1
|
Ozga JE, Stanton CA, Sargent JD, Steinberg AW, Tang Z, Paulin LM. Geographical location, cigarette risk perceptions, and current smoking among older US adults. Tob Induc Dis 2024; 22:TID-22-158. [PMID: 39268509 PMCID: PMC11391726 DOI: 10.18332/tid/191827] [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: 06/24/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/15/2024] Open
Abstract
INTRODUCTION Cigarette smoking and smoking-related lung disease are more common in rural (vs urban) areas of the United States (US). This study examined relationships between geographical location, cigarette risk perceptions, and current smoking among older adults who are at greatest risk of developing smoking-related lung disease. METHODS The study was a secondary data analysis of 12126 respondents aged ≥40 years from Wave 5 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and Poisson regressions assessed current smoking (vs never or former) as a function of geographical location in a stepwise fashion, first unadjusted, then adjusting for sociodemographic characteristics, and finally for both sociodemographic characteristics and cigarette risk perceptions (4-item scale), in three separate models. Sensitivity analyses examined whether individual risk perceptions items had a greater impact on the association between geographical location and current smoking. RESULTS Current smoking was more common among rural (20.6%) than urban (17.6%) residents. The risk ratio (RR) for rural (vs urban) residence on current smoking decreased from 1.17 (95% CI: 1.03-1.32) to 1.14 (95% CI: 1.01-1.29) to 1.08 (95% CI: 0.96-1.21) across the stepwise models. Lower cigarette risk perceptions confounded the rural-current smoking association and was an independent risk factor for smoking (adjusted RR, ARR=2.15; 95% CI: 1.94-2.18). In sensitivity analyses, believing that cigarettes are very or extremely (vs somewhat, slightly, or not at all) harmful to health and agreeing (vs not agreeing) that secondhand smoke causes lung disease in people who do not smoke, confounded the rural-current smoking association whereas beliefs about smoking causing lung cancer or lung disease in people who smoke did not. CONCLUSIONS Lower cigarette risk perceptions among rural residents confounded the positive association between rural residence and current smoking. Results from sensitivity analyses highlight potential targets for communication campaigns aimed at promoting more accurate perceptions of the harmful health consequences of cigarette smoking.
Collapse
Affiliation(s)
- Jenny E Ozga
- Westat Behavioral Health and Health Policy Practice, Rockville, United States
| | - Cassandra A Stanton
- Westat Behavioral Health and Health Policy Practice, Rockville, United States
| | - James D Sargent
- Department of Pediatrics, Geisel School of Medicine, Hanover, United States
- Department of Pediatrics, Geisel School of Medicine, Hanover, United States
| | - Alexander W Steinberg
- Department of Pulmonary and Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, United States
| | - Zhiqun Tang
- Westat Behavioral Health and Health Policy Practice, Rockville, United States
| | - Laura M Paulin
- Department of Pulmonary and Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, United States
| |
Collapse
|
2
|
Thongpriwan V, Christraksa W, Eyadat A, Gwon SH. Rethinking rural: Public health advocates' views on ENDS cessation for young adults in rural areas. Public Health Nurs 2024. [PMID: 39207208 DOI: 10.1111/phn.13397] [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: 01/22/2024] [Revised: 07/19/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
Electronic nicotine delivery systems (ENDS, commonly referred to as e-cigarettes), have become popular among young adults (YAs, 18-24 years) in the United States. YAs in rural areas increasingly consume more ENDS than those in urban areas. However, there is a knowledge gap regarding the perspectives of public health advocates (PHAs) on ENDS use and cessation among YAs in rural areas. The objectives of the study are to describe the perspectives of PHAs and identify strategies to strengthen the capacity for promoting the cessation of ENDS among YAs in rural communities. A qualitative study and interpretive description were used with semi-structured interviews. The content analysis was used to analyze the data. Twenty-two PHAs, including public health officers, nurses, and tobacco-free educators, from Wisconsin, Minnesota, and North Dakota, were invited to the semi-structured interviews. Four themes emerged: (a) Perceived ENDS use and cessation; (b) rural contexts and infrastructure influencing ENDS use; (c) essential public health responsibilities controlling ENDS use in rural areas; and (d) regulating ENDS use: Policies and law. PHAs stressed the importance of increased awareness of ENDS use in YAs, improved regulation, and tailored policies to tackle rural communities' distinct challenges. The study emphasizes the urgency for specialized programs to aid YAs in quitting ENDS in rural areas. A comprehensive strategy is needed to effectively address ENDS use among YAs in rural areas, involving education, policy adjustments, and community-based initiatives.
Collapse
Affiliation(s)
- Vipavee Thongpriwan
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Wilawan Christraksa
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anwar Eyadat
- Faculty of Nursing, Irbid National University, Irbid, Jordan
| | - Seok Hyun Gwon
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Adjunct Faculty, Clinical and Translational Science Institute of Southeast Wisconsin/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Sharma P, Tranby B, Kamath C, Brockman TA, Lenhart N, Quade B, Abuan N, Halom M, Staples J, Young C, Brewer L, Patten C. Beta Test of a Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FaithCore): Development and Usability Study. JMIR Form Res 2024; 8:e58121. [PMID: 39186365 PMCID: PMC11384179 DOI: 10.2196/58121] [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: 03/06/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Individuals living in rural communities experience substantial geographic and infrastructure barriers to attaining health equity in accessing tobacco use cessation treatment. Social media and other digital platforms offer promising avenues to improve access and overcome engagement challenges in tobacco cessation efforts. Research has also shown a positive correlation between faith-based involvement and a lower likelihood of smoking, which can be used to engage rural communities in these interventions. OBJECTIVE This study aimed to develop and beta test a social intervention prototype using a Facebook (Meta Platforms, Inc) group specifically designed for rural smokers seeking evidence-based smoking cessation resources. METHODS We designed a culturally aligned and faith-aligned Facebook group intervention, FaithCore, tailored to engage rural people who smoke in smoking cessation resources. Both intervention content and engagement strategies were guided by community-based participatory research principles. Given the intervention's focus on end users, that is, rural people who smoked, we conducted a beta test to assess any technical or usability issues of this intervention before any future trials for large-scale implementation. RESULTS No critical beta test technical and usability issues were noted. Besides, the FaithCore intervention was helpful, easy to understand, and achieved its intended goals. Notably, 90% (9/10) of the participants reported that they tried quitting smoking, while 90% (9/10) reported using or seeking cessation resources discussed within the group. CONCLUSIONS This study shows that social media platform with culturally aligned and faith-aligned content and engagement strategies delivered by trained moderators are promising for smoking cessation interventions in rural communities. Our future step is to conduct a large pilot trial to evaluate the intervention's effectiveness on smoking cessation outcomes.
Collapse
Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, United States
| | - Brianna Tranby
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Celia Kamath
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Tabetha A Brockman
- Rural Health Research Core, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| | - Ned Lenhart
- Living Water Church, Cameron, WI, United States
| | - Brian Quade
- Bethesda Lutheran Church, Eau Claire, WI, United States
| | - Nate Abuan
- Valleybrook Church, Eau Claire, WI, United States
| | - Martin Halom
- St. John's Lutheran Church (ELCA), Bloomer, WI, United States
| | | | - Colleen Young
- Mayo Clinic Connect, Health Education & Content Services, Mayo Clinic, Rochester, MN, United States
| | - LaPrincess Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Rural Health Research Core, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
4
|
Semprini J, Gadag K, Williams G, Muldrow A, Zahnd WE. Rural-Urban Cancer Incidence and Trends in the United States, 2000 to 2019. Cancer Epidemiol Biomarkers Prev 2024; 33:1012-1022. [PMID: 38801414 DOI: 10.1158/1055-9965.epi-24-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural-urban differences in cancer incidence and trends. METHODS We used the North American Association of Central Cancer Registries dataset to investigate rural-urban differences in 5-year age-adjusted cancer incidence (2015-2019) and trends (2000-2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEER∗Stat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APC). RESULTS We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared with urban areas (447.9), with the largest rural-urban difference in the South (464.4 vs. 449.3). Rural populations also exhibited higher rates of tobacco-associated, human papillomavirus-associated, and colorectal cancers, including early-onset cancers. Tobacco-associated cancer incidence trends widened between rural and urban from 2000 to 2019, with significant, but varying, decreases in urban areas throughout the study period, whereas significant rural decreases only occurred between 2016 and 2019 (APC = -0.96). Human papillomavirus-associated cancer rates increased in both populations until recently with urban rates plateauing whereas rural rates continued to increase (e.g., APC = 1.56, 2002-2019). CONCLUSIONS Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared with urban populations. Improvements in these rates were typically slower in rural populations. IMPACT Our findings underscore the complex nature of rural-urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.
Collapse
Affiliation(s)
- Jason Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Khyathi Gadag
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Gawain Williams
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Aniyah Muldrow
- Department of Sociology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| |
Collapse
|
5
|
Pan CW, Wang Y, Abboud Y, Dominguez AN, Lo CH, Pang M. Esophageal cancer mortality disparities between Black and White adults in the United States, 1999-2020: insights from CDC-WONDER. J Gastroenterol Hepatol 2024. [PMID: 39048101 DOI: 10.1111/jgh.16689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/16/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIM Esophageal cancer significantly contributes to US cancer mortality, with notable racial disparities. This study aims to provide updated esophageal cancer mortality trends among Black and White adults from 1999 to 2020. METHODS CDC-WONDER was used to identify Black and White adults in the United States from 1999 to 2020. We calculated age-standardized mortality rates, absolute rate differences, and rate ratios to compare the mortality differences between these populations. RESULTS From 1999 to 2020 in the United States, there were 303 267 esophageal cancer deaths, with significant racial disparities. The age-adjusted mortality rate for Black adults fell from 6.52 to 2.62 per 100 000, while for White adults, it declined from 4.19 to 3.97 per 100 000, narrowing the racial mortality gap. Gender-wise, the study showed a decrease in the mortality rate from 3.31 to 2.29 per 100 000 in Black women, but an increase from 1.52 to 1.99 per 100 000 in White women. Among young men, the rate dropped in Black men from 12.82 to 6.26 per 100 000 but rose in White men from 9.90 to 10.57 per 100 000. Regionally, Black adults in the Midwest and South initially had higher mortality rates than Whites, but this gap reduced over time. By 2020, Black men had lower mortality rates across all regions. CONCLUSIONS Over the last two decades, age-adjusted esophageal cancer mortality decreased in Black adults but stabilized in White adults, reflecting distinct cancer trends and risk factors. The study highlights the importance of tailored public health strategies for healthcare access and risk factor management.
Collapse
Affiliation(s)
- Chun-Wei Pan
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yazan Abboud
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Maoyin Pang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
6
|
McDaniel AM, Cooley ME, Andrews JO, Bialous S, Buettner-Schmidt K, Heath J, Okoli C, Timmerman GM, Sarna L. Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript. Nurs Outlook 2024; 72:102236. [PMID: 39043053 DOI: 10.1016/j.outlook.2024.102236] [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: 12/04/2023] [Revised: 06/15/2024] [Accepted: 06/22/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.
