Crossing borders: the impact of the California Tobacco Control Program on both sides of the US-Mexico border

Whole systems approaches to obesity and other complex public health challenges: a systematic review

BACKGROUND

Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease.

METHODS

Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken.

RESULTS

Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance.

CONCLUSIONS

Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

Substance Use Across Different Phases of the Migration Process: A Survey of Mexican Migrants Flows

This study examined the levels of substance use and changes across different migration stages, including pre-departure, travel, destination, and return, among Mexican migrants converging on the US-Mexico border. A cross-sectional survey was conducted in Tijuana, Mexico, between 2009 and 2010 among Mexican migrants returning from the US and those travelling from other Mexican regions. The overall prevalence of last 12-month at-risk drinking, illicit drug use, and current smoking, was 42.3, 17.7 and 31.4%, respectively. Compared to pre-departure migrants, males were at increased risk for illicit drug use at the destination and return stages. In contrast, females' alcohol consumption at the destination stage was lower than at pre-departure (p < 0.05). The level of smoking was stable across all stages for both genders. In the destination stage, undocumented migrants were more likely to use illicit drugs relative to their documented peers (p < 0.05). Binational interventions promoting substance use reduction are needed among this mobile population.

Complete home smoking bans and antitobacco contingencies: a natural experiment

INTRODUCTION

The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico.

METHODS

A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders.

RESULTS

Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable.

CONCLUSIONS

Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.

The Role of Parenting in Alcohol and Tobacco Use Among Latino Adolescents

Parents can impact adolescent substance use, but it is unclear which substances are most affected. This study compared associations between parenting behaviors and alcohol and tobacco use to see if parenting was equally related to both behaviors. Alcohol and tobacco use data were collected from 252 Latino adolescents living along the San Diego-Tijuana border. Logistic regression was used to test parenting behaviors' impact. Parenting was protective against alcohol use, but not related to tobacco use. Substance using peers affected both alcohol and tobacco use. Alcohol prevention efforts among Latino adolescents should target parenting behaviors.

Baby's Breath II protocol development and design: a secondhand smoke exposure prevention program targeting infants discharged from a neonatal intensive care unit

BACKGROUND

Over one-third of all children live with at least one parent who smokes cigarettes, which is associated with compromised child health. The impact of secondhand smoke exposure (SHSe) in medically fragile infants born prematurely is likely to be much higher. The Baby's Breath II study tests whether a hospital-initiated, motivational-enhancement program will result in less SHSe relative to conventional care in high-risk, low birthweight (LBW) infants discharged from a neonatal intensive care unit (NICU). The design and protocol for the ongoing BBII trial is described.

METHODS/DESIGN

Eligible participants are: (1) primary caregivers (typically mothers) of NICU infants who were born at LBW (<2500g) or ventilated for more than 12h; and (2) who smoke or live with at least one smoker. This randomized controlled trial has two conditions: Motivational interviewing plus incentives (MI+) and conventional care (CC). MI+ participants receive two hospital-based and two home-based counseling sessions, as well as incentives (i.e., prize-based draws) for (a) intervention attendance and (b) biochemical validation (i.e., urine cotinine dipstick) indicative of low or no infant SHSe. Participants in the control group receive conventional education-based care. Assessments are completed at baseline, mid-point, and 1- and 4-months post-intervention.

DISCUSSION

This study is the first to determine the efficacy of a brief intervention for reducing SHSe among high-risk, LBW infants discharged from a NICU, with the potential for saving lives and healthcare costs. Strengths, limitations and challenges to the conduct of this trial are discussed.

Cigarettes, social reinforcement, and culture: a commentary on "Tobacco as a social currency: cigarette gifting and sharing in China"

As Rich and Xiao suggested, cigarette sharing and gifting play an important role in China's smoking epidemic. Understanding the cultural roots, history, and impacts of such practices should be emphasized in tobacco control efforts. "Tobacco as a social currency" is a consequence of the tobacco industry usurping traditional values and cultural customs to make cigarette gifting acceptable, desirable, and socially reinforcing. The cigarettes-social reinforcement link created by the tobacco industry can be broken by deglamorizing smoking and cigarette gifting and by reinforcing alternative healthful behaviors. A behavioral ecological perspective, with an emphasis of understanding and engineering cultures, should guide future health promotion efforts to reduce smoking and other risk practices in China.

Latino parenting practices: a comparison of parent and child reports of parenting practices and the association with gateway drug use

Parent and adolescent self-reports are the most common sources for measuring parenting practices. This study's purpose was to compare how parent and adolescent reports of parenting behaviors differentially predict adolescent gateway drug use. The sample consisted of 252 Latino adolescent-parent dyads. After controlling for potential confounding influences, only adolescents' reports about their parents' parenting behaviors were significant and explained 38% of the variance in gateway drug use. Practitioners may recommend to parents seeking parenting advice that they solicit feedback from their adolescent to ensure parenting efforts are received in the manner they were intended.

