1
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Menson KE, Coleman SRM. Reprint of: Smoking and pulmonary health in women: A narrative review and behavioral health perspective. Prev Med 2024:108113. [PMID: 39198081 DOI: 10.1016/j.ypmed.2024.108113] [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] [Indexed: 09/01/2024]
Abstract
OBJECTIVE Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women. METHODS This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment. RESULTS Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking). CONCLUSION Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.
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Affiliation(s)
- Katherine E Menson
- Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT, USA; Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Sulamunn R M Coleman
- Department of Psychiatry, University of Vermont, Burlington, VT, USA; Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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2
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Menson KE, Coleman SRM. Smoking and pulmonary health in women: A narrative review and behavioral health perspective. Prev Med 2024; 185:108029. [PMID: 38851402 DOI: 10.1016/j.ypmed.2024.108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women. METHODS This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment. RESULTS Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking). CONCLUSION Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.
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Affiliation(s)
- Katherine E Menson
- Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT, USA; Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Sulamunn R M Coleman
- Department of Psychiatry, University of Vermont, Burlington, VT, USA; Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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3
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David JC, Fonte D, Sutter-Dallay AL, Auriacombe M, Serre F, Rascle N, Loyal D. The stigma of smoking among women: A systematic review. Soc Sci Med 2024; 340:116491. [PMID: 38096599 DOI: 10.1016/j.socscimed.2023.116491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/04/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences. METHODS In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies. RESULTS The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation. CONCLUSIONS These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.
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Affiliation(s)
| | | | - Anne-Laure Sutter-Dallay
- Inserm U1219 Bordeaux Population Health, Bordeaux, France; Hôpital Charles Perrens, Bordeaux, France
| | - Marc Auriacombe
- Hôpital Charles Perrens, Bordeaux, France; CNRS UMR 6033, SANPSY, Bordeaux, France
| | | | - Nicole Rascle
- Inserm U1219 Bordeaux Population Health, Bordeaux, France
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Clawson AH, Cole AB, Kurien CS, Blair AL. Racial and ethnic differences in distress, discrimination, substance use coping, and nicotine use among parents during COVID-19. J Ethn Subst Abuse 2022:1-24. [PMID: 36227608 PMCID: PMC10097833 DOI: 10.1080/15332640.2022.2128960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study identified contributing factors for tobacco-related inequities among parents (N = 331) during COVID-19. Compared to non-Hispanic White parents, Asian, Black, and multiracial parents experienced greater discrimination. Parents with a nicotine use history experienced greater discrimination and substance use coping relative to tobacco abstainers. Among parents who used nicotine during the pandemic (n = 45), experiencing financial loss, having COVID-19, and greater worries were positively associated with nicotine reductions during COVID-19. Being female, increased family members with COVID-19, discrimination, and substance use coping were negatively associated with nicotine reductions. Tobacco interventions that reduce substance use coping and increase alternative coping are needed.
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Affiliation(s)
- Ashley H. Clawson
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
| | - Ashley B. Cole
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
| | | | - Alexandra L. Blair
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
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Kalichman SC, Shkembi B, Eaton LA. Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma. AIDS Behav 2022; 26:27-38. [PMID: 34424389 DOI: 10.1007/s10461-021-03437-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/31/2022]
Abstract
Intersectionality has emerged as theoretically and practically important to advancing HIV stigma research. However, few psychometric measures capture the intricacies of intersectional stigma. Grounded in the HIV stigma framework and contemporary theories of intersectionality, this paper describes a novel approach to conceptualizing the measurement of intersectional stigma. Taking the notion of an intersection literally, that is the point at which two or more lines meet and form a union, we offer a geometric conceptualization for developing a psychometric instrument to measure intersectional stigma. Ratings of stigmatized attributes, such as stigma ascribed to gender, race, sexual orientation, and HIV status are assessed on independent scales to calculate their intersection using the Pythagorean Theorem, c = [Formula: see text] (a2 + b2) and its extension to multiple stigmatized attributes d = [Formula: see text] (a2 + b2 + c2). Data from a sample of Black /African American women living with HIV were used to test the concept of a geometric approach to measuring intersectional enacted stigma and intersectional anticipated stigma. Findings from the test of concept were encouraging and warrant further scale development research.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA.