Collapse
Affiliation(s)
- Anna M McDaniel
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC.
| | - Mary E Cooley
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Jeannette O Andrews
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Stella Bialous
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Kelly Buettner-Schmidt
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Janie Heath
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Chizimuzo Okoli
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Gayle M Timmerman
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Linda Sarna
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| |
Collapse
|
7
|
Kenzik KM, Davis ES, Franks JA, Bhatia S. Estimating the Impact of Rurality in Disparities in Cancer Mortality. JCO Oncol Pract 2024; 20:993-1002. [PMID: 38560814 PMCID: PMC11440519 DOI: 10.1200/op.23.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/27/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Estimation of the independent effect of rurality on cancer mortality requires causal inference methodology and consideration of area-level socioeconomic status and rural designations. METHODS Using SEER data, we identified key incident cancers diagnosed between 2000 and 2016 at age ≥20 years (N = 3,788,273), examining a 20% random sample (n = 757,655). Standardized competing risk and survival models estimated the association between rural residence, defined by Rural-Urban Continuum Codes, and cancer-specific and all-cause mortality, controlling for age at cancer diagnosis, sex, race/ethnicity, year of diagnosis, and Area Deprivation Index (ADI). We estimated the attributable fraction (AF) of rurality and high ADI (ADI > median) to the probability of mortality. Finally, we examined county measurement issues contributing to mortality rates discordant from hypothesized rates. RESULTS The 5-year standardized failure probability for cancer mortality for rural patients was 33.9% versus 31.56% for urban. The AF for rural residence was 1.04% at year 1 (0.89% by year 5), the highest among local stage disease (Y1 2.1% to Y5 1.9%). The AF for high ADI was 3.33% in Y1 (2.87% in Y5), while the joint effect of rural residence and high ADI was 4.28% in Y1 (3.71% in Y5). Twenty-two percent of urban counties and 30% of rural were discordant. Among discordant urban counties, 30% were only considered urban because of adjacency to metro area. High ADI was associated with urban discordance and low ADI with rural discordance. CONCLUSION Rural residence independently contributes to cancer mortality. The rural impact is the greatest among those with localized disease and in high deprivation areas. Rural-urban county designations may mask high-need urban counties, limiting eligibility to state and federal resources dedicated to rural areas.
Collapse
Affiliation(s)
- Kelly M Kenzik
- Department of Surgery, Boston University, Boston, MA
- Slone Epidemiology Center, Boston University, Boston, MA
| | | | - Jeffrey A Franks
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Oncology, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
8
|
Franks JA, Davis ES, Bhatia S, Kenzik KM. Contribution of County Characteristics to Disparities in Rural Mortality After Cancer Diagnosis. Am J Prev Med 2024; 67:79-89. [PMID: 38342479 PMCID: PMC11193638 DOI: 10.1016/j.amepre.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to describe what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, this manuscript sought to assess the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, characterize county profiles, and determine at-risk county profiles alongside rural settings. METHODS Patients diagnosed with cancer between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data linked to the 2010 Rural-Urban Commuting Codes and 2010 County Health Rankings. There were 757,655 patients representing 596 counties (of 3,143 in the U.S.) and 12 states. Mediation analyses, conducted in 2023, estimated the direct contribution of rurality to 5-year all-cause survival and the contribution of the rural effect indirectly through County Health Ranking domains. Latent class analysis and survival models identified county groupings and estimated the hazard of mortality associated with class membership. RESULTS Rankings for premature death, clinical care, and physical environment resulted in rural patients having 17.9%-20.2% less survival time than urban patients. Of this, 4.1%-12.6% of the total excess risk was mediated by these characteristics. Patients living in rural and high-risk county classes saw higher all-cause mortality than those in urban lower-risk counties (hazard ratio=1.04, 95% CI=1.01, 1.08 and 1.07, 95% CI=1.03, 1.11). CONCLUSIONS Counties with poorer health rankings had increased mortality risks regardless of rurality; however, the poor rankings, notably health behaviors and social and economic factors, elevated the risk for rural counties.
Collapse
Affiliation(s)
- Jeffrey A Franks
- Division of Hematology and Oncology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth S Davis
- Department of Surgery, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- Department of Surgery, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts; Slone Epidemiology Center, Boston University, Boston, Massachusetts.
| |
Collapse
|
9
|
Wang J, Liu D, Guo C, Duan Y, Hu Z, Tian M, Xu Q, Niu Y, Yan G. Association between garden work and risk of incident dementia in an older population in China: a national cohort study. Public Health 2024; 232:74-81. [PMID: 38749151 DOI: 10.1016/j.puhe.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Evidence on the association between garden work and risk of incident dementia in the older Chinese population is limited. This study aimed to explore the association between the frequency of garden work and risk of incident dementia in an older population in China. STUDY DESIGN This was a national cohort study. METHODS This study analysed data from 8676 participants (median age: 86 years) from the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazard models were used to assess the association between the frequency of garden work and risk of incident dementia using hazard ratios (HRs) and 95% confidence intervals (CIs). Multiplicative and additive interaction effects were calculated between the frequency of garden work and age, sex or residence on incident dementia; subgroup analyses of the association were also conducted by age, sex and residence. In addition, sensitivity analyses were performed to assess the robustness of the results. RESULTS During 4.31 years (median) of follow-up, 633 participants developed dementia. Compared with participants who did not engage in garden work, the adjusted risk of incident dementia for those who regularly or almost daily engaged in garden work decreased by 28% (HR = 0.72, 95% CI: 0.57-0.93). An additive interaction effect between frequency of garden work and age on incident dementia was observed, with subgroup analyses demonstrating similar statistically significant associations among participants aged ≥85 years, women and city or town residents. Sensitivity analyses were consistent with the primary analysis in the present study. CONCLUSIONS Frequent engagement in garden work may be associated with a reduced risk of dementia and may be an effective measure to prevent incident dementia in the older population in China.
Collapse
Affiliation(s)
- J Wang
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - D Liu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - C Guo
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Y Duan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Z Hu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - M Tian
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Q Xu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Y Niu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - G Yan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China.
| |
Collapse
|
10
|
Masud N, Hamilton W, Tarasenko Y. Prevalence of Cigarette Smoking, E-cigarette Use, and Dual Use Among Urban and Rural Women During the Peripartum Period, PRAMS 2015-2020. Public Health Rep 2024:333549241251982. [PMID: 38780023 DOI: 10.1177/00333549241251982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States. METHODS This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse. RESULTS During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics. CONCLUSIONS Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months.
Collapse
Affiliation(s)
- Nazish Masud
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Whitney Hamilton
- Health Services Administration, Middle Georgia State University, Macon, GA, USA
| | - Yelena Tarasenko
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| |
Collapse
|
11
|
Hahn EJ, Bucher A, Rademacher K, Beckett W, Taylor L, Darville A, Ickes MJ. Tobacco use disparities in rural communities. J Rural Health 2024. [PMID: 38602299 DOI: 10.1111/jrh.12838] [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: 09/27/2023] [Revised: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE This exploratory study described facilitators and barriers to reducing tobacco disparities in 2 small rural communities and identified ways to reduce tobacco use. METHODS This was a descriptive design using qualitative methods. We created a resource database for 2 rural Kentucky counties, using a Culture of Health Framework. We recruited 16 organizational stakeholders serving low-socioeconomic populations and conducted focus groups and key informant interviews. We also completed key informant interviews with 7 tobacco users. Lastly, we tailored Community Action Plans for each county based on the data and then solicited feedback from the key stakeholders. FINDINGS The 2 counties were similar in population size, but County A had fewer resources than County B, and the stakeholders expressed differences toward tobacco use and quitting. County A stakeholders talked most about the protobacco culture and that tobacco users accept the risks of smoking outweighing the benefits of quitting; they also expressed concerns about youth use and the influences of family, society, and industry. County B stakeholders described ambivalence about the health effects of use and quitting. County A's Action Plan identified an opportunity to build Community Health Worker-delivered tobacco treatment into a new school-based health center. County B's Action Plan focused on reaching tobacco users by providing incentives for participation and tailoring messages to different audiences. CONCLUSIONS Tobacco control resources and stakeholder perspectives vary in small rural communities, implying a need for tailored approaches. Tobacco users in rural areas are a critical population to target with cessation resources.
Collapse
Affiliation(s)
- Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda Bucher
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kathy Rademacher
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Whitney Beckett
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - LeeAnn Taylor
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Audrey Darville
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Melinda J Ickes
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
- Department of Kinesiology & Health Promotion, College of Education, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
12
|
Terry R, Gatewood A, Elenwo C, Long A, Wu W, Markey C, Strain S, Hartwell M. Disparities in preconception health indicators in U.S. women: a cross-sectional analysis of the behavioral risk factor surveillance system 2019. J Perinat Med 2024; 52:192-201. [PMID: 38146265 PMCID: PMC11190353 DOI: 10.1515/jpm-2023-0249] [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: 06/15/2023] [Accepted: 11/04/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Optimized preconception care improves birth outcomes and women's health. Yet, little research exists identifying inequities impacting preconception health. This study identifies age, race/ethnicity, education, urbanicity, and income inequities in preconception health. METHODS We performed a cross-sectional analysis of the Center for Disease Control and Prevention's (CDC) 2019 Behavioral Risk Factor Surveillance System (BRFSS). This study included women aged 18-49 years who (1) reported they were not using any type of contraceptive measure during their last sexual encounter (usage of condoms, birth control, etc.) and (2) reported wanting to become pregnant from the BRFSS Family Planning module. Sociodemographic variables included age, race/ethnicity, education, urbanicity, and annual household income. Preconception health indicators were subdivided into three categories of Physical/Mental Health, Healthcare Access, and Behavioral Health. Chi-squared statistical analysis was utilized to identify sociodemographic inequities in preconception health indicators. RESULTS Within the Physical/Mental Health category, we found statistically significant differences among depressive disorder, obesity, high blood pressure, and diabetes. In the Healthcare Access category, we found statistically significant differences in health insurance status, having a primary care doctor, and being able to afford a medical visit. Within the Behavioral Health category, we found statistically significant differences in smoking tobacco, consuming alcohol, exercising in the past 30 days, and fruit and vegetable consumption. CONCLUSIONS Maternal mortality and poor maternal health outcomes are influenced by many factors. Further research efforts to identify contributing factors will improve the implementation of targeted preventative measures in directly affected populations to alleviate the current maternal health crisis.
