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Gawłowska B, Chawłowska E. An Assessment of Health Behaviours in Primary Care Patients: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1405. [PMID: 39057548 PMCID: PMC11275404 DOI: 10.3390/healthcare12141405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/21/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
A healthy lifestyle is a key determinant of health, especially for people with chronic diseases such as diabetes or hypertension. The health behaviours which contribute to a healthy lifestyle include the following: regular physical activity, preventive examinations, maintaining a proper diet and avoiding the consumption of alcohol or cigarettes. They have a significant impact on the disease process, controlling symptoms and preventing complications. The aim of this study was to examine the health behaviours related to diet, physical activity and prevention among Polish primary health care patients and to identify predictors of health behaviours. For this reason, the standardized Health Behaviour Scale (HBS) questionnaire was used. The study was conducted among 269 patients (including 61.71% women) in primary health care facilities. The mean age of participants was 52.89 years (±17.76). The mean HBS score was 36.93 ± 9.66. A statistically significant association was found between HBS scores and such sociodemographic variables as education (p = 0.0061, r = 0.17), body mass index (p = 0.0018, r = -0.20, β = -0.36) and self-assessed economic status (p = 0.0094, r = 0.16). Women's health behaviours as measured by HBS were significantly better than men's (p < 0.001, β = -6.82). A special focus should be given to the groups manifesting poorer health behaviours (e.g., men, older people and persons with low socioeconomic status) by offering them tailored health-promoting interventions.
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Affiliation(s)
- Barbara Gawłowska
- Department of Preventive Medicine, Poznan University of Medical Sciences, 60-781 Poznań, Poland
| | - Ewelina Chawłowska
- Laboratory of International Health, Department of Preventive Medicine, Poznan University of Medical Sciences, 60-781 Poznań, Poland
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Yu Z, Peng C, Yang X, Dang C, Adekkanattu P, Gopal Patra B, Peng Y, Pathak J, Wilson DL, Chang CY, Lo-Ciganic WH, George TJ, Hogan WR, Guo Y, Bian J, Wu Y. Identifying social determinants of health from clinical narratives: A study of performance, documentation ratio, and potential bias. J Biomed Inform 2024; 153:104642. [PMID: 38621641 PMCID: PMC11141428 DOI: 10.1016/j.jbi.2024.104642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To develop a natural language processing (NLP) package to extract social determinants of health (SDoH) from clinical narratives, examine the bias among race and gender groups, test the generalizability of extracting SDoH for different disease groups, and examine population-level extraction ratio. METHODS We developed SDoH corpora using clinical notes identified at the University of Florida (UF) Health. We systematically compared 7 transformer-based large language models (LLMs) and developed an open-source package - SODA (i.e., SOcial DeterminAnts) to facilitate SDoH extraction from clinical narratives. We examined the performance and potential bias of SODA for different race and gender groups, tested the generalizability of SODA using two disease domains including cancer and opioid use, and explored strategies for improvement. We applied SODA to extract 19 categories of SDoH from the breast (n = 7,971), lung (n = 11,804), and colorectal cancer (n = 6,240) cohorts to assess patient-level extraction ratio and examine the differences among race and gender groups. RESULTS We developed an SDoH corpus using 629 clinical notes of cancer patients with annotations of 13,193 SDoH concepts/attributes from 19 categories of SDoH, and another cross-disease validation corpus using 200 notes from opioid use patients with 4,342 SDoH concepts/attributes. We compared 7 transformer models and the GatorTron model achieved the best mean average strict/lenient F1 scores of 0.9122 and 0.9367 for SDoH concept extraction and 0.9584 and 0.9593 for linking attributes to SDoH concepts. There is a small performance gap (∼4%) between Males and Females, but a large performance gap (>16 %) among race groups. The performance dropped when we applied the cancer SDoH model to the opioid cohort; fine-tuning using a smaller opioid SDoH corpus improved the performance. The extraction ratio varied in the three cancer cohorts, in which 10 SDoH could be extracted from over 70 % of cancer patients, but 9 SDoH could be extracted from less than 70 % of cancer patients. Individuals from the White and Black groups have a higher extraction ratio than other minority race groups. CONCLUSIONS Our SODA package achieved good performance in extracting 19 categories of SDoH from clinical narratives. The SODA package with pre-trained transformer models is available at https://github.com/uf-hobi-informatics-lab/SODA_Docker.