Evaluation of a social marketing campaign to support Mexico City's comprehensive smoke-free law

OBJECTIVES

We aimed to assess the level of awareness and impact of a social marketing campaign to promote Mexico City's 2008 comprehensive smoke-free law.

METHODS

Four months after the smoke-free law was implemented but before the campaign launch, we collected data from a population-based, random sample of 961 inhabitants of Mexico City. We analyzed data from 786 respondents who completed follow-up at the end of the campaign to determine campaign exposure and the association between campaign exposure and changes in campaign-targeted knowledge and attitudes.

RESULTS

Recall of any of the 5 campaign materials was 69%, with a uniform distribution of exposure to 1, 2, and 3 or more campaign materials (25%, 25%, and 19%, respectively). Exposure to a greater number of campaign materials was associated in a monotonic relation with campaign-targeted knowledge of ammonia and arsenic in cigarette smoke. In models assessing support for, perceived benefits of, and perceived right to smoke-free places, campaign exposure accounted for a positive change in half of the indicators within each of these domains.

CONCLUSIONS

Social marketing campaigns can reinforce knowledge and attitudes that favor smoke-free laws, thereby helping to establish smoke-free norms.

Crossing a border for a low-cost, high-risk environment: smoking status and excessive drinking among young adults in Tijuana

This study examines the drinking and smoking behavior of 2,311 college-age adults traveling from San Diego, California, to Tijuana, Mexico (December 2006 to December 2008). We describe this Border sample's drinking history and smoking status and estimate multivariate models of evening drinking participation and, conditional on drinking, blood alcohol concentration. Noting limitations, we present implications for identifying young adults at high risk for alcohol and tobacco use, particularly females, and lay the foundation for further research examining young adults? alcohol and tobacco use in reduced price scenarios.

Secondhand smoke avoidance by preteens living with smokers: to leave or stay?

INTRODUCTION

Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior.

PURPOSE

To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.

METHOD

Preteens aged 8-13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multiple Logistic Regression was used to determine predictors of SHS avoidance.

RESULTS

Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.

DISCUSSION

Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.

Smoking on both sides of the pacific: home smoking restrictions and secondhand smoke exposure among Korean adults and children in Seoul and California

INTRODUCTION

This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States.

METHODS

A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001-02. Multivariable regressions were used for analyses.

RESULTS

Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16-23) versus 66% (95% CI: 64-68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60-69) versus 5% (95% CI: 4-6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76-86) versus 36% (95% CI: 17-57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7-13) versus 7% (95% CI: 3-13).

CONCLUSIONS

Consistent with ecological frameworks, exposure to California's antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.

Does proximity to retailers influence alcohol and tobacco use among Latino adolescents?

Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents' home to the nearest A&T retailer (-), acculturation (+), parents' consistent use of contingency management (-), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents' consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US-Mexico border region.

It's others, not the police: smoking, reprimand, and fines among adults of Korean descent in California

OBJECTIVE

This study assesses the association of immediate social and legal reprimand and current smoking status among Californians of Korean descent.

DESIGN

Data were drawn from a population-based probability sample using a telephone survey conducted by bilingual, professional interviewers (N = 2085). About 85.0% of eligible respondents completed interviews and 86.3% of participants preferred to be interviewed in Korean.

MAIN OUTCOME MEASURE

Smoking status was measured using Centers for Disease Control and Prevention criteria, ever smoked 100 cigarettes and currently smoke every day or some days.

RESULTS AND CONCLUSION

Reports of immediate criticism by others in several settings was associated with nonsmoking, but likelihood of immediate legal penalties was unrelated. Participants were far less likely to expect legal than social sanction. Results were replicated after controlling for reinforcers of smoking and ecologically relevant variables including models of smoking, primary group social support for smoking, acculturation, sex, acculturation by sex (male) interaction, age, and education. It may be efficacious to target public health interventions encouraging appropriate social sanctions of smoking in public among persons of Korean descent, and to encourage strict enforcement of legal penalties for smoking in public places.

Do Mexican immigrants "import" social gradients in health to the US?

Greater educational attainment is consistently associated with lower mortality and better health, a pattern known as the social gradient. However, recent research suggests that Mexican-origin adults in the US have weak or flat gradients, in contrast to steep gradients for non-Hispanic whites. In this study we evaluate one hypothesis for this finding: Is the relative weakness of education gradients in health behaviors observed among Mexican-origin adults in the US due to weak gradients in the sending population? We test this "imported gradients" hypothesis with data from two nationally-representative datasets: the US National Health Interview Survey (NHIS) and the Mexican National Health Survey (ENSA 2000). We compare education gradients in smoking and obesity for recently-arrived Mexican immigrants in the US to the corresponding gradients in high-migration regions of Mexico. Results partially support the imported gradients hypothesis and have implications for health education and promotion programs targeted to immigrant populations to reduce racial and ethnic disparities in health in the US.