Collapse
Affiliation(s)
- Rachel Terry
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, 1111 W 17th St., Tulsa, OK 74107, USA
| | - Ashton Gatewood
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Covenant Elenwo
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Abigail Long
- Department of Obstetrics and Gynecology, SSM Health St. Anthony Hospital, Oklahoma City, OK, USA
| | - Wendi Wu
- Department of Obstetrics and Gynecology, SSM Health St. Anthony Hospital, Oklahoma City, OK, USA
| | - Caroline Markey
- Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Shawn Strain
- Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA; and Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| |
Collapse
|
13
|
Gwon SH, Thongpriwan V, Mobarki A, Eyadat A, Noonan D. Experiences and Perceptions of E-Cigarette Cessation for Young Adults in Rural Communities. Nurs Res 2024; 73:46-53. [PMID: 37768961 DOI: 10.1097/nnr.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS), also known as e-cigarettes, are the most commonly used tobacco products among young adults in the United States. Young adults in rural areas have a higher prevalence of ENDS use compared to their urban counterparts, yet there is limited evidence regarding the in-depth understanding of experiences and perspectives directly from young adults. OBJECTIVES The aim of this study was to explore individual experiences and perspectives about use and cessation of ENDS from young adults in rural areas. METHODS This was a qualitative study using interpretive description for analysis. Young adults (18-24 years) who used ENDS every day but not other tobacco products (cigarettes, smokeless, etc.) in the past month and had an address in a rural county of Wisconsin were eligible; there were nine participants interviewed using Zoom. Interview questions focused on initial use, maintenance of use, experiences of quitting, and social and rural environmental contexts regarding ENDS. RESULTS Three themes emerged with eight categories: (a) addiction to ENDS and health, (b) cessation and resources, and (c) rural environment and culture in ENDS addiction. DISCUSSION Findings have implications for ENDS cessation interventions targeting young adults in rural areas.
Collapse
|
14
|
Arabi S, Jahanmehr N, Khoramrooz M. National and regional economic inequalities in first- and second-hand tobacco consumption among women of reproductive ages in Iran. BMC Public Health 2023; 23:2532. [PMID: 38110920 PMCID: PMC10726556 DOI: 10.1186/s12889-023-17287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION The epidemic of tobacco consumption is one of the major public health threats the world has been facing so far. This study was performed to investigate the economic inequalities in tobacco consumption among women of reproductive ages at national and regional levels in Iran. METHODS We used data from 10,339 women of reproductive ages (18-49 years) who participated in Iran's 7th Non-Communicable Disease Risk Factor Surveillance (STEPS). Wagstaff normalized concentration index and decomposition method were applied to measure economic inequalities in first- and second-hand tobacco consumption and determine their corresponding contributory factors, respectively. RESULTS The prevalence of women's first-hand tobacco consumption, and their exposure to second-hand smoke in the home, and workplace were 3.6%, 28.3%, and 8.4%, respectively. First- and second-hand tobacco consumption was significantly more concentrated among low-economic women. Exposure to home second-hand smoke, education, and economic status had the largest contributions to the measured inequality in first-hand tobacco consumption (48.9%, 38.9%, and 30.8%, respectively). The measured inequality in women's secondhand smoke exposure at home was explained by their level of education (43.8%), economic status (30.3%), and residency in rural areas (18%), and at work by residency in rural areas (42.2%), economic status (38.8%), and level of education (32%). Our results also revealed diversity in the geographical distribution of inequalities in rural and urban areas and five regions of the country. CONCLUSION The present study highlighted the need for more enforcement of tobacco control rules and increasing tobacco taxes as general measures. Furthermore, there is a need for gender-sensitive initiatives at national and regional levels to educate, support, and empower low-economic women and households for tobacco cessation, and complying with restrictive smoking rules.
Collapse
Affiliation(s)
- Samira Arabi
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Jahanmehr
- Health Economics, Management, and Policy Department, Virtual School of Medical Education & Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Khoramrooz
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| |
Collapse
|
15
|
Paul B, Jean Simon D, Kondo Tokpovi VC, Kiragu A, Balthazard-Accou K, Emmanuel E. Tobacco use in Haiti: findings from demographic and health survey. BMC Public Health 2023; 23:2504. [PMID: 38097954 PMCID: PMC10720190 DOI: 10.1186/s12889-023-17409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. METHODS We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05. RESULTS The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use. CONCLUSION The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.
Collapse
Affiliation(s)
- Bénédique Paul
- Department of Agro-socio-economics, Chibas, Université Quisqueya, Port-au-Prince, Haiti.
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti.
| | - David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | | | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | - Ketty Balthazard-Accou
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
| | - Evens Emmanuel
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
| |
Collapse
|
16
|
Sharma P, Tranby B, Kamath C, Brockman T, Roche A, Hammond C, Brewer LC, Sinicrope P, Lenhart N, Quade B, Abuan N, Halom M, Staples J, Patten C. A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study. JMIR Res Protoc 2023; 12:e52398. [PMID: 38090799 PMCID: PMC10753420 DOI: 10.2196/52398] [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: 09/01/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. OBJECTIVE This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. METHODS We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. RESULTS The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. CONCLUSIONS Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52398.
Collapse
Affiliation(s)
- Pravesh Sharma
- Psychiatry and Psychology, Mayo Clinic Health System, Mayo Clinic, Eau Claire, WI, United States
| | - Brianna Tranby
- Behavioral Psychology, Mayo Clinic, Rochester, MN, United States
| | - Celia Kamath
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Tabetha Brockman
- Health Equity and Community Engagement in Research, Mayo Clinic, Rochester, MN, United States
| | - Anne Roche
- Psychology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Pamela Sinicrope
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ned Lenhart
- Living Water Church, Cameron, WI, United States
| | - Brian Quade
- Bethesda Lutheran Church, Eau Claire, WI, United States
| | - Nate Abuan
- Valleybrook Church, Eau Claire, WI, United States
| | - Martin Halom
- St John's Lutheran Church, Bloomer, WI, United States
| | | | - Christi Patten
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
17
|
Fan J, Mao T, Zhen S, Xu Y, Qu C. Comparative analysis of e-cigarette prevalence and influencing factors among adolescents in Jiangsu Province, China. Front Public Health 2023; 11:1221334. [PMID: 38106882 PMCID: PMC10722425 DOI: 10.3389/fpubh.2023.1221334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Objective The objectives of this study were to investigate electronic cigarette (e-cigarette) and cigarette use in Jiangsu Province, China, by analyzing the two-year trends of e-cigarette using and to explore the factors influencing the experimentation and use of e-cigarettes. Methods We conducted a cross-sectional study following the standard methodology of the Global Youth Tobacco Survey in 2019 and 2021. A three-stage cluster sampling design was applied. Eighty-two schools in 14 districts (counties) in Jiangsu Province were surveyed. All computations were performed using the SPSS 21.0 complex samples procedure. Multivariate logistic regression was used to explore the factors influencing e-cigarette experimentation and use. Results A total of 12,410 and 12,880 students were surveyed in 2019 and 2021, respectively. E-cigarette experimentation increased from 9.34% in 2019 to 13.07% in 2021 (P < 0.001). E-cigarette use increased from 2.23% in 2019 to 3.74% in 2021 (P < 0.001). The main factors associated with e-cigarette use were cigarette experimentation (OR = 2.700, P < 0.001); male gender (OR = 1.416, P = 0.011); junior high school students (OR = 1.551, P = 0.005) and vocational high school students (OR = 1.644, P = 0.001); more pocket money per week (OR1 = 1.214, P = 0.187; OR2 = 1.686, P = 0.001); exposure to second-hand smoke (SHS) at home (OR = 1.239, P < 0.001); exposure to e-cigarette advertising (OR = 1.855, P < 0.001); believe SHS is harmful (OR = 0.933, P = 0.026); closest friends smoking (OR = 2.501, P < 0.001); believe smoking makes youth look more attractive (OR1 = 1.469, P = 0.040; OR2 = 1.305, P = 0.049); believe tobacco helps youth feel more comfortable in social situations (OR1 = 2.161, P < 0.001; OR2 = 1.635, P = 0.001); will use an e-cigarette product if offered by best friends (OR = 1.322, P < 0.001); intend to use an e-cigarette product in the next 12 months (OR = 1.486, P < 0.001). Conclusion E-cigarette use among adolescents has been on the rise in recent years. E-cigarette use is associated with past cigarette use and a strong desire to smoke. It is crucial to take health education and tobacco control efforts to reduce adolescents' e-cigarette use rate.
Collapse
Affiliation(s)
- Jiannan Fan
- Institute of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Tao Mao
- Institute of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Shiqi Zhen
- Institute of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yan Xu
- Institute of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Chen Qu
- Institute of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| |
Collapse
|
18
|
Wiese LK, Pratt BA, Heinze K, Besser L, Ifill A(A, Williams CL. Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults. CURRENT GERIATRICS REPORTS 2023; 12:205-219. [PMID: 38223294 PMCID: PMC10783445 DOI: 10.1007/s13670-023-00400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 01/16/2024]
Abstract
Purpose of Review The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered. Recent Findings More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health. Summary Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.
Collapse
Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Beth A. Pratt
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Katherine Heinze
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Lilah Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - Antoinita (Annie) Ifill
- Palm Health Foundation/Community Partners of South Florida, 491 E. Main Street Suite 5A, Pahokee FL 33476, USA
| | - Christine L. Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| |
Collapse
|
19
|
James SA, Boeckman LM, Mushtaq N, Beebe LA. Predictors of Cessation in Men Using a Tobacco Quitline: A Follow-Up Study. Am J Prev Med 2023; 65:1092-1102. [PMID: 37302515 DOI: 10.1016/j.amepre.2023.06.004] [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: 02/02/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Although the effectiveness of tobacco quitline services for people who smoke cigarettes is well established, less is known about other forms of tobacco. This study aimed to compare quit rates and factors contributing to tobacco abstinence in men reporting dual use (smokeless tobacco and one additional combustible tobacco product), smokeless tobacco use only, and cigarette use only. METHODS Self-reported 30-day point-prevalence tobacco abstinence at the 7-month follow-up was calculated in males who registered with the Oklahoma Tobacco Helpline and completed a 7-month follow-up survey (N=3,721) (July 2015-November 2021). Logistic regression analysis completed in March 2023 identified variables associated with abstinence in each group. RESULTS Abstinence was reported by 33% in the dual-use group, 46% in the smokeless-tobacco-use-only group, and 32% in the cigarette-use-only group. Eight or more weeks of nicotine replacement therapy provided by the Oklahoma Tobacco Helpline was associated with tobacco abstinence in men who reported dual use (AOR=2.7, 95% CI=1.2, 6.3) and exclusive smoking (AOR=1.6, 95% CI=1.1, 2.3). The use of all nicotine replacement therapy was associated with abstinence in men who used smokeless tobacco (AOR=2.1, 95% CI=1.4, 3.1) and who smoked (AOR=1.9, 95% CI=1.6, 2.3). The number of helpline calls was associated with abstinence in men who used smokeless tobacco (AOR=4.3, 95% CI=2.5, 7.3). CONCLUSIONS Men in all three tobacco-use groups who fully utilized quitline services showed a greater likelihood of tobacco abstinence. These findings underscore the importance of quitline intervention as an evidence-based strategy for people who use multiple forms of tobacco.