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Affiliation(s)
- Zehao Yu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cheng Peng
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Xi Yang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Chong Dang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Prakash Adekkanattu
- Information Technologies and Services, Weill Cornell Medicine, New York, NY, USA
| | - Braja Gopal Patra
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Ching-Yuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Thomas J George
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA.
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Joannès C, Kelly-Irving M, Couarraze S, Castagné R. The effect of smoking initiation in adolescence on the subsequent smoking trajectories of people who smoke, and the role of adverse childhood experiences: Results from the 1958 British cohort study. Public Health Nurs 2024; 41:127-138. [PMID: 37953700 DOI: 10.1111/phn.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the association between smoking initiation in adolescence and subsequent different smoking trajectories of people who smoke, and to examine the combined effect of adverse childhood experiences (ACEs) and smoking initiation in adolescence on smoking trajectories of people who smoke. DESIGN AND SAMPLE Data are from 8757 individuals in Great Britain from the birth cohort National Child Development Study and who reported being smokers or former smokers by age 23. MEASUREMENTS Smoking initiation in adolescence was measured at 16 y and smoking trajectories were derived from smoking variables from ages 23 to 55. We modelled the relationship between smoking initiation in adolescence with or without ACEs and smoking trajectories. RESULTS Individuals who initiated smoking in adolescence were more likely to quit later than quitting in twenties (RRR quitting in thirties = 3.43 [2.40; 4.89] p < .001; RRR quitting in forties = 5.25 [3.38; 8.14] p < .001; RRR quitting in fifties = 4.48 [2.95; 6.79] p < .001), to relapse (RRR Relapse = 3.66 [2.82; 4.76] p < .001) and to be persistent smokers (RRR persistent = 5.25 [3.81; 7.25] p < .001) compared to those who had initiated smoking in young adulthood. These effects were particularly pronounced in case of ACEs. CONCLUSION Smoking prevention programs aimed at reducing smoking initiation should be promoted to adolescents to limit the burden of smoking, especially for people who have suffered adversity during childhood.
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Affiliation(s)
- Camille Joannès
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Sébastien Couarraze
- Department of Medicine, Maieutics and Paramedicine, Faculty of Health, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Raphaële Castagné
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
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Singh L, Jain P, Kumar C, Singh A, Lal P, Yadav A, Singh PK, Singh S. Trends in age of tobacco use initiation over time in Bangladesh, India and Pakistan: analysis of cross-sectional nationally representative surveys. BMJ Open 2023; 13:e067875. [PMID: 38070918 PMCID: PMC10729284 DOI: 10.1136/bmjopen-2022-067875] [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: 08/31/2022] [Accepted: 08/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Tobacco use begins at an early age and typically leads to a long-term addiction. The age of initiation for tobacco use is not well studied in South Asia, where 22% of tobacco smokers and 81% of smokeless tobacco (SLT) users reside. METHODS Data from the nationally representative Global Adult Tobacco Surveys in India, Bangladesh and Pakistan were analysed to examine patterns of initiation among smokers and smokeless tobacco users. RESULTS Data on 94 651 individuals were analysed, of which 13 396 reported were ever daily smokers and 17 684 were ever SLT users. The proportion of individuals initiating tobacco use before the age of 15 years has increased over time. The rates of SLT initiation among those aged 15-24 years increased markedly in Bangladesh (by 7.8%) and Pakistan (by 37.7%) between 1983 and 1999-2000. Among males, the increase in SLT initiation was higher in individuals aged below 15 years compared with other age groups in India and Bangladesh. Smoking initiation among females aged below 15 years has also significantly increased in India over time. Compared with the initiation of tobacco smoking before the age of 15 years, a greater increase in the proportion of SLT users was observed in urban areas. CONCLUSION Our findings indicate that the proportion of youth initiating tobacco (both smoking and smokeless) before the age of 15 years has increased over time in all three countries. Moreover, variations in age at initiation for different types of tobacco products across countries, and by rurality, were noticeable. Younger youths (aged up to 15 years) should therefore be a priority population for tobacco control interventions. Strategies such as raising the legal age of tobacco sale and use to 21 years, and, other measures under WHO Framework Convention on Tobacco Control (FCTC), may prevent underage use and avert lifelong addiction to tobacco products.
