Income disparities in smoking cessation and the diffusion of smoke-free homes among U.S. smokers: Results from two longitudinal surveys

Neighborhood Vigilance in Terms of Abstinence Expectancies for Smoking and Severity of Problems When Quitting

Background: Although social determinants of health (SDoH) have increasingly been understood as clinically important factors in the onset, maintenance, and relapse of substance use behavior, little research has evaluated neighborhood vigilance in terms of smoking. Objectives: The present investigation sought to evaluate the role of neighborhood vigilance in terms of smoking abstinence expectancies (i.e., perceived consequences of refraining from smoking, including negative mood, somatic symptoms, harmful consequences, and positive consequences) and severity of problems when trying to quit among adults who smoke. Results: Participants included 93 treatment-seeking people who smoke (45.2 years of age and 29% identified as female). Results: indicated that greater levels of neighborhood vigilance were associated with negative mood and harmful consequences abstinence expectancies. No effect was evident for somatic symptom abstinence expectancies after Bonferroni correction. Conclusions: As expected, neighborhood vigilance was not predictive of positive abstinence expectancies, offering explanatory specificity. Neighborhood vigilance was also associated with more severe problems when trying to quit smoking. The current findings suggest neighborhood vigilance represents an important contextual factor involved in certain negative beliefs about abstinence and challenges in quitting.

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.

Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy

Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.

Factors associated with attempting and succeeding in smoking cessation following a National Tobacco Control Plan: Analysis of two nationwide surveys (2010 and 2017)

INTRODUCTION

Lower rates of smoking cessation among disadvantaged groups contribute to widening health-disparities. With this recognition, in 2010 free-of-charge/subsidized smoking cessation services became available to all Israeli residents through the not-for-profit health plans.

METHODS

Based on two cross-sectional National Social Surveys, data on adult ever-smokers were used (n = 2,998 in 2010 and 2,859 in 2017). The outcome variable comprised three categories: no quit attempt, unsuccessful quit attempt and successful quit attempt. Changes over-time and demographic, socioeconomic, health- and smoking-related factors associated with quitting attempts and success were tested in the pooled sample, using multivariable multinomial logistic regression models.

RESULTS

The pooled sample of the two surveys included 2,611 participants (44.2%) who were successful quitters, 1,941 (32.7%) who reported an unsuccessful quit attempt, and 1,305 (23.1%) smokers who did not attempt to quit. Compared to 2010, ever-smokers in 2017 were less likely to report an unsuccessful quit attempt (adjusted OR = 0.81, 95%CI: 0.70-0.94). The likelihood of successfully quitting was similar in both surveys. Older age and self-reported health problem were associated with higher likelihood of quitting attempt. Meeting living expenses, being overweight/obese, engaging in physical activity and heavy smoking were associated with higher likelihood of successful smoking cessation; while environmental tobacco exposure was associated with 43% lower likelihood of successful cessation. Finally, there was an interaction between education and ethnicity. Higher education level was associated with a greater likelihood both to attempt to quit smoking and to succeed among Jewish participants, while the opposite phenomenon was observed among Arab smokers.

CONCLUSIONS

Despite the availability of subsidized smoking cessation services, social disparities in smoking cessation rates persist. Efforts should focus on proactively reaching subpopulations with low cessation rates, using tailored strategies for successful smoking cessation. Promoting smoke free homes and workplaces should be prioritized.

The Role of Pain Avoidance in the Relation between Pain Intensity and Smoking Cessation Processes

Scientific evidence suggests that smokers who experience varying levels of pain are more likely to maintain their addiction to tobacco. The relationship between pain intensity and cognitive-based smoking processes within a mechanistic framework has received relatively little attention. Pain avoidance may influence the association between pain intensity and smoking, as it is a construct that is related to adverse pain and smoking processes. Thus, the current cross-sectional study examined the indirect effect of pain intensity on three clinically significant smoking processes (i.e., prior quit problems, perceived barriers for cessation, and negative affect reduction smoking expectancies) through pain avoidance among 95 treatment-seeking adult smokers. Regression analyses were conducted using bootstrapping techniques through PROCESS, a conditional modeling program that utilizes an ordinary least squares-based path analytical framework to test for both direct and indirect associations. Results indicated that pain intensity had a statistically significant indirect association with quit problems and perceived barriers for cessation, through pain avoidance. Pain intensity did not have a statistically significant indirect association with the negative affect reduction of smoking expectancies through pain avoidance. The current findings provide evidence for the role of pain avoidance as a potential transdiagnostic mechanism that contributes to maladaptive smoking outcomes within the larger context of the reciprocal model of pain and substance use.