Collapse
Affiliation(s)
- Shirley A James
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Lindsay M Boeckman
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Nasir Mushtaq
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Laura A Beebe
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
20
|
Werts SJ, Robles-Morales R, Bea JW, Thomson CA. Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01464-4. [PMID: 37768420 DOI: 10.1007/s11764-023-01464-4] [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] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. METHODS A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world. RESULTS Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance. CONCLUSIONS Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population. IMPLICATIONS FOR CANCER SURVIVORS Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.
Collapse
Affiliation(s)
- Samantha J Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Rogelio Robles-Morales
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
21
|
Chellamuthu L, Mary JJF, Subhaashini TD. Assessment of Knowledge Gap on Cigarettes and Other Tobacco Products Act (COTPA) among Tobacco Vendors in Puducherry: A Mixed-Method Study. Indian J Community Med 2023; 48:741-747. [PMID: 37970161 PMCID: PMC10637599 DOI: 10.4103/ijcm.ijcm_54_23] [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: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 11/17/2023] Open
Abstract
Background Tobacco usage has been identified as a leading preventable cause of mortality and is responsible for six million fatalities per year globally. India had enacted COTPA in 2003. Tobacco vendors are one of the key stakeholders for Cigarettes and Other Tobacco Products Act (COTPA) implementation. Objective To assess the knowledge gap on COTPA and to explore the perceived factors influencing implementation of COTPA among tobacco vendors in Puducherry. Materials and Methods A mixed-method study was conducted among tobacco vendors from Point of Sale (PoS) around 230 educational institutions (schools and degree colleges) in Puducherry for three months. Simple random sampling was applied to select educational institutions and the tobacco vendors from PoS located around these institutions were included. Data capture was done using a pretested, face-validated questionnaire incorporated in Epicollect software 5 and data analysis by SPSSv24. Purposive sampling was employed to conduct in-depth interviews among tobacco vendors till the point of saturation and manual content analysis performed. Written informed consents were sought. Institutional Ethical Committee approval was obtained. Results Majority (95.7%) reported that they were aware of tobacco control legislation, but only one person had heard of COTPA. Awareness about the display of signage boards at PoS was observed in 75.7% vendors. Around 41.7% reported that they should not advertise any kind of tobacco products. Three major themes were identified: facilitators, barriers, and suggested measures for COTPA implementation. Conclusion Tobacco vendors in Puducherry were aware of tobacco control legislations but not familiar with the COTPA and its provisions. It is necessary to put forth efforts to educate these important stakeholders to be more cognizant of COTPA and to effectively include them in anti-tobacco programs.
Collapse
Affiliation(s)
- Lalithambigai Chellamuthu
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - J Jenifer Florence Mary
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - TD Subhaashini
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| |
Collapse
|
22
|
Wiese LAK, Gibson A, Guest MA, Nelson AR, Weaver R, Gupta A, Carmichael O, Lewis JP, Lindauer A, Loi S, Peterson R, Radford K, Rhodus EK, Wong CG, Zuelsdorff M, Saidi LG, Valdivieso-Mora E, Franzen S, Pope CN, Killian TS, Shrestha HL, Heyn PC, Ng TKS, Prusaczyk B, John S, Kulshreshtha A, Sheffler JL, Besser L, Daniel V, Tolea MI, Miller J, Musyimi C, Corkey J, Yank V, Williams CL, Rahemi Z, Park J, Magzamen S, Newton RL, Harrington C, Flatt JD, Arora S, Walter S, Griffin P, Babulal GM. Global rural health disparities in Alzheimer's disease and related dementias: State of the science. Alzheimers Dement 2023; 19:4204-4225. [PMID: 37218539 PMCID: PMC10524180 DOI: 10.1002/alz.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.
Collapse
Affiliation(s)
- Lisa Ann Kirk Wiese
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Allison Gibson
- University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Marc Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Amy R Nelson
- Frederick P. Whiddon College of Medicine, Department of Physiology & Cell Biology, University of South Alabama, Mobile, Alabama, USA
| | - Raven Weaver
- Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, Neurology, Alzheimer's Disease Research Center, University of Kansas, Kansas City, Kansas, USA
| | - Owen Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Allison Lindauer
- Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Samantha Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Rachel Peterson
- University of Montana School of Public and Community Health Sciences, Missoula, Montana, USA
| | - Kylie Radford
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Elizabeth K Rhodus
- University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- University of Kentucky Alzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky, USA
- University of Kentucky College of Medicine, for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Christina G Wong
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Megan Zuelsdorff
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ladan Ghazi Saidi
- Department of Communication Disorders, Center for Brain Biology and Behavior (CB3), University of Nebraska at Kearney, and Lincoln, Nebraska, USA
| | - Esmeralda Valdivieso-Mora
- Department of Psychology and Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador, El Salvador
| | - Sanne Franzen
- Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Caitlin N Pope
- Department of Health, Behavior, & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Timothy S Killian
- Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Hom L Shrestha
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Ontario, Canada
| | - Patricia C Heyn
- Center for Optimal Aging, Department of Physical Therapy, Marymount University, Arlington, Virginia, USA
| | - Ted Kheng Siang Ng
- Department of Psychology, Arizona State University, Phoenix, Arizona, USA
| | - Beth Prusaczyk
- Institute for Informatics (I2), Center for Population Health Informatics at I2, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Samantha John
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julia L Sheffler
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Lilah Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Valerie Daniel
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Magdalena I Tolea
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Justin Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Veronica Yank
- Department of Medicine, University of California, San Francisco, USA
| | - Christine L Williams
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Zahra Rahemi
- Clemson School of Nursing, Clemson University, Clemson, South Carolina, USA
| | - JuYoung Park
- Sandler School of Social Work, College of Social Work and Criminal Justice, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Jason D Flatt
- School of Public Health, Department of Social & Behavioral Health, University of Nevada, Las Vegas, USA
| | - Sonakshi Arora
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Sarah Walter
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Percy Griffin
- Alzheimer's Therapeutic Research Institute, Alzheimer's Clinical Trials Consortium, University of Southern California, San Diego, California, USA
| | - Ganesh M Babulal
- Scientific Engagement, Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
23
|
Warner ET, Huguet N, Fredericks M, Gundersen D, Nederveld A, Brown MC, Houston TK, Davis KL, Mazzucca S, Rendle KA, Emmons KM. Advancing health equity through implementation science: Identifying and examining measures of the outer setting. Soc Sci Med 2023; 331:116095. [PMID: 37473542 PMCID: PMC10530521 DOI: 10.1016/j.socscimed.2023.116095] [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: 10/27/2022] [Revised: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC3) Network Program. OBJECTIVE To describe the development of the Outer Setting Data Resource and characterize the county-level outer context across Centers. METHODS Our Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests. RESULTS ISC3 centers' catchment areas include 458 counties and over 126 million people across 28 states. The median percentage of population living within ½ mile of a park is higher in ISC3 counties (38.0%, interquartile range (IQR): 16.0%-59.0%) compared to nationally (18.0%, IQR: 7.0%-38.0%; p < 0.0001). The median percentage of households with no broadband access is significantly lower in ISC3 counties (28.4%, IQR: 21.4%-35.6%) compared the nation overall (32.8%, IQR: 25.8%-41.2%; p < 0.0001). The median unemployment rate was significantly higher in ISC3 counties (5.2%, IQR: 4.1%-6.4%) compared to nationally (4.9%, 3.6%-6.3%, p = 0.0006). CONCLUSIONS Our results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.
Collapse
Affiliation(s)
- Erica T Warner
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Fredericks
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daniel Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meagan C Brown
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Thomas K Houston
- General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kia L Davis
- Washington University School of Medicine, Department of Surgery, St. Louis, Missouri, USA
| | - Stephanie Mazzucca
- Washington University in St. Louis, Brown School, Prevention Research Center, St. Louis, MO, United States
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia Perelman School of Medicine, PA, USA
| | - Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
24
|
Nogueira FDAM, Damacena GN, Souza Júnior PRBD, Szcwarcwald CL. [Self-reported morbidities and lifestyles of agricultural and non-agricultural workers in Brazil: a comparative analysis between 2013 and 2019]. CIENCIA & SAUDE COLETIVA 2023; 28:1971. [PMID: 37436311 DOI: 10.1590/1413-81232023287.15922022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/15/2022] [Indexed: 07/13/2023] Open
Abstract
Differences in the profiles of illness and lifestyles among agricultural and non-agricultural workers were investigated using data from the National Health Survey (Brazilian acronym PNS) of 2013 and 2019. The prevalence and 95% CIs were calculated for the following variables: self-reported morbidities, poor self-rated health, limitations of usual activities, number of NCD, major or minor depression and lifestyles. The Poisson model was used to calculate crude and adjusted prevalence ratios, by gender and age. The sample weights and the conglomerate effect in 2013 and 2019 were considered in the analyses. A total of 33,215 non-agricultural workers and 3,797 agricultural workers were evaluated in 2013, whereas 47,849 non-agricultural workers and 4,751 agricultural workers were assessed in 2019. Agricultural workers are more susceptible to poor self-rated health, chronic back problems, excessive physical activity at work, smoking and lower consumption of vegetables and fruit. On the other hand, non-agricultural workers revealed a higher prevalence of asthma/bronchitis, depression and diabetes mellitus and greater consumption of candies and soft drinks. Differentiated NCD prevention and treatment actions for both groups of workers need to be prioritized.
Collapse
Affiliation(s)
- Fernanda de Albuquerque Melo Nogueira
- Programa de Pós-Graduação em Informação e Comunicação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Av. Brasil 4.036, sala 210, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Celia Landmann Szcwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| |
Collapse
|
25
|
Bteddini DS, LeLaurin JH, Chi X, Hall JM, Theis RP, Gurka MJ, Lee JH, Mobley EM, Khalil GE, Polansky CJ, Kellner AM, Fahnlander AM, Kelder SH, Fiellin LE, Gutter MS, Shenkman EA, Salloum RG. Mixed methods evaluation of vaping and tobacco product use prevention interventions among youth in the Florida 4-H program. Addict Behav 2023; 141:107637. [PMID: 36753933 DOI: 10.1016/j.addbeh.2023.107637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Novel prevention programs are developed to address the increase in e-cigarette use (vaping) among children. However, it remains paramount to test their feasibility in rural settings. This pilot study implemented and evaluated the feasibility and outcomes of two innovative programs, CATCH My Breath and smokeSCREEN, among youth in rural settings in Florida. METHODS We conducted four focus groups with youth aged 11-17 recruited from 4-H rural clubs in Florida. In a subsequent randomized trial, we recruited 82 youth participants and assigned them to one of three arms: CATCH My Breath, smokeSCREEN, or control. CATCH My Breath and smokeSCREEN participants attended online group intervention sessions while the control group received educational material. Pre- and post-surveys were administered to all participants to assess knowledge, susceptibility, perceived positive outcomes and risk perceptions related to tobacco and e-cigarette use. Other feasibility parameters were also assessed. RESULTS Focus group discussions provided insights about feasibility and informed the implementation of both interventions in terms of delivery format, scheduling of sessions and incentives. After the intervention, CATCH My Breath participants significantly improved their general tobacco-related knowledge (post-pre = 16.21-12.92 = 3.3, p <.01) and risk perceptions towards other flavored tobacco products (post-pre = 19.29-17.71 = 1.6, p <.05). smokeSCREEN participants significantly improved their general tobacco knowledge (post-pre = 18.77-13.77 = 5.0, p <.01), knowledge about e-cigarettes (post-pre = 9.08-6.31 = 2.8, p <.01) and risk perception towards e-cigarettes (post-pre = 24.69-21.92 = 2.8, p <.05). CONCLUSIONS This study demonstrated feasibility of delivering the interventions via participant engagement, participants' willingness to be randomized, assessment of outcome measures, and exploration of different recruitment methods. Despite the potential positive influence of CATCH My Breath and smokeSCREEN on youth participants, further evaluation with larger samples is needed.
