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Carroll DM, Jennings D, Stately A, Kamath A, Tessier KM, Cotoc C, Egbert A, Begnaud A, Businelle M, Hatsukami D, Pickner W. Pilot randomised controlled trial of a culturally aligned smoking cessation app for American Indian persons. Tob Control 2024:tc-2024-058665. [PMID: 38964856 DOI: 10.1136/tc-2024-058665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To pilot test QuitGuide for Natives, a culturally aligned version of the National Cancer Institute's QuitGuide smartphone app for smoking cessation. METHODS This randomised controlled trial was conducted remotely during 2022-2023. American Indian adults who smoked and resided in the Midwest (n=115) were randomised to QuitGuide for Natives or the general audience QuitGuide smartphone-based intervention. Group differences in feasibility (times the app was initiated), usability, acceptability ('How likely would you be to recommend the app to a friend?'), fit of app with culture and preliminary efficacy (24-hour quit attempts, cotinine-confirmed self-reported 7-day abstinence) outcomes were examined. RESULTS QuitGuide for Natives versus the general audience QuitGuide did not differ in the number of times the app was opened (adjusted incidence rate ratio 0.94 (95% CI 0.63 to 1.40); p=0.743) nor in usability score (adjusted mean difference (aMD) 0.73 (95% CI: -5.00 to 6.46); p=0.801) or likeliness of recommending the app to a friend (aMD 0.62 (95% CI -0.02 to 1.27); p=0.058). Differences were observed for all cultural fit outcomes such as 'The app fits my American Indian culture (aMD 0.75 (95% CI 0.35 to 1.16); p<0.001). QuitGuide for Natives versus the general audience QuitGuide resulted in an average of 6.6 vs 5.1 24-hour quit attempts (p=0.349) and cotinine-confirmed 7-day abstinence was achieved by 6.9% vs 3.5% (p=0.679). CONCLUSIONS Acceptability, cultural fit and preliminary efficacy findings are encouraging and will inform future, larger-scale evaluation of culturally aligned digital smoking cessation resources for American Indian adults.
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Affiliation(s)
- Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dylan Jennings
- Sigurd Olson Environmental Institute, Northland College, Ashland, Wisconsin, USA
| | - Antony Stately
- Native American Community Clinic, Minneapolis, Minnesota, USA
| | - Amika Kamath
- American Indian Cancer Foundation, Minneapolis, Minnesota, USA
| | - Katelyn M Tessier
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Crina Cotoc
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Egbert
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abbie Begnaud
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Dorothy Hatsukami
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Wyatt Pickner
- American Indian Cancer Foundation, Minneapolis, Minnesota, USA
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Crabtree MA, Stanley LR, Miech RA, Swaim RC. Nicotine use among reservation-area American Indian adolescents compared with a national sample. Drug Alcohol Depend 2024; 257:111124. [PMID: 38387255 PMCID: PMC11031341 DOI: 10.1016/j.drugalcdep.2024.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.
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Affiliation(s)
- Meghan A Crabtree
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA.
| | - Linda R Stanley
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA
| | - Richard A Miech
- Institute for Social Research, University of Michigan, 412 Maynard St, Ann Arbor, MI 48109-1399, USA
| | - Randall C Swaim
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA
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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Khayat A, Berg CJ, Levine H, Rodnay M, Abroms L, Romm KF, Duan Z, Bar-Zeev Y. PMI's IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups. Tob Control 2024; 33:e54-e61. [PMID: 36418166 PMCID: PMC10203057 DOI: 10.1136/tc-2022-057671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI's advertising messages changed during these regulatory periods for both IQOS and cigarettes. METHODS Content analysis of PMI's IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ2 test or Fisher's exact test. RESULTS The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging. CONCLUSIONS IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Xing E, Dai Z, Madar A, Welding K, Smith KC, Cohen JE. The problematic use of cultural symbols on Chinese cigarette packs. Tob Induc Dis 2023; 21:65. [PMID: 37215192 PMCID: PMC10193528 DOI: 10.18332/tid/162301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION China is the world's largest tobacco-consuming nation. With minimal packaging regulations, the Chinese tobacco industry can use many appeals to promote their products, including calling upon traditions and culture to make positive connections between consumers and harmful products. We analyzed the nature and extent of cultural appeals on Chinese cigarette packs. METHODS A total of 610 unique cigarette packs were collected in 2017 from five major Chinese cities (Beijing, Guangzhou, Shanghai, Kunming, and Chengdu) following a systematic protocol. Two trained independent coders knowledgeable about Chinese culture and language coded the packs in accordance with a specially developed codebook encompassing important Chinese cultural symbols. The prevalence of identified elements was determined and interpreted. RESULTS Overall, 60.7% (n=370) of the analyzed Chinese cigarette packs in our sample contained at least one culturally specific appeal. The most common cultural appeals included written arts (n=131; 21.5%), celebratory red as the primary pack color (n=119; 19.5%), visual arts (n=70; 11.4%), and special occasions (n=60; 9.9%). There was a diverse range of cultural appeals present on the packs. CONCLUSIONS Cultural appeals are common on Chinese tobacco packaging, with over 60% of all analyzed packs containing at least one culturally specific element. With China's packaging policies requiring health warning labels to occupy only 35% of the pack, the tobacco industry is allowed plenty of package space to incorporate cultural elements among other appeals. A plain and standardized packaging policy would eliminate the ability for Chinese tobacco companies to use cultural appeals on their cigarette packs.
