. PARTICIPANTS Daily smokers who are interested in quitting smoking and are currently in receipt of government benefits (n = 1046) will be recruited through study advertisements placed in newspapers, posters placed in government social assistance agencies and Quitline telephone-based cessation support services. After completion of a baseline computer-assisted telephone interview, participants will be allocated randomly to control or intervention group using a permuted block approach. INTERVENTION AND COMPARATOR Participants in both groups will receive 8 weeks of free combination NRT plus Quitline support. Participants in the intervention group will also receive four telephone-delivered financial education and support sessions. MEASUREMENTS The primary outcome measure will be prolonged abstinence (at 8-month follow-up) assessed using Russell Standard criteria and biochemically verified (urine cotinine). COMMENTS This is the first intervention study to evaluate the potential of co-managing financial stress as a means of enhancing smokers' capacity to quit smoking. Such an intervention may provide a scalable intervention to help low SES smokers to quit.
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Affiliation(s)
- Ryan J Courtney
- National Drug and Alcohol Research Centre, Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
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Sreeramareddy CT, Pradhan PMS, Mir IA, Sin S. Smoking and smokeless tobacco use in nine South and Southeast Asian countries: prevalence estimates and social determinants from Demographic and Health Surveys. Popul Health Metr 2014; 12:22. [PMID: 25183954 PMCID: PMC4151025 DOI: 10.1186/s12963-014-0022-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/11/2014] [Indexed: 02/08/2023] Open
Abstract
Background In South and Southeast Asian countries, tobacco is consumed in diverse forms, and smoking among women is very low. We aimed to provide national estimates of prevalence and social determinants of smoking and smokeless tobacco use among men and women separately. Methods Data from Demographic and Health Surveys completed in nine countries (India, Pakistan, Nepal, Bangladesh, Maldives, Philippines, Cambodia, Indonesia, and Timor Leste) were analyzed. Current smoking or smokeless tobacco use was assessed as response “yes” to one or more of three questions, such as “Do you currently smoke cigarettes?” Weighted country-level prevalence rates for socio-economic subgroups were calculated for smoking and smokeless tobacco use. Binary logistic regression analyses were done on STATA/IC (version 10) by ‘svy’ command. Results Prevalence and type of tobacco use among men and women varied across the countries and among socio-economic sub groups. Smoking prevalence was much lower in women than men in all countries. Smoking among men was very high in Indonesia, Maldives, and Bangladesh. Smokeless tobacco (mainly chewable) was used in diverse forms, particularly in India, among both men and women. Chewing tobacco was common in Nepal, Bangladesh, Maldives, and Cambodia. Both smoking and smokeless tobacco use were associated with higher age, lower education, and poverty, but their association with place of residence and marital status was not uniform between men and women across the countries. Conclusion Policymakers should consider type of tobacco consumption and their differentials among various population subgroups to implement country-specific tobacco control policies and target the vulnerable groups. Smokeless tobacco use should also be prioritized in tobacco control efforts.
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Affiliation(s)
- Chandrashekhar T Sreeramareddy
- Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia
| | - Pranil Man Singh Pradhan
- Consultant Senior Public Health Officer (Influenza Surveillance Project), Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Imtiyaz Ali Mir
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia
| | - Shwe Sin
- Department of Pre-clinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia
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Personal factors associated with smoking among marginalized and disadvantaged youth in Japan. A strong relationship between smoking and convenience store use. Int J Behav Med 2014; 20:504-13. [PMID: 23015471 PMCID: PMC3838587 DOI: 10.1007/s12529-012-9268-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background A national survey in Japan reported that the prevalence of smoking among high school students has sharply decreased in recent years. However, the survey only considered students who attended regular high schools (RHSs), and Japan offers part-time high schools (PHSs) that are often attended by academically and socioeconomically disadvantaged youth. Purpose Therefore, we examined the smoking prevalence and smoking-related factors among PHS students. Method A self-administered questionnaire-based survey was conducted at six PHSs. The subjects included 540 enrolled students aged 15 to 18 years. The questionnaire included items on smoking status, smokers in the family, frequency of convenience store use, lifestyle behaviors, and health awareness. Logistic regression analysis was used to identify factors that were significantly associated with smoking. Results A total of 45.6 % of students had smoking experience, and 29.3 % were smokers. For males and females, the smoking prevalence was about 3 and 7–12 times higher, respectively, than that reported in the national survey. The factors found to be significantly associated with smoking included having a smoker in the family, experience with drinking alcohol, and using convenience store daily (odds ratio [OR] = 12.5) or sometimes (OR = 3.63). There was a significant dose–response relationship between smoking and convenience store use. Conclusion The smoking prevalence among PHS students was remarkably higher than that among RHS students. These findings suggest that marginalized and disadvantaged youth should be targeted for tobacco control, and intervention is needed to protect youth from tobacco sales and advertising at convenience stores.