Collapse
Affiliation(s)
- Dima S Bteddini
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL 32610, USA; Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32610, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - George E Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Caroline J Polansky
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Allie M Kellner
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Alexandra M Fahnlander
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center School of Public Health, Austin, TX 78701, USA
| | - Lynn E Fiellin
- play2PREVENT Lab at Yale, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Michael S Gutter
- Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32610, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
| |
Collapse
|
26
|
Franks JA, Davis ES, Bhatia S, Kenzik KM. Defining rurality: an evaluation of rural definitions and the impact on survival estimates. J Natl Cancer Inst 2023; 115:530-538. [PMID: 36762829 PMCID: PMC10165490 DOI: 10.1093/jnci/djad031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/12/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Patients with cancer living in rural areas have inferior cancer outcomes; however, studies examining this association use varying definitions of "rural," complicating comparisons and limiting the utility of the results for policy makers and future researchers. METHODS Surveillance, Epidemiology, and End Results data (2000-2016) were used to assess risk of cancer mortality and mortality from any cause across 4 definitions of rurality: Urban Influence codes (UIC), National Center for Health Statistics (NCHS), Rural-Urban continuum codes (RUCC), and Index of Relative Rurality. Binary (urban vs rural) and ternary (urban, micropolitan, rural) definitions were evaluated. Multivariable parametric survival models estimated hazards of mortality overall and among 3 cancer groupings: screening related, obesity related, and tobacco related. Definition agreement was also assessed. RESULTS Overall, 3 788 273 patients with an incident cancer representing 605 counties were identified. There was little discordance between binary definitions of rural vs urban and moderate agreement at the 3 levels. Adjusted models using binary definitions revealed 15% to 17% greater hazard of cancer mortality in rural compared with urban. At the 3 levels when comparing rural with metropolitan, RUCC and NCHS saw similarly increased hazard ratios; however, Index of Relative Rurality did not. Screening-related cancers saw the highest hazards of mortality and the largest divergence between definitions. Obesity-related and tobacco-related cancers saw similarly increased hazards of mortality at the binary and ternary levels. CONCLUSIONS Hazard of death is similar across binary definitions; however, this differed when categorized as ternary or continuous, especially among screening-related cancers. Results suggest that study purpose should direct choice of definitions and categorization.
Collapse
Affiliation(s)
- Jeffrey A Franks
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Smita Bhatia
- Division of Pediatric Hematology, Oncology and Blood or Marrow Transplant, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- Department of Surgery, Boston University, Boston, MA, USA
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| |
Collapse
|
27
|
Liu D, Niu Y, Duan Y, Wang J, Yan G. Association of 3-year change in sleep duration with risk of all-cause mortality in Chinese older population: A national cohort study. Sleep Med 2023; 105:25-31. [PMID: 36940517 DOI: 10.1016/j.sleep.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Existing evidence on the association of dynamic change in sleep duration with risk of all-cause mortality in Chinese older population is limited. We aimed to explore the association of 3-year change in sleep duration with risk of all-cause mortality in a Chinese older population. MATERIALS AND METHODS A total of 5772 Chinese older participants (median age 82 years) were enrolled in the current study. Cox proportional-hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of 3-year change in sleep duration with risk of all-cause mortality. Subgroup analyses of the association between 3-year change in sleep duration and risk of all-cause mortality were conducted by age, sex and residence. RESULTS During a median of 4.08 years of follow-up, death developed in 1762 participants. Compared with -1 to <1 h/day change in sleep duration, the adjusted risk of all-cause mortality with < -3 h/day change in sleep duration may increase 26% (HR = 1.26, 95% CI: 1.05-1.52); the risk of all-cause mortality with 3-year change from short to long sleep duration, or long to short sleep duration versus stable normal sleep duration status was increased about 28% and 52%, respectively (HR = 1.28, 95% CI: 1.00-1.64 and HR = 1.52, 95% CI: 1.21-1.92). Subgroup analyses demonstrated that similar significant associations were observed among participants with 65 to <85 years, men and living in city and town. CONCLUSIONS Dynamic sleep duration change was significantly associated with risk of all-cause mortality. The current study suggests that sleep duration may be a non-invasive indicator for interventions aiming to reduction risk of all-cause mortality in Chinese older population.
Collapse
Affiliation(s)
- Dechen Liu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yuqi Niu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yingqi Duan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Jinjin Wang
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Guoli Yan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China.
| |
Collapse
|
28
|
Alkouri O, Khader Y, Al-Bashaireh AM. Prevalence of Cigarettes and Waterpipe Smoking among Jordanians, Refugees, and Migrants in Jordan and Its Associated Factors: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:82. [PMID: 36612400 PMCID: PMC9819960 DOI: 10.3390/ijerph20010082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 06/15/2023]
Abstract
Smoking is a major public health threat resulting in increased morbidity and mortality. This study aimed to determine the prevalence of current smoking among different adult populations in Jordan, including Jordanians, refugees, and migrants and determine the factors associated with smoking. A cross-sectional survey was conducted during the period of June-September 2021 among Jordanians, Syrian refugees (both urban and camp refugees), and migrants living in four governorates in Jordan, including Amman, Zarqa, Mafraq, and Irbid. The selection of the four governorates was based on criteria related to the presence of Syrian refugees in host communities. The highest prevalence of cigarette smoking was among urban Jordanians (51.1%), followed by non-camp refugees (46.7%), while the highest prevalence for waterpipe (43.2%) and dual smoking (28.7%) was among non-camp refugees. Being male, aged 25-45 years old, unemployed, and having less than a high school education, as well as being urban Jordanians, were all associated with higher odds of cigarette smoking. Being male, unemployed, and urban Jordanians or non-camp refugees were variables associated with higher odds of waterpipe smoking. The study findings indicate that the identification of smoking prevalence in Jordan and its associated factors, including gender, educational level, employment status, regional area, migration, and exposure to traumas, should be considered by healthcare providers to formulate smoking cessation programs tailored to their needs and ultimately reduce smoking prevalence.
Collapse
Affiliation(s)
- Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid 2116, Jordan
| | - Yousef Khader
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid 21163, Jordan
| | - Ahmad M. Al-Bashaireh
- Faculty of Health Science, Higher Colleges of Technology, Fujairah 23036, United Arab Emirates
| |
Collapse
|
29
|
Horn K, Schoenberg N, Rose S, Romm K, Berg CJ. Tobacco use among Appalachian adolescents: An urgent need for virtual scale out of effective interventions. Tob Prev Cessat 2022; 8:39. [PMID: 36404952 PMCID: PMC9635399 DOI: 10.18332/tpc/155331] [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: 10/27/2021] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Tobacco use, typically initiated during adolescence, can escalate into young adulthood, even among experimenting or intermittent users. Despite declines in cigarette smoking among US adolescents, use of other tobacco products and poly-tobacco are on the rise among Appalachian adolescents. Unfortunately, Appalachian adolescent tobacco users also are less likely to receive effective tobacco interventions due to various barriers: a) accessibility (e.g. service and provider shortages, affordability, and transportation; b) acceptability (e.g. issues of privacy and stigma); and c) cultural relevance. The present review provides critical considerations synthesized from an extensive body of literature on the suitability of virtual tobacco interventions, the need for well-timed interventions that address complex tobacco use, and the rationale for leveraging and scaling evidence-based interventions inform novel interventions for Appalachian adolescent tobacco users. Borrowing strength from existing in-person evidence-based adolescent tobacco interventions and state-of-the-art virtual health services, a well-planned virtual scale out of tobacco interventions holds potential to minimize barriers unique to Appalachia.
Collapse
Affiliation(s)
- Kimberly Horn
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, United States
- Fralin Biomedical Research Institute, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | - Nancy Schoenberg
- Center for Health Equity Transformation, University of Kentucky, Lexington, United States
| | - Shyanika Rose
- Center for Health Equity Transformation, University of Kentucky, Lexington, United States
| | - Katelyn Romm
- Milken Institute School of Public Health, The George Washington University, Washington, United States
| | - Carla J. Berg
- Milken Institute School of Public Health, The George Washington University, Washington, United States
| |
Collapse
|
30
|
Jennings MV, Lee H, Rocha DB, Bianchi SB, Coombes BJ, Crist RC, Faucon AB, Hu Y, Kember RL, Mallard TT, Niarchou M, Poulsen MN, Straub P, Urman RD, Walsh CG, Davis LK, Smoller JW, Troiani V, Sanchez-Roige S. Identifying High-Risk Comorbidities Associated with Opioid Use Patterns Using Electronic Health Record Prescription Data. Complex Psychiatry 2022; 8:47-55. [PMID: 36545045 PMCID: PMC9669950 DOI: 10.1159/000525313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Opioid use disorders (OUDs) constitute a major public health issue, and we urgently need alternative methods for characterizing risk for OUD. Electronic health records (EHRs) are useful tools for understanding complex medical phenotypes but have been underutilized for OUD because of challenges related to underdiagnosis, binary diagnostic frameworks, and minimally characterized reference groups. As a first step in addressing these challenges, a new paradigm is warranted that characterizes risk for opioid prescription misuse on a continuous scale of severity, i.e., as a continuum. Methods Across sites within the PsycheMERGE network, we extracted prescription opioid data and diagnoses that co-occur with OUD (including psychiatric and substance use disorders, pain-related diagnoses, HIV, and hepatitis C) for over 2.6 million patients across three health registries (Vanderbilt University Medical Center, Mass General Brigham, Geisinger) between 2005 and 2018. We defined three groups based on levels of opioid exposure: no prescriptions, minimal exposure, and chronic exposure and then compared the comorbidity profiles of these groups to the full registries and to those with OUD diagnostic codes. Results Our results confirm that EHR data reflects known higher prevalence of substance use disorders, psychiatric disorders, medical, and pain diagnoses in patients with OUD diagnoses and chronic opioid use. Comorbidity profiles that distinguish opioid exposure are strikingly consistent across large health systems, indicating the phenotypes described in this new quantitative framework are robust to health systems differences. Conclusion This work indicates that EHR prescription opioid data can serve as a platform to characterize complex risk markers for OUD using existing data.