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Affiliation(s)
- Emily Xing
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Zheng Dai
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
- Department of Economics, The George Washington University, Washington, United States
| | - Alena Madar
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Katherine Clegg Smith
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Pearson J, Giovenco DP, Lewis MJ, Moran M, Ganz O. Natural American Spirit launches 'Sky', the brand's first commercial organic cigarette with a charcoal filter. Tob Control 2023; 32:397-399. [PMID: 34593613 PMCID: PMC8964832 DOI: 10.1136/tobaccocontrol-2021-056731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennifer Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada Reno, Reno, Nevada, USA
| | - Daniel P Giovenco
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - M Jane Lewis
- Rutgers Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Meghan Moran
- Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Tam J, Levy DT, Feuer EJ, Jeon J, Holford TR, Meza R. Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective. Am J Prev Med 2023; 64:S1-S10. [PMID: 36781373 PMCID: PMC10033336 DOI: 10.1016/j.amepre.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
U.S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group previously generated smoking histories for the whole U.S. population using an age, period, and birth cohort (APC) methodological framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U.S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, educational attainment, family income, and for each of the 50 U.S. states and Washington, DC. All-cause mortality relative risks associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, demonstrating the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U.S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Eric J Feuer
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Crocetti AC, Cubillo (Larrakia) B, Lock (Ngiyampaa) M, Walker (Yorta Yorta) T, Hill (Torres Strait Islander) K, Mitchell (Mununjali) F, Paradies (Wakaya) Y, Backholer K, Browne J. The commercial determinants of Indigenous health and well-being: a systematic scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-010366. [PMID: 36319033 PMCID: PMC9628540 DOI: 10.1136/bmjgh-2022-010366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Health inequity within Indigenous populations is widespread and underpinned by colonialism, dispossession and oppression. Social and cultural determinants of Indigenous health and well-being are well described. Despite emerging literature on the commercial determinants of health, the health and well-being impacts of commercial activities for Indigenous populations is not well understood. We aimed to identify, map and synthesise the available evidence on the commercial determinants of Indigenous health and well-being. METHODS Five academic databases (MEDLINE Complete, Global Health APAPsycInfo, Environment Complete and Business Source Complete) and grey literature (Australian Indigenous HealthInfoNet, Google Scholar, Google) were systematically searched for articles describing commercial industry activities that may influence health and well-being for Indigenous peoples in high-income countries. Data were extracted by Indigenous and non-Indigenous researchers and narratively synthesised. RESULTS 56 articles from the USA, Canada, Australia, New Zealand, Norway and Sweden were included, 11 of which were editorials/commentaries. The activities of the extractive (mining), tobacco, food and beverage, pharmaceutical, alcohol and gambling industries were reported to impact Indigenous populations. Forty-six articles reported health-harming commercial practices, including exploitation of Indigenous land, marketing, lobbying and corporate social responsibility activities. Eight articles reported positive commercial industry activities that may reinforce cultural expression, cultural continuity and Indigenous self-determination. Few articles reported Indigenous involvement across the study design and implementation. CONCLUSION Commercial industry activities contribute to health and well-being outcomes of Indigenous populations. Actions to reduce the harmful impacts of commercial activities on Indigenous health and well-being and future empirical research on the commercial determinants of Indigenous health, should be Indigenous led or designed in collaboration with Indigenous peoples.