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Affiliation(s)
- Lucky Singh
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Pankhuri Jain
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Chandan Kumar
- Department of Policy & Management Studies, TERI School of Advanced Studies, New Delhi, India
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Pranay Lal
- Independent Public Health Researcher, New Delhi, India
| | - Amit Yadav
- International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Shalini Singh
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Atem FD, Bluestein MA, Harrell MB, Chen B, Messiah SE, Kuk AE, Sterling KL, Spells CE, Pérez A. Precise Estimation for the Age of Initiation of Tobacco Use Among U.S. Youth: Finding from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2017. BIOSTATISTICS AND BIOMETRICS OPEN ACCESS JOURNAL 2022; 11:555801. [PMID: 36777448 PMCID: PMC9912413 DOI: 10.19080/bboaj.2022.11.555801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context Youth tobacco use remains a prominent United States public health issue with a high economic and health burden. Method We pooled never and ever users at youth's first wave of PATH participation (waves 1-3) to estimate age of initiation for hookah, e-cigarettes, cigarettes, traditional cigars, cigarillos, and smokeless tobacco prospectively (waves 2-4). Age of initiation of each tobacco product was estimated using weighted interval-censored survival analyses. Weighted interval censoring Cox-proportional hazards regression models were used to assess the association of ever use of the TP at the first wave of PATH participation, sex, and race/ethnicity on the age of initiation of ever use of each tobacco product. Sensitivity analyses were performed to understand the impact of the recalled age of initiation for the left-censored participants by replacing the recalled age of initiation with a uniform "6" years lower bound. Results The proportion of those who ever used each tobacco product at the first wave of PATH participation ranged from 1.8% for traditional cigars to 10.4% for cigarettes. There was a significant increase in ever use of each tobacco product after the age of 14, with e-cigarettes and cigarettes showing the highest cumulative incidence of initiation by age 21, while smokeless and cigarillos recorded the lowest cumulative incidence by age 21. The adjusted Cox models showed boys initiated at earlier ages for all of these tobacco products except for hookah, which showed no difference. Similarly, apart from ever use of hookah, non-Hispanic White youth were more likely to initiate each tobacco product at earlier ages compared to Hispanic, non-Hispanic Black, and non-Hispanic Other youth. Conclusion The increased sample size and the inclusion of ever users yielded greater precision for age of initiation of each tobacco product than analyses limited to never users at the first wave of PATH participation. These analyses can help elucidate population selection criteria for estimating the age of initiation of tobacco products.
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Affiliation(s)
- Folefac D. Atem
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Meagan A. Bluestein
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701,Consultant with litigation involving the vaping industry, Austin TX
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Arnold E. Kuk
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Kymberle L. Sterling
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Charles E. Spells
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Adriana Pérez
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
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Prevalence of Anxiety in Smoking Cessation: A Worldwide Systematic Review and Meta-analysis. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oura P, Rissanen I, Junno JA, Harju T, Paananen M. Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up. Sci Rep 2020; 10:16365. [PMID: 33004859 PMCID: PMC7529914 DOI: 10.1038/s41598-020-73334-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023] Open
Abstract
Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population’s smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual’s annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28–1.45) and physical inactivity (OR 1.20–1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29–1.33), and male sex increases the odds of adult quitting (OR 1.30–1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions.
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Affiliation(s)
- Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland. .,Kerava Health Care Center, Metsolantie 2, 04200, Kerava, Finland.