Collapse
Affiliation(s)
- Mariela V Jennings
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Hyunjoon Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel B Rocha
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania, USA
| | - Sevim B Bianchi
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Crist
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annika B Faucon
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Travis T Mallard
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Niarchou
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Peter Straub
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lea K Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanessa Troiani
- Geisinger Clinic, Geisinger, Danville, Pennsylvania, USA.,Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania, USA.,Neuroscience Institute, Geisinger, Danville, Pennsylvania, USA.,Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Sandra Sanchez-Roige
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | |
Collapse
|
31
|
Opoczyńska-Świeżewska D, Raciborski F, Samoliński B. Reduction in the prevalence of tobacco use accompanying legislative changes in tobacco policy in Poland in the years 2010-2019. Int J Occup Med Environ Health 2022; 35:393-405. [PMID: 35289337 PMCID: PMC10464804 DOI: 10.13075/ijomeh.1896.01867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Tobacco use is one of the most serious public health problems. Each year, it contributes to preventable disability and death of 8 million people worldwide. The aim of the study was to determine the change in the prevalence of tobacco and e-cigarettes use among Polish adults in the years 2010-2019 and the potential impact of legislative interventions on tobacco consumption in Poland. MATERIAL AND METHODS The research was based on an analysis of secondary data obtained from a cross-sectional study as part of the public opinion monitoring in Poland. The study was carried out in 2 editions (2010 and 2019) on representative samples of approximately 1000 Polish residents >18 years of age. RESULTS The proportion of traditional cigarette smokers decreased from 30.4% to 26.0% in the years 2010-2019 (p < 0.05). In the male group decreased from 40.3% to 31.0% (p < 0.001); among females, the values remained at the same level (21.3%). The greatest change in the percentage of current smokers was recorded in cities with ≥500 000 inhabitants (from 30.3% to 17.1%) and <100 000 inhabitants (from 31.5% to 24.6%) (p < 0.05). The total support for the new legal regulations increased from 73.9% to 89.8% (p < 0.001). The use of e-cigarettes in 2019 declared only 1.9%. CONCLUSIONS The percentage of adult traditional cigarette smokers decreased significantly between 2010 and 2019 (mainly among men). Among women, the percentage of cigarette smokers remained the same. The most significant declines in cigarette smoking were also observed among residents of the largest cities (≥500 000 inhabitants). During the same period, there was a further increase in the acceptance of legal restrictions on smoking cigarettes in public places. E-cigarette use among adults is a niche phenomenon in Poland, but it is much more prevalent among women than men. Int J Occup Med Environ Health. 2022;35(4):393-405.
Collapse
Affiliation(s)
- Dagmara Opoczyńska-Świeżewska
- Medical University of Warsaw, Department of Prevention of Environmental Hazards, Allergology and Immunology, Warsaw, Poland
| | - Filip Raciborski
- Medical University of Warsaw, Department of Prevention of Environmental Hazards, Allergology and Immunology, Warsaw, Poland
| | - Bolesław Samoliński
- Medical University of Warsaw, Department of Prevention of Environmental Hazards, Allergology and Immunology, Warsaw, Poland
| |
Collapse
|
32
|
Mantey DS, Omega-Njemnobi O, Hunt ET, Lanza K, Cristol B, Kelder SH. Home Smoke-Free Policies as Children Age: Urban, Rural, and Suburban Differences. Nicotine Tob Res 2022; 24:1985-1993. [PMID: 35901848 PMCID: PMC9653085 DOI: 10.1093/ntr/ntac186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Parents/guardians can effectively reduce tobacco smoking and secondhand smoke exposure among youth by adopting and enforcing rules against indoor tobacco smoking (ie, home smoke-free policies). We investigate home smoke-free policies from childhood to adolescence in the United States and across rural, suburban, and urban households. AIMS AND METHODS We analyzed 2019-2020 National Survey of Children's Health data from n = 5,955 parents of youth aged 0-17, living at home with a tobacco smoker in the United States (U.S). Geographical categories were: rural, suburban, and urban. Home smoke-free policy reflected prohibiting tobacco smoking inside the home. Weighted logistic regressions examined the (1) association between youth age and home smoke-free policies, (2) interaction between geographic category and youth age, and (3) differing associations between youth age and home smoke-free policies by geography. Models controlled for youth race, ethnicity, sex, parental education, household annual income, and home structure. RESULTS Approximately 13.2% of U.S. households with a smoker did not have a home smoke-free policy. Stratified analyses found one-year increase in youth age was associated with lower odds of having a home smoke-free policy in rural (aOR:0.91; 95%CI: 0.87-0.95) and urban (aOR: 0.96; 95%CI: 0.92-1.00; p = .039), but not suburban (aOR:1.00; 95%CI: 0.95-1.05) households, controlling for covariates. CONCLUSION Odds of having a smoke-free home in the U.S. declined significantly in rural (9% per year) and urban (4%) but not suburban (0%) households. We quantify declines in home smoke-free policies as children age and identify geographic disparities for this environmental determinant of health. IMPLICATIONS Health promotion efforts targeting secondhand smoke prevention is needed, particularly for parents of older youth. Furthermore, there is a clear geographic bias in secondhand smoke exposure among all youth particularly older youth. Tailored interventions are needed to address geographic disparities in secondhand smoke exposure among rural and urban youth.
Collapse
Affiliation(s)
- Dale S Mantey
- Corresponding Author: Dale S. Mantey, PhD, MPA, UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA. Telephone: 254-541-2797; Fax: 512-482-6185; E-mail:
| | - Onyinye Omega-Njemnobi
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Ethan T Hunt
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Kevin Lanza
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Benjamin Cristol
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Steven H Kelder
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| |
Collapse
|
33
|
Bykowski KA. Management of primary hypertension in rural populations. Nurse Pract 2022; 47:30-37. [PMID: 35604296 DOI: 10.1097/01.npr.0000829796.72770.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT Hypertension affects almost 20% of Canada's population and is even more prevalent in rural locations due to decreased availability of healthcare; lower income levels and levels of formal education; and higher rates of obesity, smoking, and alcohol use, among others. This article uses current evidence to describe the management of primary hypertension in rural populations.
Collapse
Affiliation(s)
- Kathleen A Bykowski
- Kathleen A. Bykowski is an RN currently enrolled in the Master of Nursing, Nurse Practitioner program at the University of Alberta in Edmonton, Alberta, Canada
| |
Collapse
|
34
|
Rayens MK, McGeeney T, Wiggins AT, Bucher A, Ickes M, Huntington-Moskos L, Clark P, Hahn EJ. Smoke-free Ordinances and Youth Tobacco Use in Kentucky. Am J Health Promot 2022; 36:673-677. [PMID: 35081759 DOI: 10.1177/08901171211066913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12. DESIGN Secondary data analysis from the 2004-2018 biennial Kentucky Incentives for Prevention Survey. SETTING Public high schools in Kentucky. SAMPLE N = 353502 10th/12th graders. MEASURES County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use. ANALYSIS Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use. RESULTS Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location. CONCLUSION Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.
Collapse
Affiliation(s)
- Mary Kay Rayens
- University of Kentucky Colleges of Nursing and Public Health, Lexington, KY, USA
| | | | - Amanda T Wiggins
- Ringgold ID: 4530University of Kentucky College of Nursing, Lexington, KY, USA
| | - Amanda Bucher
- Ringgold ID: 4530University of Kentucky College of Nursing, Lexington, KY, USA
| | - Melinda Ickes
- Ringgold ID: 5170University of Kentucky College of Education, Lexington, KY, USA
| | | | - Patti Clark
- Kentucky Cabinet for Health and Family Services, Frankfort, KY, USA
| | - Ellen J Hahn
- University of Kentucky Colleges of Nursing and Public Health, Lexington, KY, USA
| |
Collapse
|
35
|
Santiago-Torres M, Mull KE, Sullivan BM, Ferketich AK, Bricker JB. Efficacy of an acceptance and commitment therapy-based smartphone application for helping rural populations quit smoking: Results from the iCanQuit randomized trial. Prev Med 2022; 157:107008. [PMID: 35257698 PMCID: PMC9793445 DOI: 10.1016/j.ypmed.2022.107008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
Limited access to evidence-based smoking cessation interventions among rural populations contributes to high rates of cigarette smoking and poor cessation outcomes. Yet, accessible digital interventions for cessation focusing on rural populations are lacking. In a secondary analysis, we determined the acceptability and efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) relative to a U.S. Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) for smoking cessation among rural participants enrolled in the two-arm randomized iCanQuit trial. Participants were enrolled between May 2017 and September 2018 and randomized to either receive iCanQuit or QuitGuide for 12-months. Rural residence was determined by sub-county level Rural-Urban Commuting Area codes. A total of 550 rural participants were recruited from 43 U.S. states. Self-reported complete-case 30-day point-prevalence abstinence was 15% (33/226) for iCanQuit vs. 9% (22/253) for QuitGuide at 3-months (OR = 1.83; 95% CI: 1.03, 3.25) and 29% (66/231) for iCanQuit vs. 25% (64/288) for QuitGuide at 12-months (OR = 1.19 95% CI: 0.80, 1.79). Retention rate was 89% at 12-months and did not differ by arm. iCanQuit vs. QuitGuide participants were significantly more engaged and satisfied with the iCanQuit application. Increased acceptance of internal cues to smoke mediated the effect of treatment on cessation. Findings suggest that iCanQuit had significantly higher short-term quit rates, descriptively higher long-term quit rates, and operated through its hypothesized mechanisms of action relative to QuitGuide. Future larger studies are needed to further evaluate the efficacy of and methods for disseminating the iCanQuit application for smoking cessation among U.S. rural adults nationwide. Trial registrationClinicalTrials.gov Identifier: NCT02724462.