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Affiliation(s)
- Alessandro Connor Crocetti
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Beau Cubillo (Larrakia)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mark Lock (Ngiyampaa)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Troy Walker (Yorta Yorta)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Karen Hill (Torres Strait Islander)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | | | - Yin Paradies (Wakaya)
- Deakin University Alfred Deakin Institute for Citizenship and Globalisation, Burwood, Victoria, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jennifer Browne
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Tribal Tobacco Use Project II: Planning, Implementation, and Dissemination Using Culturally Relevant Data Collection among American Indian Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137708. [PMID: 35805376 PMCID: PMC9265766 DOI: 10.3390/ijerph19137708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 01/13/2023]
Abstract
American Indians have substantially higher commercial tobacco-related cancer rates when compared to the general population. To effectively combat commercial tobacco-related cancer, it is important that tribal nations obtain current and accurate community-specific data on commercial tobacco use and exposure-related attitudes and behaviors. With the goal to collect, synthesize, and disseminate data on tobacco use, including the role traditional tobacco plays among American Indian people, the American Indian Cancer Foundation (AICAF) and various stakeholders developed and implemented the Tribal Tobacco Use Project II (TTUP II) during 2018-2021. Building upon its predecessor, the Tribal Tobacco Use Project I (TTUP I), TTUP II used principles of community-based participatory research and culturally appropriate methods, such as Reality-Based Research, in partnership with tribal nations. We describe the TTUP II rationale, methods for participant recruitment and data collection, emphasizing the importance of using culturally relevant survey items to disentangle commercial tobacco use from traditional tobacco use. American Indian traditional tobacco is viewed as medicine in these communities with a unique socio-cultural context that must be addressed when engaging in commercial tobacco control efforts in American Indian communities. This approach may be useful to other tribal nations who are interested in conducting culturally relevant tobacco surveillance efforts.
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Struik LL, Werstuik ST, Sundstrom A, Dow-Fleisner S, Ben-David S. Factors that influence the decision to vape among Indigenous youth. BMC Public Health 2022; 22:641. [PMID: 35366834 PMCID: PMC8977012 DOI: 10.1186/s12889-022-13095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/25/2022] [Indexed: 11/02/2022] Open
Abstract
Abstract
Background
The use of e-cigarettes (vaping) among Indigenous youth is much higher than that of their non-Indigenous counterparts, which has raised the concerns of various Indigenous scholars and communities. To better understand the most salient constructs that influence Indigenous youth decision-making around vaping, we co-created a qualitative research study with a Syilx First Nation community that was guided by the Unified Theory of Behavior (UTB).
Methods
Through semi-structured interviews and a sharing circle, we gathered the perspectives and experiences of 16 Syilx youth in British Columbia, Canada. After an initial collaborative coding and training session, the interviews were transcribed and coded by Indigenous peer researchers using Nvivo. Through both directed and conventional qualitative content analysis methods, the final conceptual framework was collaboratively developed.
Results
Syilx youth reported that vaping decision-making is underpinned by colonialism, and the historical disproportionate impact of the tobacco industry. The youth spoke to several individual determinants that influence intentions to vape (e.g., vaping helps you cope) and to not vape (e.g., family and community connectedness), and determinants that translate intentions to vape to decision to vape (e.g., access to vaping), and to not vape (e.g., access to trusted adults and support from the band). The youth suggested that prevention efforts must be informed by an understanding of why Indigenous youth vape and what strengthens their resolve to not vape.
Conclusions
Vaping decision-making among Indigenous youth is underpinned by their cultures, contexts, and histories. To effectively address vaping among Indigenous youth, continued engagement of Indigenous youth in planning, developing, implementing, and evaluating both prevention and policies efforts is a necessity.