Multi-Level Influences of Smoke-Free Policies in Subsidized Housing: Applying the COM-B Model and Neighborhood Assessments to Inform Smoke-Free Policies

Smoke-free policies in multi-unit housing are associated with reduced exposure to secondhand smoke (SHS); however, attitudes toward comprehensive smoke-free policies among residents in subsidized multi-unit housing are unknown. In this mixed-methods study, we explored the socio-ecological context for tobacco and cannabis use and attitudes toward policies restricting indoor use of these products through interviews with residents (N = 134) and staff (N = 22) in 15 federally subsidized multi-unit housing in San Francisco, California. We conducted a geo-spatial and ethnographic environmental assessment by mapping alcohol, cannabis, and tobacco retail density using ArcGIS, and conducted systematic social observations of the neighborhood around each site for environmental cues to tobacco use. We used the Capability, Opportunity, and Motivation behavior (COM-B) model to identify factors that might influence implementation of smoke-free policies in multi-unit housing. Knowledge and attitudes toward tobacco and cannabis use, social norms around smoking, neighborhood violence, and cannabis legalization were some of the social-ecological factors that influenced tobacco use. There was spatial variation in the availability of alcohol, cannabis, and tobacco stores around sites, which may have influenced residents' ability to maintain smoke-free homes. Lack of skill on how to moderate indoor smoking (psychological capability), lack of safe neighborhoods (physical opportunity), and the stigma of smoking outdoors in multi-unit housing (motivation) were some of the barriers to adopting a smoke-free home. Interventions to increase adoption of smoke-free policies in multi-unit housing need to address the co-use of tobacco and cannabis and commercial and environmental determinants of tobacco use to facilitate smoke-free living.

The smoke-free home study: study protocol for a cluster randomized controlled trial of a smoke-free home intervention in permanent supportive housing

Background

Formerly chronically homeless adults who live in permanent supportive housing (PSH) have high prevalence of smoking. It is uncommon to find smoke-free policies in PSH because of the concern that such policies contradict PSH’s harm reduction framework and could increase homelessness should residents lose their housing because of the policy. However, in the absence of such policies, non-smoking PSH residents face the harmful effects of secondhand smoke exposure while residents who smoke see increased risks from high rates of smoking throughout their residence. Our pilot work highlighted the feasibility and acceptability of an intervention designed to promote voluntary adoption of a smoke-free home. Here we report a protocol for a cluster randomized controlled trial of the smoke-free home intervention for formerly chronically homeless residents in PSH.

Methods

The smoke-free home intervention provides face-to-face counseling and instruction to PSH residents on how to adopt a smoke-free home and offers training for PSH staff on how to refer residents to tobacco cessation services. We will randomize 20 PSH sites in the San Francisco Bay Area to either the intervention or wait-list control arms. We will enroll 400 PSH residents who smoke cigarettes in their housing unit and 120 PSH staff who work at the sites. At baseline, three- and six-months follow-up, we will ask residents to report their tobacco use and cessation behaviors and adoption of smoke-free homes. We will ask staff to answer questions on their knowledge, attitudes, practices, and barriers related to supporting residents’ smoking cessation. The primary outcome for PSH residents is adoption of smoke-free homes for 90 days or more at six-months follow-up, and the secondary outcome is point prevalence tobacco abstinence. The primary outcome for PSH staff is change in Smoking Knowledge Attitudes Practices survey score.

Discussion

Voluntary adoption of smoke-free homes is a promising approach for reducing exposure to secondhand smoke and reducing tobacco use among a population facing high rates of tobacco-related disease, and is aligned with PSH’s harm reduction framework. Findings from this study have the potential to inform adoption of tobacco control policies among vulnerable populations most at risk for smoking-related harms.

Trial registration

This study was registered with the U.S. National Institute of Health Clinical Trials register on April 22, 2021: NCT04855357.