Collapse
Affiliation(s)
- Margarita Santiago-Torres
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA
| |
Collapse
|
36
|
Nalugoda F, Nabukalu D, Ssekasanvu J, Ssekubugu R, Hoe C, Kagaayi J, Sewankambo NK, Serwadda DM, Wawer MJ, Grabowski KM, Reynolds SJ, Kigozi G, Gray RH, Yeh PT, Chang LW. Smoker characteristics and trends in tobacco smoking in Rakai, Uganda, 2010-2018. Tob Induc Dis 2022; 20:23. [PMID: 35342383 PMCID: PMC8883481 DOI: 10.18332/tid/144623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco use is a major public health concern, particularly in low- and middle-income countries where 80% of the world's smokers reside. There is limited population-based data from rural Africa on patterns of tobacco smoking and smoker characteristics. We assessed trends in rates of smoking, characteristics of smokers, and factors associated with smoking using repeat population-based cross-sectional surveys in south-central Uganda. METHODS Data accrued over five survey rounds (2010-2018) of the Rakai Community Cohort Study (RCCS) from consenting individuals aged 15-49 years including sociodemographic and behavioral characteristics and smoking status. Proportions of smokers per survey were compared using χ2 test for trends, and factors associated with smoking were assessed by multivariable logistic regression. RESULTS The prevalence of tobacco smoking in the general population declined from 7.3% in 2010-2011 to 5.1% in 2016-2018, p<0.001. Smoking rates declined among males (13.9-9.2%) and females (2.2-1.8%) from 2010-2011 to 2016-2018. Smoking prevalence was higher among previously married (11.8-11.7%) compared to currently (8.4-5.3%) and never married persons (3.1-1.8%) from 2010-2011 to 2016-2018. Older age (≥35 years) was associated with higher odds of smoking (AOR=8.72; 95% CI: 5.68-13.39 in 2010-2011 and AOR=9.03; 95% CI: 5.42-15.06 in 2016-2018) compared to those aged <35 years (AOR=4.73; 95% CI: 3.15-7.12 in 2010-2011 and AOR=4.83; 95% CI: 2.95-7.91 in 2016-2018). Primary and secondary/higher education level was significantly associated with lower odds of smoking (AOR=0.20; 95% CI: 0.14-0.29 in 2010-2011 and AOR=0.26; 95% CI: 0.18-0.39 in 2016-2018) compared to no education (AOR=0.43; 95% CI: 0.31-0.59 in 2010-2011 and AOR=0.48; 95% CI: 0.34-0.68 in 2016-2018). Number of sexual partners and HIV status were not associated with smoking. CONCLUSIONS We observed declining trends in tobacco smoking in the Rakai region of rural Uganda. Smoking was more prevalent in men, older individuals, individuals who were previously married, and individuals with lower education. The decline in smoking may be due to tobacco control efforts, but there is a continued need to target sub-populations with higher smoking prevalence.
Collapse
Affiliation(s)
| | | | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | | | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson K. Sewankambo
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David M. Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria J. Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Kate M. Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, United States
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | | | - Ronald H. Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Ping T. Yeh
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, United States
| |
Collapse
|
37
|
Richey BF, Obrock RS, Gee ZM, Lu DY, Jacobsen G, Richards SC. SMOKING, RURAL RESIDENCE AND DIABETES AS RISK FACTORS FOR PRESUMED OCULAR HISTOPLASMOSIS SYNDROME. Retina 2022; 42:369-374. [PMID: 34690340 PMCID: PMC8765210 DOI: 10.1097/iae.0000000000003322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the relationship of smoking, urbanicity, and diabetes to presumed ocular histoplasmosis syndrome (POHS) and associated choroidal neovascularization (CNV). METHODS Medical records of 751 adult patients with POHS were reviewed, including 603 patients without CNV and 148 patients with CNV. Age-matched and gender-matched controls were randomly selected from the same practice for comparison. Statistical comparisons of smoking history, urbanicity, and diabetic history were performed using chi-square and conditional logistic regression analyses. RESULTS Increased rates of current or former smoking, rural residence, and diabetes were found in patients with POHS compared with controls. POHS patients with CNV had increased rates of current or former smoking and rural residence as compared with controls. CONCLUSION A history of current or past smoking is associated with an increased risk of developing both POHS alone and POHS with CNV. We did not find a significant additional risk of smoking on the development of CNV in patients with POHS. Patients living in rural locations are more likely than those in urban locations to develop both POHS and POHS with CNV. Diabetics may be more likely to develop POHS than nondiabetics.
Collapse
Affiliation(s)
| | | | - Zachary M. Gee
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - David Y. Lu
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan; and
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | |
Collapse
|
38
|
Smoking, Health Risks, Coping Mechanisms and Depression in the age of COVID-19: a cross-sectional study of the Lebanese Population. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 8:100323. [PMID: 35156073 PMCID: PMC8824168 DOI: 10.1016/j.jadr.2022.100323] [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: 12/27/2021] [Revised: 01/02/2022] [Accepted: 02/05/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction We compared depression of people who smoke and those who do not, depending on whether they have an underlying disease making them at risk for COVID-19. Moreover, we analyzed the factors associated with their depression. Methods We recruited 948 Lebanese residents, ages 18 and above. Our survey included the Patient Health Questionnaire-9 (PHQ-9) to assess depression. We divided participants, based on smoking and having a disease making one at risk for a COVID19 infection into four groups: non-smokers not at risk (NSNR), non-smokers at risk (NSR), smokers not at risk (SNR), and smokers at risk (SR). Results SR had PHQ-9 scores higher than other groups. The diet was not changed during the pandemic, whereas weight increased in all groups but SR. Those not at risk slept longer, while sports were decreased in NSR and SNR. Hobbies were decreased in all groups except SNR. Depending on the group, factors such as age, sex, residency, diet, exercise, sleep duration, and hobbies were associated with PHQ-9 scores. Limitations we cannot draw causal relationships. Participation required internet access, and participants might not represent the actual population due to the snowball effect. Also, recall bias might skew results. We did not inquire about sexual activity, which could be an essential coping mechanism. Conclusion Factors associated with depression for one group did not necessarily do so for another. Controlling the underlying risk or smoking cessation could move a patient to a group with more options associated with depression, thereby additional methods to decrease depression.
Collapse
|
39
|
Hahn EJ, Rademacher K, Bucher A, Sine K, Wiggins AT, Rayens MK. Smoke-Free Policy Disparities in Long-Term Care Facilities. Am J Health Promot 2022; 36:403-409. [DOI: 10.1177/08901171211051333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers’ Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.
Collapse
Affiliation(s)
- Ellen J. Hahn
- College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | | | - Amanda Bucher
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Karlee Sine
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Mary Kay Rayens
- College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
40
|
Nativity Status and Poly Tobacco Use among Young Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031230. [PMID: 35162251 PMCID: PMC8835020 DOI: 10.3390/ijerph19031230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18–30 years of age sampled in the National Health Interview Survey (2015–2019), a nationally representative sample of the US population. We calculated prevalence of use of any and two or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n = 3096) and US-born (n = 6811) young adults. Logistic regression models were adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs. 10.7%; Cigar = 1.8% vs. 4.8%; E-cigarette = 2.3% vs. 4.5%, respectively; p < 0.01) or poly tobacco use (1.9% vs. 4.2%; p < 0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26–0.63)). Conclusions: The findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.
Collapse
|
41
|
Gonzalez M, Sanders-Jackson A. Traditional Cigarette and Poly-Tobacco Use Are Associated with Medical Opioid Use in Rural Areas of the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211864. [PMID: 34831619 PMCID: PMC8619274 DOI: 10.3390/ijerph182211864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Abstract
Introduction: Medical prescriptions for opioids are higher in rural areas of the US as compared to urban areas. Tobacco use may also play a role in this process. This analysis examines the association between differing types of tobacco use and medical opioid use. Methods: We analyze the relationship between tobacco product use and medical opioid use among the US general population living in rural (non-metropolitan) areas using the publicly available sample adult file 2019 National Health Interview Survey (NHIS) (n = 5028). Tobacco use was classified into the following categories: only using cigarettes, only using e-cigarettes/vapes, only using cigars, only using smokeless tobacco, or using two or more of the following products. We used a binary logistic regression, controlling for individual differences. Results: Individuals who reported using only traditional cigarettes (and no other tobacco product, OR = 1.62, 95% CI: 1.31, 2.01), or who reported being a poly-tobacco users (OR = 2.13, 95% CI: 1.40, 3.22) had higher odds of medical opioid use in the last twelve months. Conclusion: Results suggest a link between tobacco use, particularly cigarette use and poly-tobacco use, and medical opioid use in rural communities. Clinical and structural level interventions need to be implemented in rural communities to reduce comorbid tobacco and opioid use.
Collapse
Affiliation(s)
- Mariaelena Gonzalez
- Department of Public Health, School of Social Sciences Humanities and the Arts, University of California Merced, Merced, CA 95343, USA
- Nicotine and Cannabis Policy Center, University of California Merced, Merced, CA 95343, USA
- Correspondence:
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, College of Communications Arts and Sciences, Michigan State University, East Lansing, MI 48824, USA;
| |
Collapse
|
42
|
Dai H, Tamrakar N, Rathnayake N, Samson K. Geographical distribution and social determinants of Tobacco 21 policy adoption and retail inspections in the United States, 2015-2019. Tob Induc Dis 2021; 19:55. [PMID: 34602933 PMCID: PMC8445336 DOI: 10.18332/tid/140148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco control laws that raise the minimum age of tobacco sales to 21 years (T21) play a pivotal role in youth tobacco prevention, yet empirical data are sorely needed to inform enforcement, compliance efforts, and future legislation. METHODS Spatial analysis was conducted at the zip code level by geocoding the states and localities that adopted T21 ordinances from 2015 to 2019. A multi-level logistic regression model was conducted to examine disparities in neighborhood socioeconomic status (SES), FDA retail inspection, and state-level tobacco control policies associated with T21 adoption. RESULTS T21 adoption at the state and local level increased considerably from 1.4% of zip codes in 2015 to 40.2% in 2019. However, the T21 ordinances were disproportionally adopted in New England (82.6%) and Pacific (73.6%) regions with scarce coverage in East South Central (<0.1%), Mountain (1.6%), and West North Central regions (6.1%). The T21 policies were more likely to be adopted in areas with stronger tobacco control policies, urban areas (vs rural, adjusted odds ratio, AOR=1.25, p=0.005), areas with a larger Hispanic (AOR=1.19, p<0.0001) or Asian population (AOR=1.12, p<0.0001), and in areas where the population had higher levels of education (AOR=1.05, p<0.0001). It was less likely to be adopted in areas with larger proportions of American Indians, youths, and young adults. Nearly 40% of zip codes with tobacco retailers did not receive annual FDA tobacco retail inspections for underage sales in 2019. The average retail violation rate of underage sales of tobacco products in T21 regions was lower than in non-T21 regions. CONCLUSIONS Disparities in T21 adoption, retail inspections, and retail compliance may limit the policy impact. Unified enforcement of youth tobacco access restrictions with resources and interventions in vulnerable communities is needed to reduce tobacco-related health disparities.
Collapse
Affiliation(s)
- Hongying Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Niran Tamrakar
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Nirosha Rathnayake
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Kaeli Samson
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| |
Collapse
|
43
|
Ozga JE, Romm KF, Turiano NA, Douglas A, Dino G, Alexander L, Blank MD. Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Exp Clin Psychopharmacol 2021; 29:429-439. [PMID: 34014742 PMCID: PMC9752977 DOI: 10.1037/pha0000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to health-relevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | | | - Geri Dino
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | - Linda Alexander
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
| | - Melissa D. Blank
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| |
Collapse
|
44
|
Kirkland JT, Berry A, Beck Dallaghan GL, Moore Z, Koonce TF. Social Factors of Health Care: a Thematic Analysis of First and Second Year Medical Student Reflections. MEDICAL SCIENCE EDUCATOR 2021; 31:1685-1692. [PMID: 34603841 PMCID: PMC8446133 DOI: 10.1007/s40670-021-01360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Addressing health disparities is necessary to ensure appropriate care for patients. This study examined the impact of Clinical Week experiences on students' recognition of social determinants of health early in their medical education. METHODS A 5-day experience each of the first three semesters of medical school provided direct patient care experiences. Two Clinical Weeks were spent in outpatient clinics located primarily in rural areas. Students completed a reflective writing assignment about their experiences after each 5-day experience. Ninety-two reflections during AY 2018-2019 included discussions about social determinants of health. Two investigators analyzed these essays independently using narrative inquiry techniques. After inductive coding was complete, researchers discussed themes and their broader meaning. RESULTS Themes emerged related to health disparities experienced by rural communities, minority populations, and both uninsured and underinsured patients. Reflections emphasized a lack of public accommodations in rural settings, such as public transportation and access to healthy food. Students noted how ethnic, cultural, and linguistic identity affect a patient's experience with healthcare. Other themes involved the challenges patients face affording treatment plans and conversely how health status can impact economic stability. Finally, students emphasized the importance of physician advocacy in overcoming such barriers to quality health care. CONCLUSIONS Although not the emphasis of Clinical Week, students' reflections identified critical social issues impacting the health of patients they encountered. This experience could be adapted at other institutions.