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
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Social Norms Change and Tobacco Use: A Protocol for a Systematic Review and Meta-Analysis of Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212186. [PMID: 34831942 PMCID: PMC8618876 DOI: 10.3390/ijerph182212186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Tobacco use kills more than eight million individuals each year, and results in substantial economic and human capital loss across nations. While effective supply-side solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers, and less feasible to implement in countries with weaker tobacco control policy environments. Thus, effective demand-side solutions are needed. Shifting social norms around tobacco use is one such promising approach. To this end, a systematic review and meta-analysis of social norms intervention studies to influence tobacco use will be conducted following PRISMA 2020 guidance. Tobacco intervention studies with at least two time points that explicitly mention social norms or social influence as part of an intervention or set of measured variables will be included. Literature sources will comprise PubMed, Scopus, PsycInfo, and the Cochrane Trial Registry, as well as several grey literature sources. Two reviewers will independently screen studies, and risk of bias will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools. The primary outcomes will be change in tobacco use and change in social norms. A random-effects meta-analysis will be conducted for both outcomes. Sources of heterogeneity will be explored using meta-regression with key covariates. Non-reporting biases will be explored using funnel plots. PROSPERO: CRD42021251535.
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Negotiating Multiple Stigmas: Substance Use in the Lives of Women Experiencing Homelessness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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8
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Addressing Smoking Cessation among Women in Substance Use Treatment: A Qualitative Approach to Guiding Tailored Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115764. [PMID: 34072064 PMCID: PMC8198796 DOI: 10.3390/ijerph18115764] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022]
Abstract
Intersecting socially marginalized identities and unique biopsychosocial factors place women with substance use disorders (SUDs) experiencing myriad disadvantages at higher risk for smoking and stigmatization. Here, based on our work with women receiving care for SUDs in four participating treatment/women-serving centers (N = 6 individual clinics), we: (1) describe the functions of smoking for women with SUDs; and (2) explore participants’ experiences of a comprehensive tobacco-free workplace (TFW) program, Taking Texas Tobacco-Free (TTTF), that was implemented during their SUD treatment. Ultimately, information gleaned was intended to inform the development of women-tailored tobacco interventions. Data collection occurred pre- and post-TTTF implementation and entailed conducting client (7) and clinician (5) focus groups. Using thematic analysis, we identified four main themes: “the social context of smoking,” “challenges to finding support and better coping methods,” “addressing underlying conditions: building inner and outer supportive environments,” and “sustaining support: TFW program experiences.” Women reported that: smoking served as a “coping mechanism” for stress and facilitated socialization; stigmatization hindered quitting; non-stigmatizing counseling cessation support provided alternative coping strategies; and, with clinicians, the cessation opportunities TTTF presented are valuable. Clinicians reported organizational support, or lack thereof, and tobacco-related misconceptions as the main facilitator/barriers to treating tobacco addiction. Effective tobacco cessation interventions for women with SUDs should be informed by, and tailored to, their gendered experiences, needs, and recommendations. Participants recommended replacing smoking with healthy stress alleviating strategies; the importance of adopting non-judgmental, supportive, cessation interventions; and the support of TFW programs and nicotine replacement therapy to aid in quitting.
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Kava CM, Soule EK, Seegmiller L, Gold E, Snipes W, Westfield T, Wick N, Afifi R. "Taking Up a New Problem": Context and Determinants of Pod-Mod Electronic Cigarette Use Among College Students. QUALITATIVE HEALTH RESEARCH 2021; 31:703-712. [PMID: 33213262 PMCID: PMC7878307 DOI: 10.1177/1049732320971236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this article, we explore the context and determinants of pod-mod electronic cigarette (ECIG) use among college students aged 18 to 24 in the United States. We conducted semi-structured interviews with 55 students (M age = 20 years, 56% female, 65% White) on three campuses in the Northwest, Midwest, and Southeast. We performed a thematic analysis. Students described ECIG use by peers, increased ECIG exposure and prevalence in college, and school-related stress as reasons for vaping. Pod-mod features such as convenience, design, easy concealment, and flavors made vaping more appealing. Negative aspects of vaping included addiction, cost, and possible health consequences. Most viewed vaping as a college behavior and intended to quit after graduation. Our results show that the college environment plays a major role in young adult ECIG use. These findings can inform the development of targeted interventions to prevent and control uptake of ECIGs by young adults.