Who's Quitting? Who Needs Additional Support? Cessation Disparities by Race, Education, and Income, 2007 to 2018

PURPOSE

The current study (1) examines how disparities in quitting cigarette and other tobacco product use have changed by race and socioeconomic status and (2) utilizes an expanded measure, any tobacco quit ratio (aQR), that extends previous work on cigarette quit ratios and captures use and cessation in a growing tobacco marketplace.

DESIGN

Repeated cross-sectional representative survey; Setting: Minnesota.

SUBJECTS

Adult Minnesotans from the 2007 and 2018 Minnesota Adult Tobacco Survey (combined N=9,258).

MEASURES

Cigarette QR (cQR), aQR (cigarette, cigar, smokeless, pipe, e-cigarette, hookah), past year quit attempts, and recent cessation.

ANALYSIS

Weights ensured statewide representativeness. Regression analyses tested for differences by race (Black vs White), income (low vs medium/high), and education (low vs medium/high) across survey years.

RESULTS

cQRs and aQRs were relatively high among White respondents and those with medium-high education and income. The disparity in aQR between White and Black respondents decreased from 2007 to 2018. Black respondents were more likely to try to quit than White respondents but were less likely to report recent cessation.

CONCLUSION

Cessation disparities by race and socioeconomic status have changed little between 2007 and 2018, and the magnitude of the disparity for several cessation indicators remains large. Public health professionals and medical practitioners can play a key role in reducing disparities by supporting public policies and cessation interventions that target social determinants of health and associated barriers to quitting.

Healthcare Utilization and Smoking among South Carolina’s Long-Term Uninsured

Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without healthcare insurance for at least 24 months. Multivariable logistic regression was used to estimate differences in the likelihood of delaying healthcare due to cost and/or not filling a needed prescription between smokers and non-smokers. Among LTU, smoking was a significant predictor of delaying healthcare at the 10% level (AOR = 1.36, 95% CI = 0.99–1.86); the sensitivity analysis strengthened this association at the 5% level (AOR = 1.43, 95% CI = 1.06–1.93). Smoking was a significant predictor of not filling needed prescriptions (AOR = 1.44, 95% CI = 1.06–1.96). While neglected healthcare utilization was common among the LTU, this problem was more severe among smokers. The wider gap in access to healthcare services among the LTU, especially LTU who smoke, warrants further attention from the research community and policy makers.

Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic Trial Protocol

Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engaged, pragmatic randomized clinical trial will compare the effectiveness of four interventions promoting smoking cessation among underserved patients referred for LCS. By using an additive study design, all four arms provide standard "ask-advise-refer" care. Arm 2 adds free or subsidized pharmacologic cessation aids, arm 3 adds financial incentives up to $600 for cessation, and arm 4 adds a mobile device-delivered episodic future thinking tool to promote attention to long-term health goals. We hypothesize that smoking abstinence rates will be higher with the addition of each intervention when compared with arm 1. We will enroll 3,200 adults with LCS orders at four U.S. health systems. Eligible patients include those who smoke at least one cigarette daily and self-identify as a member of an underserved group (i.e., is Black or Latinx, is a rural resident, completed a high school education or less, and/or has a household income <200% of the federal poverty line). The primary outcome is biochemically confirmed smoking abstinence sustained through 6 months. Secondary outcomes include abstinence sustained through 12 months, other smoking-related clinical outcomes, and patient-reported outcomes. This pragmatic randomized clinical trial will identify the most effective smoking cessation strategies that LCS programs can implement to reduce smoking burdens affecting underserved populations. Clinical trial registered with clinicaltrials.gov (NCT04798664). Date of registration: March 12, 2021. Date of trial launch: May 17, 2021.

Addressing tobacco use in the context of complex social needs: A new conceptual framework and approach to address smoking cessation in community health centers

Objective

This article presents a new conceptual framework “Connection to Health for Smokers” (CTHS), its application to address smoking cessation, and its acceptability in community health centers (CHCs).

Methods

CTHS, an online interactive patient educational tool comprehensively implements the “5 A's” (ask, advise, assess, assist, and arrange) within the context of patients' social and behavioral health needs. Semi-structured interviews were conducted with five health educators (nurses) who administered CTHS with 62 patients to evaluate the acceptability of the program. Thematic analyses were conducted with interview transcripts.