| | - Ina Rissanen
- Departments of Neurology and Neurosurgery, Oulu University Hospital, PO Box 50, 90029, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Northern Ostrobothnia Hospital District, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Juho-Antti Junno
- Cancer Research and Translational Medicine Research Unit, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Terttu Harju
- Research Unit of Internal Medicine, Faculty of Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Kerava Health Care Center, Metsolantie 2, 04200, Kerava, Finland
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Thomeer MB, Hernandez E, Umberson D, Thomas PA. Influence of Social Connections on Smoking Behavior across the Life Course. ADVANCES IN LIFE COURSE RESEARCH 2019; 42:100294. [PMID: 31903090 PMCID: PMC6941891 DOI: 10.1016/j.alcr.2019.100294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although we know much about demographic patterns of smoking, we know less about people's explanations for when, how and why they avoid, develop, or alter smoking habits and how these explanations are linked to social connections across the life course. We analyze data from in-depth interviews with 60 adults aged 25-89 from a large southwestern U.S. city to consider how social connections shape smoking behavior across the life course. Respondents provided explanations for how and why they avoided, initiated, continued, and/or quit smoking. At various times, social connections were viewed as having both positive and negative influences on smoking behavior. Both people who never smoked and continuous smokers pointed to the importance of early life social connections in shaping decisions to smoke or not smoke, and viewed later connections (e.g., marriage, coworkers) as less important. People who quit smoking or relapsed tended to attribute their smoking behavior to social connections in adulthood rather than early life. People who changed their smoking behavior highlighted the importance of transitions as related to social connections, with more instability in social connections often discussed by relapsed smokers as a reason for instability in smoking status. A qualitative approach together with a life course perspective highlights the pivotal role of social connections in shaping trajectories of smoking behavior throughout the life course.
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Hernandez EM, Vuolo M, Frizzell LC, Kelly BC. Moving Upstream: The Effect of Tobacco Clean Air Restrictions on Educational Inequalities in Smoking Among Young Adults. Demography 2019; 56:1693-1721. [PMID: 31388944 PMCID: PMC6800635 DOI: 10.1007/s13524-019-00805-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.
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Affiliation(s)
- Elaine M Hernandez
- Department of Sociology, Indiana University, Ballantine Hall 744, 1020 E. Kirkwood Avenue, Bloomington, IN, 47405-7103, USA.
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Laura C Frizzell
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, 700 W State Street, West Lafayette, IN, 47907, USA
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Sharapova S, Reyes-Guzman C, Singh T, Phillips E, Marynak KL, Agaku I. Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014-2016. Tob Control 2018; 29:49-54. [PMID: 30498008 DOI: 10.1136/tobaccocontrol-2018-054593] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tobacco use mostly begins in adolescence and young adulthood. Earlier age of initiation of cigarette smoking is associated with greater nicotine dependence and sustained tobacco use. However, data are limited on the age of initiation of non-cigarette tobacco products, and the association between using these products and nicotine dependence and progression to established use. METHODS Combined 2014-2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6-12 yielded 19 580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco and hookah. Analyses assessed age of reported first use of each product among ever-users, overall and by sex and race/ethnicity. Current daily use, past 30-day use, feelings of craving tobacco and time to first tobacco use after waking were assessed by age of first use. RESULTS Among ever-users, weighted median age for first use was 12.6 years for cigarettes, 13.8 years for cigars, 13.4 years for smokeless tobacco, 14.1 years for hookah and 14.1 years for e-cigarettes. First trying these tobacco products at age ≤13 years was associated with greater current use of the respective product and nicotine dependence compared with initiating use at age >13 years. CONCLUSIONS First tobacco use at age ≤13 years is associated with current daily and past 30-day use of non-cigarette tobacco products, and with the development of nicotine dependence among youth ever-users. Proven tobacco prevention interventions that reach early adolescents are important to reduce overall youth tobacco use.
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Affiliation(s)
- Saida Sharapova
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn Reyes-Guzman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Tushar Singh
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elyse Phillips
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristy L Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Israel Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kelly BC, Vuolo M, Frizzell LC, Hernandez EM. Denormalization, smoke-free air policy, and tobacco use among young adults. Soc Sci Med 2018; 211:70-77. [DOI: 10.1016/j.socscimed.2018.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
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12
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A 10-year observational study on the trends and determinants of smoking status. PLoS One 2018; 13:e0200010. [PMID: 29979744 PMCID: PMC6034816 DOI: 10.1371/journal.pone.0200010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Most studies on motivation and intention to quit smoking have been conducted among adolescents and young adults but little is known regarding middle-aged subjects. We aimed to assess the trends and determinants of smoking status in a population-based cohort. METHOD Observational, prospective study with a first mean follow-up at 5.6 years and a second at 10.9 years. Data from 3999 participants (49.2% women, aged 35-75 years) living in Lausanne (Switzerland). RESULTS Baseline prevalence of never, former and current smokers was 41.3, 34.3 and 24.3%, respectively. During the study period, more than 90% of never and former and almost 60% of current smokers at baseline retained their status after 10.9 years. Among 973 current smokers, 216 (22.2%) had quit for at least 5 years. Multivariable analysis showed increasing age to be positively associated with quitting (p-value for trend <0.001). Among 1373 former smokers, 149 (10.9%) had relapsed; increasing age (p-value for trend <0.001) was negatively associated and family history of lung disease was positively associated with relapse [OR and 95% CI: 1.53 (1.06-2.21)]. Among 1653 never smokers, 128 (7.7%) initiated smoking; Male gender [1.46 (1.01-2.12)] and living in coupled relationship [0.66 (0.45-0.97)] were associated with smoking initiation. CONCLUSION Most middle-aged never and former smokers did not change their status with time, while 22.2% of current smokers sustained quitting. This is encouraging and could be improved with adequate supportive methods. In comparison to available data, this study confirms the difficult task of identifying subjects at risk of a negative behavioral change.