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Affiliation(s)
| | - Eric K Soule
- East Carolina University, Greenville, North Carolina, USA
| | - Laura Seegmiller
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Emily Gold
- East Carolina University, Greenville, North Carolina, USA
| | - William Snipes
- East Carolina University, Greenville, North Carolina, USA
| | - Taya Westfield
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Noah Wick
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Rima Afifi
- University of Iowa College of Public Health, Iowa City, Iowa, USA
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Axelsson Fisk S, Lindström M, Perez-Vicente R, Merlo J. Understanding the complexity of socioeconomic disparities in smoking prevalence in Sweden: a cross-sectional study applying intersectionality theory. BMJ Open 2021; 11:e042323. [PMID: 33574148 PMCID: PMC7880088 DOI: 10.1136/bmjopen-2020-042323] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Socioeconomic disparities in smoking prevalence remain a challenge to public health. The objective of this study was to present a simple methodology that displays intersectional patterns of smoking and quantify heterogeneities within groups to avoid inappropriate and potentially stigmatising conclusions exclusively based on group averages. SETTING This is a cross-sectional observational study based on data from the National Health Surveys for Sweden (2004-2016 and 2018) including 136 301 individuals. We excluded people under 30 years of age, or missing information on education, household composition or smoking habits. The final sample consisted on 110 044 individuals or 80.7% of the original sample. OUTCOME Applying intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of self-reported smoking across 72 intersectional strata defined by age, gender, educational achievement, migration status and household composition. RESULTS The distribution of smoking habit risk in the population was very heterogeneous. For instance, immigrant men aged 30-44 with low educational achievement that lived alone had a prevalence of smoking of 54% (95% CI 44% to 64%), around nine times higher than native women aged 65-84 with high educational achievement and living with other(s) that had a prevalence of 6% (95% CI 5% to 7%). The discriminatory accuracy of the information was moderate. CONCLUSION A more detailed, intersectional mapping of the socioeconomic and demographic disparities of smoking can assist in public health management aiming to eliminate this unhealthy habit from the community. Intersectionality theory together with AIHDA provides information that can guide resource allocation according to the concept proportionate universalism.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Lindström
- Unit for Social Medicine and Health Policy, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
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Schilling L, Spallek J, Maul H, Schneider S. Study on E-Cigarettes and Pregnancy (STEP) - Results of a Mixed Methods Study on Risk Perception of E-Cigarette Use During Pregnancy. Geburtshilfe Frauenheilkd 2021; 81:214-223. [PMID: 33574625 PMCID: PMC7870285 DOI: 10.1055/a-1308-2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/08/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction
E-cigarette use during pregnancy is a risk factor for maternal and fetal health. Early studies on animals showed that in utero exposure to e-cigarettes can have negative health outcomes for the fetus. There has been only limited research into the risk perceptions of e-cigarette use during pregnancy. This study was conducted to comprehensively characterize the constructs of risk perceptions with regard to e-cigarette use during pregnancy using an
I
ntegrated
H
ealth
B
elief
M
odel (IHBM).
Methods
Our
ST
udy on
E
-cigarettes and
P
regnancy (STEP) used a mixed methods approach, with the study divided into an initial qualitative part and a quantitative part. A netnographic approach was used for the first part, which consisted of the analysis of 1552 posts from 25 German-language online discussion threads on e-cigarette use during pregnancy. Using these qualitative results, a quantitative questionnaire was developed to explore risk perception constructs about e-cigarette use during pregnancy. This questionnaire was subsequently administered to pregnant women (n = 575) in one hospital in Hamburg, Germany. Descriptive and bivariate analysis was used to examine differences in risk perception according to participantsʼ tobacco and e-cigarette user status before and during pregnancy. While the study design, methods and sample have been extensively described in our recently published study protocol in the January 2020 issue of
Geburtshilfe und Frauenheilkunde
, this paper is devoted to a presentation of the results of our mixed methods study.