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Maddox R, Bovill M, Waa A, Gifford H, Tautolo ES, Nez Henderson P, Martinez S, Clark H, Bradbrook S, Calma T. Reflections on Indigenous commercial tobacco control: 'The dolphins will always take us home'. Tob Control 2022; 31:348-351. [PMID: 35241610 DOI: 10.1136/tobaccocontrol-2021-056571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Raglan Maddox
- Modewa Clan, Milne Bay, Papua New Guinea
- Aboriginal and Torres Strait Islander Health Group, National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Bovill
- Wiradjuri, New South Wales, New South Wales, Australia
- School of Health and Medicine, Hunter Medical Research Institute, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Aotearoa, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Heather Gifford
- Ngāti Hauiti, Aotearoa, New Zealand
- Research for Māori Health and Development, Whakauae Research Services, Whanganui, New Zealand
| | - El-Shadan Tautolo
- Samoa/Ngāti Tapuniu, Samoa, Samoa
- AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Patricia Nez Henderson
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Sydney Martinez
- Cherokee Nation Citizen, Tahlequah, Oklahoma, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hershel Clark
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Shane Bradbrook
- Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu, Aotearoa, New Zealand
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group, Northern Territory, South Australia, Australia
- Office of the National Coordinator, Tackling Indigenous Smoking, Canberra, Australian Capital Territory, Australia
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Chandran M, Schulman KA. HSR Invited Commentary Racial Disparities in Healthcare and Health. Health Serv Res 2022; 57:218-222. [PMID: 35184275 PMCID: PMC8928009 DOI: 10.1111/1475-6773.13957] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mayuri Chandran
- Department of Medicine, School of Medicine Stanford University
| | - Kevin A. Schulman
- Clinical Excellence Research Center, School of Medicine Stanford University
- Graduate School of Business Stanford University
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Nez Henderson P, Lee JP, Soto C, O′Leary R, Rutan E, D′Silva J, Waa A, Henderson ZP, Nez SS, Maddox R. Decolonization of Tobacco in Indigenous Communities of Turtle Island (North America). Nicotine Tob Res 2022; 24:289-291. [PMID: 34516637 PMCID: PMC8807169 DOI: 10.1093/ntr/ntab180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Patricia Nez Henderson
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Juliet P Lee
- Pacific Institute for Research and Evaluation-California, Prevention Research Center, Berkeley, CA, USA
| | - Claradina Soto
- Navajo Nation (Diné)/ Jemez Pueblo, Los Angeles, CA, USA
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Rae O′Leary
- Turtle Mountain Band of Chippewa, Timber Lake, SD, USA
- Missouri Breaks Research Industries, Inc., Timber Lake, SD, USA
| | - Emma Rutan
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | | | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Wellington, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Zahlanii P Henderson
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Shanoa S Nez
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Raglan Maddox
- Modewa Clan, Papua New Guinea, Canberra, Australian Capital Territory, Australia
- Aboriginal and Torres Strait Islander Health, National Centre for Epidemiology and Population Health, Australian Nation University, Canberra, Australian Capital Territory, Australia
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Sheffer CE, Williams JM, Erwin DO, Smith PH, Carl E, Ostroff JS. Tobacco-Related Disparities Viewed Through the Lens of Intersectionality. Nicotine Tob Res 2022; 24:285-288. [PMID: 34555170 PMCID: PMC8807250 DOI: 10.1093/ntr/ntab193] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Despite remarkable progress, tobacco control efforts are not equitably distributed, and tobacco-related disparities continue to contribute to significant health disparities. Our premise in this commentary is that Intersectionality can serve as a productive analytical framework for examining tobacco-related disparities across and within multiple marginalized populations. Intersectionality is a theoretical framework for understanding the multiple interlocking societal systems that bestow privilege and oppression and is increasingly being to the study of health inequities. We present a model and describe how tobacco-related disparities can be understood via critical elements of Intersectionality. We conclude that the application of Intersectionality to understanding tobacco-related disparities has potential to stimulate meaningful discussion and lead to new and innovative multilevel and cross-cutting interventions to eliminate tobacco-related disparities and foster culturally safe environment in which all people can thrive. IMPLICATIONS This commentary describes how Intersectionality can serve as a productive analytic framework for examining the development and maintenance of tobacco-related disparities across and within many marginalized groups.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Phillip H Smith
- Department of Kinesiology, Nutrition, and Health, Miami University, Oxford, OH, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Michos ED, Reddy TK, Gulati M, Brewer LC, Bond RM, Velarde GP, Bailey AL, Echols MR, Nasser SA, Bays HE, Navar AM, Ferdinand KC. Improving the enrollment of women and racially/ethnically diverse populations in cardiovascular clinical trials: An ASPC practice statement. Am J Prev Cardiol 2021; 8:100250. [PMID: 34485967 PMCID: PMC8408620 DOI: 10.1016/j.ajpc.2021.100250] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death for both women and men worldwide. In the United States (U.S.), there are significant disparities in cardiovascular risk factors and CVD outcomes among racial and ethnic minority populations, some of whom have the highest U.S. CVD incidence and mortality. Despite this, women and racial/ethnic minority populations remain underrepresented in cardiovascular clinical trials, relative to their disease burden and population percentage. The lack of diverse participants in trials is not only a moral and ethical issue, but a scientific concern, as it can limit application of future therapies. Providing comprehensive demographic data by sex and race/ethnicity and increasing representation of diverse participants into clinical trials are essential in assessing accurate drug response, safety and efficacy information. Additionally, diversifying investigators and clinical trial staff may assist with connecting to the language, customs, and beliefs of study populations and increase recruitment of participants from diverse backgrounds. In this review, a working group for the American Society for Preventive Cardiology (ASPC) reviewed the literature regarding the inclusion of women and individuals of diverse backgrounds into cardiovascular clinical trials, focusing on prevention, and provided recommendations of best practices for improving enrollment to be more representative of the U.S. society into trials.