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Zhang C, Fan J. A study of the perception of health risks among college students in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2133-49. [PMID: 23712317 PMCID: PMC3717728 DOI: 10.3390/ijerph10062133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022]
Abstract
The present survey was designed to investigate the perception of health risks among college students in China. The data are the responses of a sample of 3,069 college students at one university to surveys that include measures of several dimensions of public judgments about fifteen specific hazards. Chinese college students conveyed their concerns as falling into three broad categories: Environmental (e.g., global warming, natural catastrophes, the ozone hole, air pollution, chemical pollution, pesticides in food), Technological (e.g., nuclear power stations, thermal power, genetically modified food, medical X-rays), and Social (cigarette smoking, drinking alcohol, overtime study or work, mental stress, motor vehicle accidents). The data were collected with a self-report questionnaire. Descriptive statistics were used to illustrate the levels of perceived risk according to the percent of "high risk" responses as well as the mean response values. Generally, the hazards that were perceived as posing the greatest health risk were those belonging to the social health risks; items related to technology risks received the lowest percentage of "high health risk" rankings. Traditional environmental risks such as natural catastrophes, pollution issues (chemical pollution, air pollution), and pesticides in food were ranked as being relatively high risks. The respondents were less concerned about new emerging issues and long-term environmental risks (global warming). In this survey, motor vehicle accidents were considered to be a "high health risk" by the greatest percentage of respondents. Generally speaking, the female respondents' degree of recognition of health risks is higher than that of male respondents. Only for the item of smoking was the male respondents' degree higher than that of females. There is also a geographic imbalance in the health risk perceptions. The degree of recognition of health risks from respondents in municipalities is generally lower than that of respondents from other areas except for items such as natural disasters, smoking, medical X-rays, and mental stress, which are exceptions.
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Affiliation(s)
- Chenggang Zhang
- School of Social Sciences, Tsinghua University, Beijing 100084, China
| | - Jingbo Fan
- College of Humanities & Social Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
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Doku D, Darteh EKM, Kumi-Kyereme A. Socioeconomic inequalities in cigarette smoking among men: evidence from the 2003 and 2008 Ghana demographic and health surveys. ACTA ACUST UNITED AC 2013; 71:9. [PMID: 23621799 PMCID: PMC3686574 DOI: 10.1186/0778-7367-71-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/22/2013] [Indexed: 11/25/2022]
Abstract
Background Tobacco use is a public health burden in both developed and developing countries. However, there is still a dearth of nationally representative studies from Sub-Saharan Africa to inform interventions in the region. Socioeconomic trends and disparities in cigarette smoking were explored among Ghanaian men. Method A nationally representative sample of Ghanaian men 15–59 years was surveyed in the 2003 (N = 5015) and 2008 (N = 4568) Ghana Demographic and Health Surveys (N = 9583). Logistic regression analyses were conducted to investigate cigarette smoking by socioeconomic status (SES) and the changes over the two study periods. The results are presented as adjusted odds ratios (AOR) at 95% confidence intervals (CI) Results The prevalence decreased by 1.7% from 9% (95% CI 0.09–0.11) in 2003 to 7.3% (95% CI 0.07–0.09) in 2008. The prevalence of cigarette smoking was higher in the older age groups (25–34 year-olds and 35–59 year-olds) compared to 15–24 year-olds. Education (AOR = 2.2, 95% CI 1.4–3.4; no education vs higher education) and occupation (AOR = 4.2, 95% CI 2.3–7.6; not working vs managerial position) and being in labour force (AOR = 2.6, 95% CI 1.7–4.0) were related to cigarette smoking. Furthermore, religion, wealth (AOR = 3.1 95% CI 2.1–4.5; poorest compared to richest) and rural residence (AOR = 1.8, 95% CI 1.5–2.1) were associated with cigarette smoking. Over the period, cigarette smoking seems to have decreased among Ghanaian male at the population level but not among all groups by age, education, wealth and place of residence. Conclusion Cigarette smoking interventions should be structured to reduce the menace among men. Such interventions must also particularly target lower socioeconomic groups in order to avert an increase in the inequalities in the behaviour and prervent a consequent increase in the socioeconomic gradient in tobacco-related diseases and deaths.