Results
Themes related to perceived threats identified in the qualitative study part were
nicotine-related health risks
and
potential health risks of additional ingredients
. Perceived benefits were
possibility and facilitation of smoking cessation
and a presumed
potential to reduce harm
. The subsequent quantitative part showed that nearly all participants (99.3%) perceived e-cigarettes which contained nicotine as constituting a threat to the health of the unborn child. The most commonly perceived barrier was health-related (96.6%), while the most commonly perceived benefit was a reduction in the amount of tobacco cigarettes consumed (31.8%). We found that particularly perceived benefits varied depending on the participantʼs tobacco and e-cigarette user status.
Conclusion
When considering future prevention strategies, the potential health risks and disputed effectiveness of e-cigarettes as a tool for smoking cessation need to be taken into account and critically discussed.
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Affiliation(s)
- Laura Schilling
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany.,Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | | | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Crooks N, Singer R, Tluczek A. Black Female Sexuality: Intersectional Identities and Historical Contexts. ANS Adv Nurs Sci 2021; 44:52-65. [PMID: 33181567 DOI: 10.1097/ans.0000000000000332] [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] [Indexed: 11/26/2022]
Abstract
Black females experience significant sexual health disparities. Intersectionality theory offers nurses a framework to address health disparities. Intersectionality theory examines how categorical identities of difference confer power or oppression, affect social interactions, and influence individuals' engagement with institutional structures. This secondary analysis of qualitative data details the damaging effects that power, oppression, and disadvantaged identities have on the sexual health of Black women. Twenty participants explained how the intersection of race, gender, age, education, and sexuality influences sexual health risk. Our expanded model of intersectionality theory emphasizes historical context with implications for research, practice, and education to promote health equity.
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Affiliation(s)
- Natasha Crooks
- University of Illinois Chicago College of Nursing, Chicago (Drs Crooks and Singer); and School of Nursing, University of Wisconsin-Madison, Madison (Dr Tluczek)
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Hewer RMF, Hill S, Amos A, consortium SILNER. Student perceptions of smoke-free school policies in Europe – a critical discourse analysis. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1856332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Dogar O, Keding A, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Parrott S, Li J, Readshaw A, Sheikh A, Siddiqi K. Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. LANCET GLOBAL HEALTH 2020; 8:e1408-e1417. [DOI: 10.1016/s2214-109x(20)30312-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
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Wagnild JM, Pollard TM. "Sit Yourself Down": Women's Experiences of Negotiating Physical Activity During Pregnancy. QUALITATIVE HEALTH RESEARCH 2020; 30:1072-1082. [PMID: 32141381 PMCID: PMC7682526 DOI: 10.1177/1049732320909103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Approaches to understanding why physical activity (PA) tends to decline during pregnancy are generally based on individualized behavioral models, examining "barriers" or "enablers." In contrast, we used a social practice approach to explore the ways in which women negotiate PA during pregnancy within the contexts and routines of their everyday lives. Semistructured interviews were conducted with 18 pregnant women who had been classed as being at risk of gestational diabetes. We found that leisure-time physical activities were valued as pleasurable and therapeutic, but women's roles as employees and carers for others often constrained their opportunities for leisure-time PA. Women encountered others' expectations that they should sit down and slow down. This surveillance was often resisted, as women relied on "listening to the body" as a way to negotiate PA. These findings have important implications for public health strategies or interventions designed to promote PA during pregnancy.
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Affiliation(s)
- Janelle M. Wagnild
- Durham University, Durham, United Kingdom
- Janelle M. Wagnild, Department of Anthropology, Dawson Building, Durham University, South Road, Durham, DH1 3LE, UK.