Results

CHC health educators viewed CTHS has enhanced patient-centered communication, was able to identify patients' needs beyond tobacco use, and individualize action planning to integrate social and behavioral health needs.

Conclusion

CTHS received enthusiasm from CHC health educators as a helpful tool to address tobacco use among their patients. Comprehensive on-site smoking cessation programs at CHCs that provide a structured evidence-based approach informed by an understanding of each patient's coexisting social and behavioral health needs may play an important role in reducing tobacco use disparities in the United States.

Innovation

CTHS offers a new promising framework to comprehensively integrate the 5A's within the context of social and behavioral determinants of health for smoking cessation.

•

Social and behavioral health challenges may interfere smoking cessation

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CTHS implements “5A's” while addressing coexisting social and behavioral needs

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Integrate patients' needs in tobacco treatment optimizes cessation outcomes

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Nurses viewed addressing complex needs helpful to motivate smokers to quit smoking

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Comprehensive patient-centered approach may reduce tobacco use disparities

Effectiveness of Varenicline Versus Combination Nicotine Replacement Therapy for Smoking Cessation: One-Year Outcomes in a Smoking Cessation Clinic in Taiwan

INTRODUCTION

Varenicline and combination nicotine replacement treatment (cNRT) have been recommended as the most effective pharmacotherapies, with equal abstinence rate for smoking cessation in a network meta-analysis of randomized trials, but data from real-world long-term follow-up studies are rare. This study aimed to compare the 12-month sustained abstinence rates of smokers using varenicline versus cNRT in their quit attempt.

METHODS

A total of 3569 smokers were recruited via the Department of Family Medicine outpatient department at Kaohsiung Veteran General Hospital between June 2013 and March 2019. Participants received counseling from a physician and chose either varenicline (N = 2870) or cNRT (N = 699) for smoking cessation. Both varenicline and cNRT users could receive a free 8-week supply and eight clinic visits over 90 days. Participants were followed-up by telephone at 12, 24, and 52 weeks from first visit. The primary outcome measure of the study was self-reported sustained abstinence up to 52 weeks.

RESULTS

Varenicline users had a significantly higher sustained abstinence rate at weeks 12-52, adjusted for baseline variables (15.2% vs 10.3%, p = .001; adjusted odds ratio = 1.47, 95% confidence interval: 1.05-2.05). Other significant predictors of 52 weeks sustained abstinence were being male, having a higher income, attending more clinical visits, and have lower nicotine dependence.

CONCLUSION

Varenicline appears to have higher sustained abstinence rates to 52 weeks compared with cNRT, in a smoking cessation clinic where smokers can choose their medication option.

IMPLICATIONS

Network meta-analysis of randomized trials suggests that varenicline and cNRT are similarly effective for smoking cessation. This study shows that 1-year sustained abstinence rates were significantly higher among smokers using varenicline, compared with smokers using cNRT, when used as part of a structured smoking cessation program. These findings are highly relevant to policy makers and service providers to help determine provision of smoking cessation treatment.

Smoke-Free Home Intervention in Permanent Supportive Housing: A Multifaceted Intervention Pilot

INTRODUCTION

Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area.

AIMS AND METHODS

We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. Rest of the methods, PSH residents (n = 100) and staff (n = 62) from 15 PSH sites participated in the intervention between October 2017 and February 2018. Research staff provided counseling to PSH residents on how to adopt an SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of an SFH for ≥90 days, and the secondary outcome was carbon monoxide-verified PPA at 6-month follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-month follow-up.

RESULTS

At 6 months, 31.3% of PSH residents had adopted an SFH (vs. 13.0% at baseline) and 16.9% reported carbon monoxide-verified PPA. A positive attitude toward an SFH policy was associated with increased odds of SFH adoption (adjusted odds ratio = 8.68, 95% confidence interval: 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (adjusted odds ratio = 26.27, 95% confidence interval: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-month follow-up.

CONCLUSIONS

In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents.

IMPLICATIONS

To date, few interventions have addressed SFHs and their association with tobacco use among PSH residents. A "ground-up" approach that relies on buy-in from residents and that promotes voluntary SFHs is an innovative way to increase smoke-free living environments in PSH. This approach could pave a pathway for smoke-free policy implementation in these sites. PSH can play a role in reducing the burden of tobacco use by empowering its residents to adopt voluntary SFHs, which could increase smoking cessation among residents.