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Do social characteristics influence smoking uptake and cessation during young adulthood? Int J Public Health 2017; 63:115-123. [PMID: 29082416 DOI: 10.1007/s00038-017-1044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study uses a Bourdieusian approach to assess young adults' resources and examines their association with smoking initiation and cessation. METHODS Data were drawn from 1450 young adults participating in the Interdisciplinary Study of Inequalities in Smoking, a cohort study in Montreal, Canada. We used logistic regression models to examine the association between young adults' income, education, and peer smoking at baseline and smoking onset and cessation. RESULTS Young adults where most or all of their friends smoked had greater odds of smoking onset. Young adults that had completed pre-university postsecondary education also had higher odds of smoking onset after controlling for social support, employment status, and lacking money to pay for expenses. Income and the sociodemographic variables age and sex were not associated with smoking onset. Young adults where half of their friends smoked or where most to all of their friends smoked had lowers odds of smoking cessation. Men were more likely to cease smoking than women. Education, income and age were not associated with cessation. CONCLUSIONS Interventions focusing on peer smoking may present promising avenues for tobacco prevention in young adults.
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Liu J, Zhao S, Chen X, Falk E, Albarracín D. The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation. Psychol Bull 2017; 143:1082-1115. [PMID: 28771020 PMCID: PMC5789806 DOI: 10.1037/bul0000113] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although the influence of peers on adolescent smoking should vary depending on social dynamics, there is a lack of understanding of which elements are most crucial and how this dynamic unfolds for smoking initiation and continuation across areas of the world. The present meta-analysis included 75 studies yielding 237 effect sizes that examined associations between peers' smoking and adolescents' smoking initiation and continuation with longitudinal designs across 16 countries. Mixed-effects models with robust variance estimates were used to calculate weighted-mean Odds ratios. This work showed that having peers who smoke is associated with about twice the odds of adolescents beginning (OR ¯ = 1.96, 95% confidence interval [CI] [1.76, 2.19]) and continuing to smoke (OR ¯ = 1.78, 95% CI [1.55, 2.05]). Moderator analyses revealed that (a) smoking initiation was more positively correlated with peers' smoking when the interpersonal closeness between adolescents and their peers was higher (vs. lower); and (b) both smoking initiation and continuation were more positively correlated with peers' smoking when samples were from collectivistic (vs. individualistic) cultures. Thus, both individual as well as population level dynamics play a critical role in the strength of peer influence. Accounting for cultural variables may be especially important given effects on both initiation and continuation. Implications for theory, research, and antismoking intervention strategies are discussed. (PsycINFO Database Record
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Affiliation(s)
- Jiaying Liu
- Annenberg School for Communication, University of Pennsylvania
| | - Siman Zhao
- Department of Human Development and Family Studies, Purdue University
| | - Xi Chen
- Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign
| | - Emily Falk
- Annenberg School for Communication, University of Pennsylvania
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Gagné T, Veenstra G. Trends in smoking initiation in Canada: Does non-inclusion of young adults in tobacco control strategies represent a missed opportunity? Canadian Journal of Public Health 2017; 108:e14-e20. [PMID: 28425894 DOI: 10.17269/cjph.108.5839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/12/2017] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Young adults face high prevalence rates for smoking. Recent evidence suggests that many people initiate smoking during young adulthood, but little is currently known about trends in initiation rates for this age group. METHODS We examined rates of initiation to first cigarette (FC) and daily smoking (DS) during youth (5-17 years) and young adulthood (18-25 years) using nationally representative data from the 2001, 2003, 2005, 2007, 2009, 2011 and 2013 cycles of the Canadian Community Health Survey. We included all participants aged 25-26 to obtain seven mutually exclusive retrospective cohorts (n = 16 216). We used logistic regression to examine four correlates of smoking - sex, education, poverty status, and immigration status - and whether these factors modify time