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Schilling L, Schneider S, Maul H, Spallek J. STudy on E-Cigarettes and Pregnancy (STEP) - Study Protocol of a Mixed Methods Study on Risk Perception of E-Cigarette Use During Pregnancy and Sample Description. Geburtshilfe Frauenheilkd 2020; 80:66-75. [PMID: 31949321 PMCID: PMC6957352 DOI: 10.1055/a-1061-7288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction During pregnancy, the mother's healthy lifestyle is crucial for the health of the fetus. Potential risk factors for maternal and child health should therefore be identified and reduced as early as possible. The consumption of e-cigarettes represents one of these potential risk factors. Exploring risk perceptions about e-cigarette use during pregnancy can provide early indications of possible user motives. Therefore, our mixed methods ST udy on E -cigarettes and P regnancy (STEP) aimed to comprehensively analyze risk perceptions about e-cigarette use during pregnancy based on an I ntegrated H ealth B elief M odel (IHBM). This paper describes the study design, methods, sample population and limitations of STEP. Methods Our sequential mixed methods study combined qualitative and quantitative approaches. In the qualitative section of the study which preceded the quantitative part of the study, we aimed to characterize risk perceptions about e-cigarette use during pregnancy. We used a netnographic research approach which analyzed discussion threads in online forums dealing with e-cigarette use during pregnancy. The analysis was based on an IHBM. Identified themes were incorporated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimed to quantify, among other things, perceived threats, barriers and benefits and to explore differences in risk perception according to sociodemographic characteristics and tobacco and e-cigarette usage. Results In the qualitative section, 1552 posts in 25 online discussion threads dealing, inter alia, with e-cigarette use during pregnancy were identified. The quantitative part looked at the responses in the questionnaires handed in by 575 pregnant women who attended a hospital in Hamburg (Germany) from April 2018 to January 2019 (response rate: 27.5%). Conclusion Data collection was successful for both the qualitative and quantitative parts of the study. When interpreting the results of STEP, different limitations should be taken into account. The results of STEP provide starting points for the development of tailored preventive measures for pregnant women.
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Affiliation(s)
- Laura Schilling
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
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Wilson SM, Medenblik AM, Neal JM, Strauss JL, McNiel JM, Christian WE, Beckham JC, Calhoun PS. Lifetime Smoking Patterns and Preferences for Smoking Cessation Among Women Veterans Receiving Veterans Health Administration Care. QUALITATIVE HEALTH RESEARCH 2019; 29:2096-2107. [PMID: 31307290 PMCID: PMC6848747 DOI: 10.1177/1049732319857536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants' smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.
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Affiliation(s)
- Sarah M Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa M Medenblik
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julia M Neal
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Jennifer L Strauss
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - J Murray McNiel
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Warren E Christian
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
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Boeckmann M, Warsi S, Noor M, Dogar O, Mustagfira EH, Firoze F, Zahid R, Readshaw A, Siddiqi K, Kotz D. Health worker and patient views on implementation of smoking cessation in routine tuberculosis care. NPJ Prim Care Respir Med 2019; 29:34. [PMID: 31481678 PMCID: PMC6722140 DOI: 10.1038/s41533-019-0146-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
Smoking worsens tuberculosis (TB) outcomes. Persons with TB who smoke can benefit from smoking cessation. We report findings of a multi-country qualitative process evaluation assessing barriers and facilitators to implementation of smoking cessation behaviour support in TB clinics in Bangladesh and Pakistan. We conducted semi-structured qualitative interviews at five case study clinics with 35 patients and 8 health workers over a period of 11 months (2017-2018) at different time points during the intervention implementation phase. Interviews were conducted by trained researchers in the native languages, audio-recorded, transcribed into English and analysed using a combined deductive-inductive approach guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. All patients report willingness to quit smoking and recent quit attempts. Individuals' main motivations to quit are their health and the need to financially provide for a family. Behavioural regulation such as avoiding exposure to cigarettes and social influences from friends, family and colleagues are main themes of the interviews. Most male patients do not feel shy admitting to smoking, for the sole female patient interviewee stigma was an issue. Health workers report structural characteristics such as high workload and limited time per patient as primary barriers to offering behavioural support. Self-efficacy to discuss tobacco use with women varies by health worker. Systemic barriers to implementation such as staff workload and socio-cultural barriers to cessation like gender relations, stigma or social influences should be dealt with creatively to optimize the behaviour support for sustainability and scale-up.