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Affiliation(s)
- Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Tina K. Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA
| | - LaPrincess C. Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Rachel M. Bond
- Internal Medicine, Creighton University School of Medicine, Chandler, AZ USA
- Women's Heart Health, Dignity Health, AZ USA
| | - Gladys P. Velarde
- Division of Cardiology, University of Florida Health, Jacksonville, FL USA
| | | | - Melvin R. Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA USA
| | - Samar A. Nasser
- Division of Clinical Research and Leadership, George Washington University School of Medicine, Washington, DC USA
| | - Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
| | - Ann Marie Navar
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX USA
| | - Keith C. Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA USA
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16
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Epperson AE, Prochaska JJ. Native owned and grown or demeaning and offensive? American Indian adults' perspectives on Natural American Spirit branded cigarettes. Tob Control 2021; 32:393-396. [PMID: 34599085 DOI: 10.1136/tobaccocontrol-2021-056736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/02/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Owned by a major US tobacco company with no American Indian/Alaska Native (AI/AN) tribal affiliation, Natural American Spirit (NAS) cigarette packs feature an American Indian warrior, thunderbird and peace pipe. The current study examined AI/AN adults' perceptions of NAS cigarette packs in the US, which have not been reported on prior. METHODS AI/AN adults were recruited via Qualtrics national panels (n=500; 64% female, age M=39.9 years, 47% current smokers) in 2020. After viewing NAS pack images online (front, back and sides), participants were asked about NAS tribal affiliation, health perceptions and purchase intentions. Participants also wrote-in what the NAS pack logos meant to them. RESULTS Most participants (65%) believed NAS is AI/AN-owned and/or grown on tribal lands. Among current smokers, beliefs of an AI/AN affiliation were associated with misperceptions of NAS being a healthier cigarette and with greater intention to purchase NAS cigarettes (p's<0.01). Participants who did not believe NAS was grown or owned by AI/AN tribes were more likely to describe the NAS warrior logo as cultural misappropriation (17%) than participants who believed NAS was AI/AN tribally affiliated (4%, p<0.001). CONCLUSIONS The findings indicate a dichotomy in beliefs among surveyed AI/AN adults regarding NAS brand cigarettes. A majority held the misconception that NAS is tribally affiliated, while an informed and concerned minority characterised the branding as cultural misappropriation. The current packaging is reasonably expected to result in beliefs that NAS cigarettes are AI/AN tribally affiliated, and these beliefs may be associated with misperceptions of lesser harm.
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Affiliation(s)
- Anna E Epperson
- Department of Psychological Sciences, University of California, Merced, Merced, California, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford, California, USA
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Moran MB, Heley K, Czaplicki L, Weiger C, Strong D, Pierce J. Tobacco Advertising Features That May Contribute to Product Appeal Among US Adolescents and Young Adults. Nicotine Tob Res 2021; 23:1373-1381. [PMID: 33377146 PMCID: PMC8360628 DOI: 10.1093/ntr/ntaa275] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Cigarette advertising is a causal agent of smoking uptake among young people. Although prior research links ad receptivity to tobacco product interest and use, little is known regarding the specific advertising tactics associated with increased product appeal among young people. METHODS A national sample of 13-20 year-olds (N = 3688, youth) and 21-24 year-olds (N = 1556, young adults) in the US participated in an online survey in 2017 (mean age 18.1 years). The majority (72.0%) of youth and nearly half (44.8%) of young adults were never smokers. Participants were shown a cigarette ad, randomly assigned from a pool of 50 advertisements, and reported how much they liked the ad, and were curious about and interested in using the advertised product. All 50 advertisements were content analyzed for a variety of features. Data from the survey and content analysis were merged and mixed effects analyses used to identify the features associated with increased liking, curiosity, and interest in using, referred to collectively as product appeal. RESULTS Presence of a sweepstakes offer was associated with increased liking, curiosity and interest among youth and curiosity and interest among young adults. Outdoors settings, flora imagery, natural descriptors, and environmental themes were associated with increased appeal. Price reductions (eg, coupons) were associated with decreased appeal among youth. CONCLUSIONS This study identified several advertising tactics associated with increased appeal among youth and young adults. If additional research confirms these findings, the U.S. Food and Drug Association should consider restricting use of these tactics in tobacco advertising. IMPLICATIONS This study's findings provide insight into features of cigarette ads that appeal to youth and young adults. Overall, the presence of sweepstakes appealed to youth and young adults and outdoors and environmental themes were particularly appealing to young adults. Such tactics could serve to further brand engagement, improve brand image and lead to initiation or escalation of use. If confirmatory studies further demonstrate the effects of the tactics identified in this study on youth product appeal, U.S. Food and Drug Administration should consider using its authority to restrict the use of youth-appealing tactics.