Collapse
Affiliation(s)
| | - Aiden Berry
- Department of Medicine-Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gary L. Beck Dallaghan
- Office of Educational Scholarship, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Zach Moore
- Office of Academic Affairs, University of North Carolina Adams School of Dentistry, Chapel Hill, NC USA
| | - Thomas F. Koonce
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC USA
| |
Collapse
|
45
|
Mantey DS, Omega-Njemnobi O, Barroso CS. Secondhand Smoke Exposure at Home and/or in a Vehicle: Differences Between Urban and Non-Urban Adolescents in the United States, From 2015 to 2018. Nicotine Tob Res 2021; 23:1327-1333. [PMID: 33155051 PMCID: PMC8496497 DOI: 10.1093/ntr/ntaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Secondhand smoke exposure during adolescence is linked to increased risk for cigarette smoking susceptibility and initiation. Non-urban youth may encounter a disproportionate number social and environmental risk factors for secondhand smoke exposure. Research is needed to explore geographic disparities in secondhand smoke exposure. AIMS AND METHODS Four years of National Youth Tobacco Survey (2015-2018) data were pooled. Participants were 69 249 middle and high school students. Multivariable logistic regression examined the relationship between geographic region and secondhand smoke exposure (1) at home and (2) in a vehicle. A multivariable, multinomial logistic regression examined the relationship between geographic region and number of sources of secondhand smoke exposure (ie, 0, 1 source, 2 sources). Covariates included sex, race/ethnicity, grade level, past 30-day tobacco use, and living with a tobacco user. RESULTS From 2015 to 2018, ~28.4% of middle and high school students reported secondhand smoke exposure either at home, in a vehicle, or both. Non-urban youth had greater odds of reporting secondhand smoke exposure at home (Adj OR: 1.26; 95% CI: 1.15 to 1.38) and in a vehicle (Adj OR: 1.50; 95% CI: 1.35 to 1.65), compared with urban youth. Similarly, non-urban youth had greater odds of reporting secondhand smoke exposure via one source (RRR: 1.21; 95% CI: 1.11 to 1.31) and two sources (RRR: 1.61; 95% CI: 1.42 to 1.82), relative to no exposure, than urban youth. CONCLUSION Secondhand smoke exposure at home and/or in a vehicle varies across geographic region. Targeted interventions should be developed and implemented to reduce secondhand smoke exposure among at-risk youth. IMPLICATIONS Findings showcase the need to address secondhand smoke exposure in non-urban areas and how it impacts adolescents. Public health interventions and regulatory policies aimed at improving social norms and expanding health infrastructure in rural communities should be designed and implemented in order to prevent and reduce secondhand smoke exposure among non-urban youth.
Collapse
Affiliation(s)
- Dale S Mantey
- University of Texas School of Public Health,
Austin, TX, USA
| | | | - Cristina S Barroso
- University of Tennessee, College of Education, Health, and
Human Sciences, Knoxville, TN, USA
| |
Collapse
|
46
|
Lazaro A, Ceballos R, Fischer M, Smuin S, Halpern-Felsher B. A novel approach to training educators to conduct school-based adolescent e-cigarette education and prevention: Using the Tobacco Prevention Toolkit. Addict Behav 2021; 118:106858. [PMID: 33640832 DOI: 10.1016/j.addbeh.2021.106858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Emerging tobacco products, especially e-cigarettes, present a challenge for educators tasked with providing adolescent tobacco prevention education, as they typically have insufficient time to stay uptodate with the latest information on all tobacco products. To equip educators to implement e-cigarette and other prevention materials, we developed a novel, experiential training of the Tobacco Prevention Toolkit, comprising three components: (1) information session, (2) website navigation demonstration, and (3) hands-on curriculum demonstration allowing educators to present and practice Toolkit lessons. METHODS We evaluated this experiential training using a post-training survey, conducted with 486 participants (75% female) from 21 separate trainings. Surveys included demographic questions, training evaluation questions, and 4 open-ended questions administered via Qualtrics. Quantitative data were analyzed for frequencies via R statistical software. Qualitative data were analyzed using grounded theory. RESULTS Training participants overwhelmingly agreed or strongly agreed that their knowledge of e-cigarettes increased as a result of the training; they were satisfied with the overall training; and they indicated intention to use the Toolkit in the future. Participants favored the enthusiastic presenters, the information about e-cigarettes, the website navigation, and the curriculum demonstration features of the training. Participants requested more time for various components of the training, more in-depth information about e-cigarettes, and more direction for Toolkit implementation. CONCLUSIONS This novel, experiential training increased educator-reported knowledge of tobacco products and was overwhelmingly well-received, suggesting that such training can be important for effective dissemination of other e-cigarette prevention and intervention curricula.
Collapse
Affiliation(s)
- Adrienne Lazaro
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Richard Ceballos
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Molly Fischer
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | | | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
| |
Collapse
|
47
|
Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136755. [PMID: 34201718 PMCID: PMC8267625 DOI: 10.3390/ijerph18136755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was found among never and ever e-cigarette users living in households with tobacco users. The ANOVA results suggest a positive, monotonic relationship between tobacco use status and temptation to try e-cigarettes, and that the adjusted group means differ by gender and race/ethnicity. The findings can inform tobacco prevention interventions for youth at higher risk for e-cigarette use, especially youth who have not yet tried e-cigarettes.
Collapse
|
48
|
Ellis-Suriani Z, Norsa'adah B, Othman A, Siti-Azrin AH. Association between secondhand smoke exposure at home and cognitive performance among rural primary school children in Malaysia. Tob Induc Dis 2021; 19:27. [PMID: 33867904 PMCID: PMC8049107 DOI: 10.18332/tid/133638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure is linked to a series of serious health problems. Children may be particularly vulnerable to the effects of SHS exposure at home. This study aimed to determine the association between SHS exposure at home and cognitive performance in school children. METHODS A multistage sampling was performed across rural primary schools in Kuala Krai, Kelantan, Malaysia. Data were collected using self-administered questionnaires and the children aged 10-11 years (n=312) were subjected to cognitive tests including digit span, letter-number sequencing, coding, and symbol search. Cognitive performance was tested using subscales derived from the Wechsler Intelligence Scale for Children. RESULTS The prevalence of SHS exposure at home was 55.8%, where 11.9% of children lived with one smoker, while 43.9% of children lived with ≥2 smokers. There was a significant difference in the mean score of the combined cognitive tests between SHS-exposed and non-exposed children after adjustment for sex, parental educational level, family income and academic performance [Pillai's Trace=0.084, F statistic (df)=6.803 (4302), p<0.001]. CONCLUSIONS More than half of the primary school children in rural Kuala Krai were exposed to SHS from at least one smoker at home. There was a significant association between SHS exposure at home and cognitive performance.
Collapse
Affiliation(s)
- Zulkarnain Ellis-Suriani
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Azizah Othman
- Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Ab Hamid Siti-Azrin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| |
Collapse
|
49
|
Mistry SK, Ali AM, Rahman MA, Yadav UN, Gupta B, Rahman MA, Huque R. Changes in Tobacco Use Patterns during COVID-19 and Their Correlates among Older Adults in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041779. [PMID: 33673087 PMCID: PMC7918812 DOI: 10.3390/ijerph18041779] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
The present study explored the changes in tobacco use patterns during the COVID-19 pandemic and their correlates among older adults in Bangladesh. This cross-sectional study was conducted among 1032 older adults aged ≥60 years in Bangladesh through telephone interviews in October 2020. Participants’ characteristics and COVID-19-related information were gathered using a pretested semi-structured questionnaire. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic (6 months prior to the survey). Nearly half of the participants (45.6%) were current tobacco users, of whom 15.9% reported increased tobacco use during the COVID-19 pandemic and all others had no change in their tobacco use patterns. Tobacco use was significantly increased among the participants from rural areas, who had reduced communications during COVID-19 compared to pre-pandemic (OR = 2.76, 95%CI:1.51–5.03). Participants who were aged ≥70 years (OR = 0.33, 95% CI: 0.14–0.77), widowed (OR = 0.36, 95% CI: 0.13–1.00), had pre-existing, non-communicable, and/or chronic conditions (OR = 0.44, 95% CI: 0.25–0.78), and felt themselves at the highest risk of COVID-19 (OR = 0.31, 95% CI: 0.15–0.62), had significantly lower odds of increased tobacco use. Policy makers and practitioners need to focus on strengthening awareness and raising initiatives to avoid tobacco use during such a crisis period.
Collapse
Affiliation(s)
- Sabuj Kanti Mistry
- Department of Health Research, ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka 1216, Bangladesh;
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia;
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
- Correspondence: ; Tel.: +61-40-6863358
| | - Armm Mehrab Ali
- Department of Health Research, ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka 1216, Bangladesh;
- Global Research and Data Support, Innovations for Poverty Action, 101 Whitney Avenue, New Haven, CT 06510, USA
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia;
- Center for Research, Policy and Implementation, Biratnagar 56613, Nepal
- Department of Public Health, Torrens University, Melbourne, VIC 3000, Australia;
| | - Bhawna Gupta
- Department of Public Health, Torrens University, Melbourne, VIC 3000, Australia;
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, VIC 3806, Australia;
- Australian Institute of Primary Care and Ageing, La Trobe University, Melbourne, VIC 3086, Australia
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh;
- Research and Development, ARK Foundation, Gulshan, Dhaka 1212, Bangladesh
| |
Collapse
|
50
|
Cardarelli K, Westneat S, Dunfee M, May B, Schoenberg N, Browning S. Persistent disparities in smoking among rural Appalachians: evidence from the Mountain Air Project. BMC Public Health 2021; 21:270. [PMID: 33530976 PMCID: PMC7856720 DOI: 10.1186/s12889-021-10334-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/25/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. METHODS A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. RESULTS MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51-2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. CONCLUSIONS Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.
Collapse
Affiliation(s)
- Kathryn Cardarelli
- College of Public Health, University of Kentucky, Lexington, KY, USA.
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
| | - Susan Westneat
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Madeline Dunfee
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Beverly May
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Nancy Schoenberg
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Steven Browning
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| |
Collapse
|