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Affiliation(s)
- Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany. .,Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. .,Department of Environment and Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | | | - Maryam Noor
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Omara Dogar
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | | | - Fariza Firoze
- ARK Foundation, Suite C-3 & C-4, House #06, Road #109, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Raana Zahid
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Anne Readshaw
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany.,Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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19
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Schilling L, Schneider S, Karlheim C, Maul H, Tallarek M, Spallek J. Perceived threats, benefits and barriers of e-cigarette use during pregnancy. A qualitative analysis of risk perception within existing threads in online discussion forums. Midwifery 2019; 79:102533. [PMID: 31499382 DOI: 10.1016/j.midw.2019.102533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 08/31/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Previous studies have shown that e-cigarettes are perceived as being less harmful than tobacco cigarettes by pregnant women and might be used to quit smoking during pregnancy. Our aim was to further explore and characterise perceived threats, benefits and barriers of e-cigarette use during pregnancy. METHODS Our STudy on E-cigarettes and Pregnancy (STEP) was, among others, based on a netnographic approach of analysing existing threads in German-speaking online discussion forums dealing with perceived threats and benefits of e-cigarette use during pregnancy. For the analysis, we used an inductive-deductive qualitative content analysis. FINDINGS Based on 25 online discussion threads containing 1552 posts, we identified perceived threats, perceived benefits and perceived barriers to e-cigarette use during pregnancy, among others, as main themes. Subthemes identified within the main theme perceived threats were severe nicotine related health risks, potential health risks of additional ingredients, relative risks and lack of knowledge and research studies. As perceived benefits, we identified possibility and facilitation of smoking cessation, harm reduction and financial benefits. Perceived barriers were lack of satisfaction and social stigma. CONCLUSION Our qualitative results suggest that the perception of the health threats related to e-cigarette use during pregnancy varies according to the nicotine content and the perception of relative risks compared with tobacco cigarettes. In addition to this, risk perception is defined through further health and non-health related barriers and benefits (e.g. suitability of e-cigarettes as a smoking cessation aid, social stigma).
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Affiliation(s)
- Laura Schilling
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany; Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Marie Tallarek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
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20
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Khenti A, Bobbili SJ, Sapag JC. Evaluation of a Pilot Intervention to Reduce Mental Health and Addiction Stigma in Primary Care Settings. J Community Health 2019; 44:1204-1213. [DOI: 10.1007/s10900-019-00706-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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21
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Stanley SJ, Pitts MJ. "I'm Scared of the Disappointment": Young Adult Smokers' Relational Identity Gaps and Management Strategies as Sites of Communication Intervention. HEALTH COMMUNICATION 2019; 34:904-911. [PMID: 29469651 DOI: 10.1080/10410236.2018.1440507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While cigarette smoking is decreasing among young adults, rates of nicotine consumption through other devices, most notably electronic cigarettes, are on the rise. Framed by communication theory of identity, this study examines young adult smokers' experiences with relational others in regard to their smoking. Focus group discussions and individual interviews convened with 20 young adult cigarette and electronic cigarette smokers revealed identity gaps implicating the relational layer of identity, including personal-relational, enacted-relational, and personal-enacted-relational identity gaps. Participants used communicative and behavioral strategies to manage relational discrepancies. The documented identity gaps and management strategies present opportunities for targeted smoking cessation interventions that amplify dissonance created through identity gaps as a motivational tactic.
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22
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McCready G, Glenn NM, Frohlich KL. "Don't smoke in public, you look like trash": An exploratory study about women's experiences of smoking-related stigmatisation and the connection to neighbourhood-level deprivation. Health Place 2019; 58:102142. [PMID: 31203033 DOI: 10.1016/j.healthplace.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/16/2019] [Accepted: 05/17/2019] [Indexed: 12/01/2022]
Abstract
In this exploratory qualitative study we used Goffman's theory of stigmatisation to examine how women experience smoking-related stigma in relation to neighbourhood-level deprivation. From an existing cohort, we recruited fifteen women who smoked. We found differences in the women's experiences and abilities to negotiate and avoid a stigmatised smoking identity based on neighbourhood-level deprivation. Women in high-deprivation neighbourhoods described limited access to such places and this restricted their abilities to 'pass' as non- or not-quite-smokers and avoid smoking-related stigmatisation. We discuss the implications of the findings in relation to social-spatial inequalities in health and public health policy.