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Affiliation(s)
- Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Heley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Weiger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
| | - John Pierce
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
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Affiliation(s)
- Andrew Waa
- Public Health, University of Otago, Wellington, New Zealand
- Ngati Hine/Ngapuhi
| | - Raglan Maddox
- Aboriginal and Torres Strait Islander Health Program, National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Modewa Clan
| | - Patricia Nez Henderson
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
- Navajo Nation (Diné)
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Wilson D. The haka: Wonderful bonding, sending a challenge in a global crisis or merely cultural appropriation? J Clin Nurs 2020; 29:3588-3590. [PMID: 32416016 DOI: 10.1111/jocn.15319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Denise Wilson
- Ngāti Tahinga, Aotearoa, New Zealand.,Faculty of Health and Environmental Sciences, Taupua Waiora Māori Research Centre, Auckland University of Technology, Auckland, New Zealand
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Azagba S, Shan L, Latham K, Qeadan F. Trends in cigarette smoking among American Indians and Alaska Natives in the USA: 1992-2015. Cancer Causes Control 2020; 31:73-82. [PMID: 31734765 DOI: 10.1007/s10552-019-01250-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE While smoking prevalence may be declining in the general population, health disparities in tobacco use remain a public health priority. This study examined national, sociodemographic, and geographic trends in American Indians and Alaska Natives (AIs/ANs) smoking prevalence from 1992/1993 to 2014/2015. Additionally, correlates of cigarette smoking were examined among this group. METHODS Data were drawn from the 1992-2015 Tobacco Use Supplement to the Current Population Survey. Cochran-Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by sociodemographic characteristics. Multivariable logistic regression was conducted to examine the correlates of cigarette smoking for AIs/ANs in 2014/2015. RESULTS The trend analysis indicated that the prevalence of smoking, among AIs/ANs, decreased significantly from 39.1% in the 1992/1993 cycle to 20.9% in the 2014/2015. This decrease was seen in both males and females, with the prevalence of smoking decreasing from 43.6% and 35.4%, respectively, in 2006/2007 to 23.8% and 18.3% in 2014/2015. The decreasing trend was also found for all subgroups, except for the 55+ age group. Multivariable analysis showed higher odds of smoking among males, those with low income compared to those with median or higher income, and those living in non-metropolitan areas. Those aged 25-54 were more likely to be smokers compared with the 55+ age group. CONCLUSIONS Results indicate a recent decrease in AIs/ANs smoking prevalence, although these populations still experience a high prevalence of smoking compared to the general population. Our findings highlight the need for a comprehensive tobacco control strategy that includes working with stakeholders within the AI/AN community.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA.
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
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Smiley SL, Soto C, Cruz TB, Kintz N, Rodriguez YL, Sussman S, Baezconde-Garbanati L. Point-of-sale marketing of little cigars and cigarillos on and near California Tribal lands. Tob Control 2020; 29:122-124. [PMID: 30385648 PMCID: PMC6690808 DOI: 10.1136/tobaccocontrol-2018-054558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the USA. Tobacco marketing at point-of-sale is associated with smoking, possibly due to easy access to cheap tobacco products. The sale of novel tobacco products like little cigars/cigarillos (LCCs) has increased in recent years which may further increase combustible tobacco use among American Indians. METHODS Between October 2015 and February 2017, trained community health workers collected LCC product and price information by conducting audits of tobacco retailers on Tribal lands (n=53) and retailers within a 1-mile radius of Tribal lands (n=43) in California. Χ2 analyses were performed to examine associations among the availability and advertising of LCCs, including indoor price promotions and store location. RESULTS Overall, 85.4% of stores sold LCCs, 76.0% sold flavoured LCCs and 51.0% sold LCCs for less than $1. Indoor price promotions were displayed at 45 (46.9%) stores. Stores within a 1-mile radius of Tribal lands sold significantly more LCC (p<0.01) and flavoured LCCs (p=0.01) than stores on Tribal lands. Stores within a 1-mile radius of Tribal lands also displayed significantly more LCCs priced at less than $1 (p<0.01) than stores on Tribal lands. CONCLUSIONS LCCs are widely available in stores on and near California Tribal lands. Stores located a short distance away from Tribal lands were more likely to sell LCCs, including flavoured versions, more likely to sell LCCs priced below $1, and more likely to advertise little LCC price promotions than stores on Tribal lands. Policy-makers and Tribal leaders should consider regulations that would limit access to LCCs at point of sale to help prevent youth initiation and reduce smoking-related morbidity and mortality among American Indians.