Widening disparities in cigarette smoking by race/ethnicity across education level in the United States

Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993-2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.

A longitudinal analysis of nondaily smokers: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

PURPOSE

Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.

METHODS

The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.

RESULTS

After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs. <ninth grade: RRR (95% CI) = 0.30 (0.09-0.95)]. Living with smokers was associated with decreased likelihood of quitting [RRR (95% CI) = 0.45 (0.24-0.86)]. Having insurance was associated with quitting [RRR (95% CI) = 2.11 (1.18-3.76)] and becoming a daily smoker [RRR (95% CI) = 3.00 (1.39-6.48)].

CONCLUSIONS

Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases.

Single-parent status and smoke-free home rules among daily smokers

OBJECTIVE

In Canada, the home has become the primary locale in which children are exposed to tobacco smoke. Single parents are less likely than two-parent families to ban smoking at home, but the extent to which this relates to economic inequalities across family structures is unclear. Our objective was to estimate the association between household structure (single- vs. non-single-parent family) and smoke-free home rules, accounting for indicators of economic disadvantage.

METHODS

Data were available in a telephone survey conducted in 2011-2012 in Québec, Canada, of 567 daily smokers (mean (SD) age 38.3 (8.1); 56.6% female) who lived with children. Poisson regression models with robust variance were used to determine whether single-parent status was independently associated with living in a smoke-free home after accounting for age, sex, language, household size, age of youngest child, neighbourhood material deprivation, socio-economic status and employment status.

RESULTS

Of 122 participants living in a single-parent family, 33 (27%) reported that their home was smoke-free, compared with 250 of 445 participants (56.2%) living in non-single-parent families. Single parents were approximately 40% less likely to live in smoke-free homes than other daily smokers, even after accounting for indicators of economic disadvantage.

CONCLUSIONS

Single parents, regardless of income or level of neighbourhood material deprivation, were less likely to report smoke-free home rules. These smokers represent a distinct subgroup that warrants targeted interventions to help them implement such rules by addressing their specific needs against a backdrop of creating more equitable access to the social determinants of health.

Smoke-Free or Not: Attitudes Toward Indoor Smoke-Free Policies Among Permanent Supportive Housing Residents

Purpose:

Interventions for tobacco dependence are most effective when combined with smoke-free policies, yet such policies are rare in permanent supportive housing (PSH) for formerly homeless adults. We aimed to provide in-depth analysis of attitudes and barriers to and facilitators of implementing smoke-free policies in PSH.

Approach:

Current smokers living in PSH completed a questionnaire and participated in in-depth, semistructured interviews on smoking history, attitudes toward smoke-free policies, and perceived barriers to cessation.

Setting:

We collaborated with 6 San Francisco Bay Area PSH agencies.

Participants:

Thirty-six residents in PSH.

Methods:

Interviews, conducted by trained interviewers, were digitally recorded, transcribed, and analyzed using content analysis methods. Participants were recruited until we reached thematic saturation, or no new themes emerged from the interviews.

Results:

Over half of participants (52.8%, n = 19) reported depression, and 97.2% (n = 35) reported current substance use. Support for indoor smoking bans in living areas was modest (33.1%), although most residents anticipated cutting down (61%) and reported they would not move because of a smoking ban (77.8%). There was interest in quitting smoking, although co-use of tobacco with other substances was a major barrier.

Conclusion:

This study is the first to explore attitudes toward smoke-free policies in PSH. We found that residents in PSH support smoke-free policies and consider them feasible if implementation processes are sound. Our findings underscore the need to address barriers to adopting smoke-free policies and accessing smoking cessation services. In particular, interventions must address the co-use of tobacco with other substances and the impact of smoking on financial and housing stability.

Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019

Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.

Impact of changes in home smoking bans on tobacco cessation among quitline callers

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (P < 0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR = 10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR = 8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR = 2.06, 95% CI: 1.47, 2.89) compared with callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers' goal setting activities to achieve tobacco cessation.

Obesity and Socioeconomic Disparities: Rethinking Causes and Perinatal Care

Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.

Correction: Income disparities in smoking cessation and the diffusion of smoke-free homes among U.S. smokers: Results from two longitudinal surveys

[This corrects the article DOI: 10.1371/journal.pone.0201467.].