Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence

Reducing lifestyle risk behaviours in disadvantaged groups in high-income countries: A scoping review of systematic reviews

High prevalence of risk behaviours may exacerbate existing poor health in disadvantaged groups. We aimed to identify and bring together systematic reviews with a focus on reducing risk behaviours in disadvantaged groups and highlight where evidence is lacking. We searched MEDLINE and Embase up to October 2020, with supplementary searching in Epistemonikos and Health Systems Evidence. We included systematic reviews that reported behavioural outcomes and targeted smoking, excessive alcohol use, unhealthy diet, or physical inactivity in groups with the following characteristics: low income or low socio-economic status (SES), unemployed people, homeless people, care leavers, prisoners, refugees or asylum seeker, Gypsies, Travellers, or Roma, people with learning disabilities and people living in disadvantaged areas. Reviews that included primary studies from any high-income country were eligible. Reviews were mapped based on the disadvantaged group(s) and behaviour(s) targeted. Ninety-two reviews were included, with the majority (n = 63) focusing on people with low income or low SES. We identified gaps in the evidence for care leavers; Gypsies, Travellers, and Roma and limited evidence for refugees and unemployed people. Few reviews targeted alcohol use. There was limited evidence on barriers and facilitators to behaviour change. This suggests there is insufficient evidence to inform policy and practice and new reviews or primary studies may be required.

A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda

Background

Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations.

Methods

In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction.

Results

The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods.

Conclusions

Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.

Socio-economic distribution of e-cigarette use among recent former regular smokers and current smokers at ages 25-26 in England

BACKGROUND AND AIMS

E-cigarettes may potentially help young adult smokers to quit smoking, yet little is known about differences among socio-economic groups. We examined associations between key socio-economic characteristics and e-cigarette use among recent former smokers and current smokers in a sample of young adults in England.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

We used data on 346 recent former regular (daily for 12+ months) smokers and 1913 current smokers from the ages 25-26 wave of the Next Steps cohort study (2015-2016). In multinomial logistic regression, we estimated relative risk ratios (RRR) of e-cigarette use (never, former, non-daily, daily) by educational attainment, social class [using the National Statistics Socio-economic classification (NS-SEC)] and employment status [full-time, part-time, unemployed and other 'inactivity' (e.g. stay-at-home parents and permanantly disabled)], adjusting for sex.

FINDINGS

Among recent former regular smokers, there were no patterns of association between socio-economic characteristics and e-cigarette use. Among current smokers: (1) compared with higher occupation (NS-SEC I/II), intermediate occupation (NS-SEC III/IV) was positively associated with non-daily e-cigarette use [RRR = 1.77, 95% confidence interval (CI) = 1.03-3.03]; (2) compared with full-time employment, unemployment was negatively associated with non-daily and daily e-cigarette use (RRR = 0.38, 95% CI = 0.18-0.81; RRR = 0.12, 95% CI = 0.02-0.56) and other economic inactivity was negatively associated with daily e-cigarette use (RRR = 0.39, 95% CI = 0.16-0.93).

CONCLUSIONS

Among young adult smokers in England, lower-status occupational groups were more likely to use e-cigarettes on a non-daily basis than to have never used compared with higher status occupational groups. Compared with people in full-time employment, those without employment were less likely to use e-cigarettes daily than to have never used.