Differential impact of local and federal smoke-free legislation in Mexico: a longitudinal study among adult smokers

OBJECTIVE

To assess the impact of Mexico City and federal smoke-free legislation on secondhand tobacco smoke (SHS) exposure and support for smoke-free laws.

MATERIAL AND METHODS

Pre- and post-law data were analyzed from a cohort of adult smokers who participated in the International Tobacco Control (ITC) Policy Evaluation Suvey in four Mexican cities. For each indicator, we estimated prevalence, changes in prevalence, and between-city differences in rates of change.

RESULTS

Self-reported exposure to smoke-free media campaigns generally increased more dramatically in Mexico City. Support for prohibiting smoking in regulated venues increased overall, but at a greater rate in Mexico City than in other cities. In bars and restaurants/cafés, self-reported SHS exposure had significantly greater decreases in Mexico City than in other cities; however, workplace exposure decreased in Tijuana and Guadalajara, but not in Mexico City or Ciudad Juárez.

CONCLUSIONS

Although federal smoke-free legislation was associated with important changes smoke-free policy impact, the comprehensive smoke-free law in Mexico City was generally accompanied by a greater rate of change.

Predictors of weapon carrying in youth attending drop-in centers

OBJECTIVE

To test and compare 2 predictive models of weapon carrying in youth (n = 308) recruited from 4 drop-in centers in San Diego and Imperial counties.

METHODS

Both models were based on the Behavioral Ecological Model (BEM).

RESULTS

The first and second models significantly explained 39% and 53% of the variance in weapon carrying, respectively, and both full models shared the significant predictors of being black(-), being Hispanic (-), peer modeling of weapon carrying/jail time (+), and school suspensions (+).

CONCLUSIONS

Results suggest that the BEM offers a generalizable conceptual model that may inform prevention strategies for youth at greatest risk of weapon carrying.

Culture as an explanation in population health

In the last two decades, culture has emerged in population health as a common explanation for health outcomes and disparities. This paper systematically reviews such cultural accounts, focusing on a historical sample of articles from prominent population health journals (1930-2008, n=100) and a contemporary sample of articles in the American Journal of Public Health (2008, n=95). The review reveals that references to culture rarely (1) specify the precise pathways by which culture influences health or (2) assess the plausibility of these pathways. Despite these weaknesses, a few studies have begun to clarify, measure, and assess how culture can influence health outcomes, and these articles reflect promising new avenues for understanding how cultural factors influence variation in health and well-being.

Employment and social "determinants" of smoking in urbanizing China: a representative survey

INTRODUCTION

This study explored social determinants of smoking among a sample of male Chinese adults in Changqiao, a community representing the transition from traditional to a "mobile" urban culture in China. New commercial systems have introduced high profits but also layoffs in the absence of government security systems.

METHODS

In-person interviews were conducted by trained interviewers with 123 male participants selected at random. Bivariate and multivariate analyses were computed based on the Behavioral Ecological Model (BEM). About 61% of male participants were ever-smokers and 48% were current smokers.

RESULTS

Current smoking was associated with involuntary unemployment (odds ratio [OR] = 6.52), the absence of home smoking restrictions (OR = 0.34), and social reinforcement such as friends' smoking (OR = 4.02) and receiving smoking-related gifts (OR = 6.39).

DISCUSSION

Findings support the BEM. It is especially important to verify the relationship between unemployment and smoking, given the recent rise in involuntary job loss due to the transitional economy in China.

Home smoking bans and secondhand smoke exposure in Mexico and the US

OBJECTIVE

This study examines the association between home smoking ban status and home secondhand smoke exposure (SHSE) among Mexican-descent adults and children in three cities representing different levels of exposure to the California Tobacco Control Program.

METHOD

From 2003-2004, a cross-sectional tobacco survey was conducted with a population-based sample of Mexican-descent adults in San Diego, California (N=1103) and Mexican adults in Tijuana (N=398) and Guadalajara (N=400), Mexico.

RESULTS

After adjustment for demographic, behavioral, cultural, and contextual covariates, a complete home smoking ban was associated with Mexican American and Mexican adults and children being less likely to experience SHSE in the home compared to their counterparts with partial or no smoking restrictions. The association was significant across the three survey sites, but stronger in San Diego than in any of the two Mexican cities.

CONCLUSION

Home smoking bans reduce the risk of home SHSE among Mexican Americans and Mexicans, regardless of the smoking status of the household residents and other individual and environmental variables. Even if household residents continue smoking and communitywide tobacco control efforts are suboptimal, the promotion of home smoking bans can protect adults and children from home SHSE.