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Affiliation(s)
- Sabrina L Smiley
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Claradina Soto
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tess Boley Cruz
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Natalie Kintz
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yaneth L Rodriguez
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steve Sussman
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lourdes Baezconde-Garbanati
- Tobacco Center of Regulatory Science for Vulnerable Populations, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Epperson AE, Johnson TO, Schleicher NC, Henriksen L. The Price of Natural American Spirit Relative to Other Cigarette Brands. Nicotine Tob Res 2019; 21:1715-1720. [PMID: 30759248 PMCID: PMC6861830 DOI: 10.1093/ntr/ntz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION American Spirit cigarettes feature American Indian/Alaska Native (AI/AN) imagery in the branding and are marketed as environmentally friendly, without additives, and four varieties contain organic tobacco. This study is the first to examine retail price of American Spirit relative to other cigarette brands and to assess how its price varies by neighborhood demography. METHODS In a random sample of licensed tobacco retailers (n = 1277), trained data collectors recorded availability and price of American Spirit, Pall Mall, Newport, Marlboro, and the cheapest cigarettes regardless of brand. Data were collected in January-March 2017 in California, the state with the largest AI/AN population. Paired t tests assessed prices (before sales tax) of American Spirit relative to others. Ordinary least squares regressions modeled prices as a function of neighborhood demography, adjusting for store type. RESULTS American Spirit was sold in 77% of stores at an average price of $7.03 (SD = 0.66), which was $0.75-$1.78 (12.0%-34.4%) higher than Pall Mall, Newport, and Marlboro in the same stores. American Spirit costs significantly less in neighborhoods with a higher proportion of school-age residents; however, this pattern was not unique to that brand. Contrary to expectation, American Spirit did not cost less in neighborhoods with a higher proportion of AI/ANs. CONCLUSION This study is the first to document lower prices for American Spirit in neighborhoods with a higher proportion of school-age youth. Future research should consider whether the ultra-premium price of American Spirit contributes to misperceptions that the brand is organic and less harmful than other cigarettes. IMPLICATIONS In a large random sample of licensed tobacco retailers in California, American Spirit costs significantly more than other brands, 12.0%-34.4% more than Pall Mall, Newport, and Marlboro in the same stores. After controlling for store type, American Spirit price was significantly lower in neighborhoods with a higher proportion of school-age residents. Research about how an ultra-premium price contributes to misperceptions that all American Spirit varieties are organic and the brand is less harmful and less addictive than other cigarette brands would be informative for ongoing litigation and product regulation.
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Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Trent O Johnson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nina C Schleicher
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Carroll DM, Soto C, Baezconde-Garbanati L, Huang LL, Lienemann BA, Meissner HI, Rose SW, Unger JB, Cruz TB. Tobacco Industry Marketing Exposure and Commercial Tobacco Product Use Disparities among American Indians and Alaska Natives. Subst Use Misuse 2019; 55:261-270. [PMID: 31544562 PMCID: PMC6980664 DOI: 10.1080/10826084.2019.1664589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Non-Hispanic American Indians and Alaska Natives (NH AI/AN) have the highest commercial tobacco use (CTU) among U.S. racial/ethnic groups. Tobacco marketing is a risk factor, however few studies examine it among NH AI/AN. Objective: We identified prevalence of tobacco industry marketing exposure and correlates of CTU among NH AI/AN compared to other racial/ethnic groups. Methods: Data were from wave 1 (2013-2014; N = 32,320) of the Population Assessment of Tobacco and Health Study, analyzing self-reported exposure to tobacco ads from stores, tobacco package displays, direct mail and email marketing. Correlates of CTU were identified and interactions between racial/ethnic groups and tobacco marketing were assessed. Results: NH AI/AN (n = 955) had a higher prevalence of exposure to retail tobacco ads (64.5% vs 59.3%; p < 0.05), mail (20.2% vs.14.3%; p < 0.001) and email (17.0% vs.10.6%; p < 0.001) marketing than NH Whites (n = 19,297). Adjusting for tobacco use and related risk factors, exposure to email marketing remained higher among NH AI/AN than NH Whites. Interactions between racial/ethnic groups and marketing exposures on CTU were nonsignificant. CTU was higher among NH AI/AN than NH Whites and among adults who reported exposure to tobacco ads, mail, and email marketing. Conclusions/importance: There is higher tobacco marketing exposure in stores and via mail for NH AI/AN. Email marketing exposure was higher, even after controlling for tobacco-related risk factors. The tobacco industry may be targeting NH AI/AN through emails, which include coupons and other marketing promotions. Culturally relevant strategies that counter-act tobacco industry direct marketing tactics are needed to reduce disparities in this population.