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Affiliation(s)
- David Doku
- Department of Population and Health, University of Cape Coast, Private Mail Bag, University Post Office, Cape Coast, Ghana
| | - Eugene Kofuor Maafo Darteh
- Department of Population and Health, University of Cape Coast, Private Mail Bag, University Post Office, Cape Coast, Ghana
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, University of Cape Coast, Private Mail Bag, University Post Office, Cape Coast, Ghana
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Iglesias-Rios L, Parascandola M. A historical review of R.J. Reynolds' strategies for marketing tobacco to Hispanics in the United States. Am J Public Health 2013; 103:e15-27. [PMID: 23488493 DOI: 10.2105/ajph.2013.301256] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hispanics are the fastest growing racial/ethnic group in the United States, and smoking is the leading preventable cause of morbidity and mortality among this population. We analyzed tobacco industry documents on R. J. Reynolds' marketing strategies toward the Hispanic population using tobacco industry document archives from the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) between February-July 2011 and April-August 2012. Our analysis revealed that by 1980 the company had developed a sophisticated surveillance system to track the market behavior of Hispanic smokers and understand their psychographics, cultural values, and attitudes. This information was translated into targeted marketing campaigns for the Winston and Camel brands. Marketing targeted toward Hispanics appealed to values and sponsored activities that could be perceived as legitimating. Greater understanding of tobacco industry marketing strategies has substantial relevance for addressing tobacco-related health disparities.
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Affiliation(s)
- Lisbeth Iglesias-Rios
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20892, USA.
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Orisatoki R. The public health implications of the use and misuse of tobacco among the Aboriginals in Canada. Glob J Health Sci 2012; 5:28-34. [PMID: 23283033 PMCID: PMC4776962 DOI: 10.5539/gjhs.v5n1p28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 10/25/2012] [Accepted: 10/15/2012] [Indexed: 11/25/2022] Open
Abstract
Tobacco smoking among the Aboriginal populations is a major public health issue in Canada. It remains a major contributory risk factor to the poor health status as well as years of potential life lost seen among the indigenous people. The use of tobacco has a spiritual importance to the people as a means of making connection to the Creator, but unfortunately tobacco smoking has taken a recreational aspect which has little or no connection with Aboriginal spirituality. The non-traditional use of tobacco is believed by the Elders to be disrespectful to the Aboriginal culture and traditional way of life. There is an increase in rate of use of smokeless tobacco as well as smoking of tobacco among the youth with increase in percentage among females. There are socioeconomic implications as well as adverse health effects of the misuse of tobacco on the Aboriginal people that need to be addressed. The healthcare professionals have a unique role in helping patients to reduce tobacco use within the community through programs that are culturally sensitive and relevant. Successful strategies requires general support from the community and it is very important that some of that support comes from community leaders, including spiritual, professional, administrative and elected policy makers.
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Latimer K, Wilson P, Kemp J, Thompson L, Sim F, Gillberg C, Puckering C, Minnis H. Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors. Child Care Health Dev 2012; 38:611-28. [PMID: 22372737 DOI: 10.1111/j.1365-2214.2012.01366.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Disruptive behaviour disorders (DBDs), including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are chronic disorders with significant overlap in aetiology and presentation. An integrative examination of environmental risk factors is lacking. Six literature searches of web-based bibliographic databases were completed to identify literature on DBDs in general and five disorders in particular: CD, ODD, ADHD, deficits of attention, motor control and perception, and reactive attachment disorder. Searches were filtered to focus on studies including diagnostic assessment, focussing on environmental risk and protective factors in the first 4 years of life. The database searches generated 9806 papers of which 47 were reviewed after filters had been applied. The evidence suggests links between a number of early life risk factors and DBDs, including prenatal cigarette smoking and alcohol use, prenatal viral illness, maternal stress and anxiety, low birthweight, peri-partum and early neonatal complications, parental stress and parenting styles in infancy, early deprivation, adoption and separation. Despite the understanding that there is sharing of risk factors between the DBDs, there has been a disproportionate focus on the role of certain risk factors at the expense of others and the field is weakened by difficulties in controlling for all potential confounding variables.
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Affiliation(s)
- K Latimer
- Institute of Mental Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
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Sheffer C, Mackillop J, McGeary J, Landes R, Carter L, Yi R, Jones B, Christensen D, Stitzer M, Jackson L, Bickel W. Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers. Am J Addict 2012; 21:221-32. [PMID: 22494224 DOI: 10.1111/j.1521-0391.2012.00224.x] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tobacco use disproportionately affects lower socioeconomic status (SES) groups. Current explanations as to why lower SES groups respond less robustly to tobacco control efforts and tobacco dependence treatment do not fully account for this disparity. The identification of factors that predict relapse in this population might help to clarify these differences. Good candidates for novel prognostic factors include the constellation of behaviors associated with executive function including self-control/impulsiveness, the propensity to delay reward, and consideration and planning of future events. This study examined the ability of several measures of executive function and other key clinical, psychological, and cognitive factors to predict abstinence for highly dependent lower SES participants enrolled in intensive cognitive-behavioral treatment for tobacco dependence. Consistent with predictions, increased discounting and impulsiveness, an external locus of control as well as greater levels of nicotine dependence, stress, and smoking for negative affect reduction predicted relapse. These findings suggest that these novel factors are clinically relevant in predicting treatment outcomes and suggest new targets for therapeutic assessment and treatment approaches.
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Affiliation(s)
- Christine Sheffer
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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