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Affiliation(s)
- Geneviève McCready
- Institut de recherche en santé publique de l'Université de Montréal, Université de Montréal, 7101 av. du Parc, C.P. 6128, Succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada; Département de médecine sociale et préventive, ESPUM, Université de Montréal, 7101 av. du Parc, Office 3128, Montréal, QC, H1B 3C1, Canada.
| | - Nicole M Glenn
- Institut de recherche en santé publique de l'Université de Montréal, Université de Montréal, 7101 av. du Parc, C.P. 6128, Succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada; Département de médecine sociale et préventive, ESPUM, Université de Montréal, 7101 av. du Parc, Office 3128, Montréal, QC, H1B 3C1, Canada; Centre for Healthy Communities, School of Public Health, University of Alberta, 3-035 ECHA, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Katherine L Frohlich
- Institut de recherche en santé publique de l'Université de Montréal, Université de Montréal, 7101 av. du Parc, C.P. 6128, Succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada; Département de médecine sociale et préventive, ESPUM, Université de Montréal, 7101 av. du Parc, Office 3128, Montréal, QC, H1B 3C1, Canada.
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23
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Lapalme J, Haines-Saah R, Frohlich KL. More than a buzzword: how intersectionality can advance social inequalities in health research. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1584271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Josée Lapalme
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche en santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Katherine L. Frohlich
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche en santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
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Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, Pescosolido B, Murray SM. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med 2019; 17:7. [PMID: 30764816 PMCID: PMC6376691 DOI: 10.1186/s12916-018-1246-9] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.
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Affiliation(s)
- Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294 USA
| | | | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, OH USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Kaylee B. Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Cheema AW, Meagher KM, Sharp RR. Multiple Marginalizations: What Bioethics Can Learn From Black Feminism. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:1-3. [PMID: 30784383 DOI: 10.1080/15265161.2019.1575142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Lipperman-Kreda S, Antin TM, Hunt GP. The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers. DRUGS (ABINGDON, ENGLAND) 2018; 26:475-483. [PMID: 34262244 PMCID: PMC8276780 DOI: 10.1080/09687637.2018.1490391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
AIMS We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma. FINDINGS Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.
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Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation 180 Grand Avenue, Suite 1200, Oakland, CA 94612
| | - Tamar M.J Antin
- Prevention Research Center, Pacific Institute for Research and Evaluation 180 Grand Avenue, Suite 1200, Oakland, CA 94612
- Institute for Scientific Analysis 1150 Ballena Blvd, Suite 211, Alameda, CA 94501
| | - Geoffrey P. Hunt
- Institute for Scientific Analysis 1150 Ballena Blvd, Suite 211, Alameda, CA 94501
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27
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Antin TMJ, Hunt G, Sanders E. The "here and now" of youth: the meanings of smoking for sexual and gender minority youth. Harm Reduct J 2018; 15:30. [PMID: 29855377 PMCID: PMC5984472 DOI: 10.1186/s12954-018-0236-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives. METHODS This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense. RESULTS Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health. CONCLUSIONS These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.
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Affiliation(s)
- Tamar M. J. Antin
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Geoffrey Hunt
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Emile Sanders
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
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Thirlway F. How will e-cigarettes affect health inequalities? Applying Bourdieu to smoking and cessation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:99-104. [PMID: 29414491 PMCID: PMC5912796 DOI: 10.1016/j.drugpo.2018.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/16/2017] [Accepted: 01/06/2018] [Indexed: 11/23/2022]
Abstract
This paper uses the work of Bourdieu to theorise smoking and cessation through a class lens, showing that the struggle for distinction created the social gradient in smoking, with smoking stigma operating as a proxy for class stigma. This led to increased policy focus on the health of bystanders and children and later also to concerns about electronic cigarettes. Bourdieu's concept of habitus is deployed to argue that the e-cigarette helps middle-class smokers resolve smoking as a symptom of cleft habitus associated with social mobility or particular subcultures. E-cigarette use is also compatible with family responsibility and sociable hedonism; aspects of working-class habitus which map to the 'practical family quitter' and the 'recreational user' respectively. The effectiveness of class stigma in changing health behaviours is contested, as is the usefulness of youth as a category of analysis and hence the relevance of concerns about young people's e-cigarette use outside a class framework of smoking and cessation. With regard to health inequalities, whilst middle-class smokers have in class disgust a stronger incentive to quit than working-class smokers, there is potential for tobacco control to tap into a working-class ethos of family care and responsibility.
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Affiliation(s)
- Frances Thirlway
- Durham University, Anthropology Department, The Palatine Centre, Stockton Road, Durham DH1 3LE, UK.