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Affiliation(s)
- Dana Mowls Carroll
- Tobacco Research Programs, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claradina Soto
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Li-Ling Huang
- PhD Program in Global Health and Health Security, Taipei Medical University, Taipei, Taiwan
| | - Brianna A Lienemann
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Helen I Meissner
- National Institutes of Health, Office of Disease Prevention, Bethesda, Maryland, USA
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, DC, United States
- University of Kentucky College of Medicine, Lexington, KY, United States
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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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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Waa A, Robson B, Gifford H, Smylie J, Reading J, Henderson JA, Nez Henderson P, Maddox R, Lovett R, Eades S, Finlay S, Calma T. Foundation for a Smoke-Free World and healthy Indigenous futures: an oxymoron? Tob Control 2019; 29:237-240. [PMID: 31076451 PMCID: PMC7042962 DOI: 10.1136/tobaccocontrol-2018-054792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Andrew Waa
- Ngati Hine/Ngapuhi.,Eru Pomare Māori Health Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Bridget Robson
- Ngāti Raukawa.,Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Heather Gifford
- Ngāti Hauiti.,Whakauae Maori Health Research and Development, Auckland, New Zealand
| | - Janet Smylie
- Métis, Métis Nation.,Well Living House, Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jeff Reading
- Tyendinega Mohawk First Nation, Haudenosaunee (Iroquois) Confederacy.,I-HEART Centre St. Paul's Hospital, Providence Health Care, British Columbia First Nations Health Authority Chair in Heart Health and Wellness, West Vancouver, British Columbia, Canada
| | - Jeffrey A Henderson
- Cheyenne River Sioux Tribe (Lakota).,Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Patricia Nez Henderson
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA.,Navajo Nation (Diné)
| | - Raglan Maddox
- Well Living House, Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada .,Modewa Clan.,Centre for Research and Action in Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Raymond Lovett
- Ngiyamppa, (Wongaibon).,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sandra Eades
- Noongar.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Summer Finlay
- Yorta Yorta.,Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute and School of Health Sciences, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia.,Vice President (Aboriginal and Torres Strait Islander)-Public Health Association of Australia, Canberra, Australian Capital Territory, Australia.,Co-Vice Chair, Indigenous WorkingGroup, World Federation of Public Health Associations
| | - Tom Calma
- Elder, Kungarakan tribal group and a member of the Iwaidja tribal group.,Consultant to the Commonwealth Department of Health, Indigenous tobacco control advocate, Canberra, Australian Capital Territory, Australia
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Epperson AE, Averett PE, Blanchflower T, Gregory KR, Lee JGL. "The Packaging Is Very Inviting and Makes Smokers Feel Like They're More Safe": The Meanings of Natural American Spirit Cigarette Pack Design to Adult Smokers. HEALTH EDUCATION & BEHAVIOR 2019; 46:260-266. [PMID: 30606071 DOI: 10.1177/1090198118820099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS The aim of this investigation was to identify which design elements on Natural American Spirit packs are salient to (i.e., noticed by) U.S. adult smokers and what meanings smokers derive from these elements. METHOD We conducted a secondary analysis of qualitative data from a study of cigarette packaging design. U.S. adult smokers ( n = 33) from all nine census regions participated in six telephone-based focus groups in March 2017. We used constant comparison analysis to identify key themes. RESULTS Four themes were identified, two focused on salient design elements and two focused on design element meanings. The themes of "bright and flashy color" and "the American Indian logo" were identified as key design elements, while the themes of "healthy and safer" and "targeting at-risk smokers" were identified as meanings smokers derived from design elements. CONCLUSIONS Pack design elements influence smokers' perceptions about reduced health risk of Natural American Spirit cigarettes and may be especially dangerous to vulnerable populations, including young adults and American Indians. Findings from this study suggest that the banning of text descriptors may not be enough to address misconceptions about "healthier" cigarettes.
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