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29
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Triandafilidis Z, Ussher JM, Perz J, Huppatz K. Young Australian women's accounts of smoking and quitting: a qualitative study using visual methods. BMC WOMENS HEALTH 2018; 18:5. [PMID: 29301518 PMCID: PMC5755039 DOI: 10.1186/s12905-017-0500-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
Abstract
Background Although the overall rate of smoking in Australia continues to decline, the rate of decline has begun to slow. Rates of smoking among young women in Australia have been a particular concern, which has led to the development of targeted public health campaigns. Poststructuralist theory has successfully been used in research to explore the way in which young women experience smoking. However, there is an absence of poststructuralist analysis of young women’s experiences of quitting. This study aims to address this gap. Methods We carried out 27 interviews with young Australian women smokers and ex-smokers. Eighteen of those women then participated in a photography activity and follow-up interviews. A Foucauldian discourse analysis of the data was conducted. Results Through our analysis, we identified three discourses: ‘The irresponsibility of smoking: Quitting as responsible’, ‘The difficulties of quitting: Smoking as addictive’, and ‘Making a decision to quit: Smoking as a choice’. In relation to these discourses, participants took up contradictory positions of responsibility and resistance, addiction and agency. Taking up these positions had implications for young women’s subjectivity, and the way they engaged with tobacco controls and cessation support. Conclusions The analysis highlights the complex and contradictory nature of young women’s experiences with smoking and quitting. The study’s findings are considered in relation to the improvement of tobacco control policies and cessation support programmes targeted at young women.
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Affiliation(s)
- Zoi Triandafilidis
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia
| | - Kate Huppatz
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia
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30
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Triandafilidis Z, Ussher JM, Perz J, Huppatz K. ‘It’s one of those “It’ll never happen to me” things’: young women’s constructions of smoking and risk. HEALTH, RISK & SOCIETY 2017. [DOI: 10.1080/13698575.2017.1384801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Zoi Triandafilidis
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Kate Huppatz
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
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31
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Ussher JM, Charter R, Parton C, Perz J. Constructions and experiences of motherhood in the context of an early intervention for Aboriginal mothers and their children: mother and healthcare worker perspectives. BMC Public Health 2016; 16:620. [PMID: 27450083 PMCID: PMC4957285 DOI: 10.1186/s12889-016-3312-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The colonisation of Australia has been associated with traumatic consequences for Aboriginal health and wellbeing, including the breakdown of the traditional family unit and negative consequences for the mother/child relationship. Early-intervention programs have been developed to assist families to overcome disadvantage and strengthen mother/child attachment. However, there is no research examining Aboriginal women's subjective experiences and constructions of motherhood in the context of such programs, and no research on the perceived impact of such programs, from the perspective of Aboriginal mothers and healthcare workers (HCWs), with previous research focusing on child outcomes. METHOD Researchers conducted participant observation of an early intervention program for Aboriginal mothers and young children over a 6 month period, one-to-one interviews and a focus group with 10 mothers, and interviews with nine HCWs, in order to examine their perspectives on motherhood and the intervention program. RESULTS Thematic analysis identified 2 major themes under which subthemes were clustered. Constructions of motherhood: 'The resilient mother: Coping with life trauma and social stress' and 'The good mother: Transformation of self through motherhood'; Perspectives on the intervention: '"Mothers come to life": Transformation through therapy'; and '"I know I'm a good mum": The need for connections, skills and time for self'. CONCLUSIONS The mothers constructed themselves as being resilient 'good mothers', whilst also acknowledging their own traumatic life experiences, predominantly valuing the peer support and time-out aspects of the program. HCWs positioned the mothers as 'traumatised', yet also strong, and expressed the view that in order to improve mother/child attachment a therapeutic transformation is required. These results suggest that early interventions for Aboriginal mothers should acknowledge and strengthen constructions of the good and resilient mother. The differing perspectives of mothers and HCWs on the role and impact of the early intervention program reinforces the need for Aboriginal mothers to be involved in the design and implementation of services aimed at assisting their families.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith South DC, NSW, 2751, Australia.
| | - Rosie Charter
- Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith South DC, NSW, 2751, Australia
| | - Chloe Parton
- Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith South DC, NSW, 2751, Australia
| | - Janette Perz
- Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith South DC, NSW, 2751, Australia
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