trends in smoking. RESULTS We found that initiation rates decreased during youth (p < 0.001 for FC, p = 0.02 for DS) but not during young adulthood (p = 0.94 for FC, p = 0.28 for DS). We found that men and respondents with fewer educational credentials had relatively higher odds of initiating during young adulthood. Trends in young adulthood stayed constant across subgroups. Trends in youth were modified by education: participants who did not complete high school had no decrease in initiation to FC and DS while those with post-secondary education experienced a decrease in both outcomes. CONCLUSION Tobacco control has failed to address smoking initiation during young adulthood. Given the considerable amount of initiation that occurs during this period, practitioners and policy-makers should direct more of their planning toward young adults.
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Affiliation(s)
- Thierry Gagné
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM); Département de médicine sociale et préventive, Université de Montréal, Montréal, QC.
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Baig SA, Pepper JK, Morgan JC, Brewer NT. Social identity and support for counteracting tobacco company marketing that targets vulnerable populations. Soc Sci Med 2017; 182:136-141. [PMID: 28427731 DOI: 10.1016/j.socscimed.2017.03.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 12/01/2016] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE Tobacco companies use advertising to target vulnerable populations, including youth, racial/ethnic minorities, and sexual minorities. OBJECTIVE We sought to examine how personal identity affects support for population-specific anti-smoking advertisements that could serve as countermeasures to industry marketing practices. METHODS In 2014-2015, we surveyed probability phone samples of adults and adolescents (n = 6,139) and an online convenience sample of adults (n = 4,137) in the United States. We experimentally varied the description of tobacco industry marketing practices (no description, general, or specific to a target group). The four prevention target groups were teens; African Americans; Latinos; and gays, lesbians, and bisexuals (GLBs). Participants were either members or non-members of their prevention target group. RESULTS Support was highest for anti-smoking advertisements targeting teens, moderate for Latinos and African Americans, and lowest for GLBs. In-group members expressed higher support than out-group members when anti-smoking advertisements targeted African Americans, Latinos, and GLBs (all p < 0.05). However, when teens were the target prevention group, in-group members expressed lower support than out-group members (p < 0.05). The description of industry marketing practices did not have an effect. Results were similar across the phone and online studies. CONCLUSIONS Our findings suggest that the public strongly supports advertisements to prevent smoking among teens, but support for similar efforts among other vulnerable populations is comparatively low. Anti-smoking campaigns for vulnerable populations may benefit from a greater understanding of the role of social identity in shaping public support for such campaigns.
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Affiliation(s)
- Sabeeh A Baig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599, USA.
| | - Jessica K Pepper
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599, USA; RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, USA.
| | - Jennifer C Morgan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599, USA.
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27514, USA.
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Salvi D, Nagarkar A. A qualitative study exploring women's journeys to becoming smokers in the social context of urban India. Women Health 2017; 58:466-482. [PMID: 28328385 DOI: 10.1080/03630242.2017.1310171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In India, the prevalence of smoking among women is increasing, and the reasons behind this are unclear. We aimed to study the factors leading to initiation and maintenance of the smoking habit in women in Pune, India. Twenty-seven urban women smokers, ranging from 21 to 60 years of age (31.96 ± 10.70 years), were interviewed between September 2015 and February 2016. The in-depth interviews consisted of questions on pre-decided categories, including initiation, motivation to continue smoking, and risk perception. Thematic analysis revealed that peer pressure, curiosity, fascination, experimentation, and belonging to a group were factors that led to initiation, while lack of alternatives for stress relief, work environments, and lack of leisure time activities provided circumstances to continue smoking. Participants recognized a sense of liberation and independence from smoking cigarettes and perceived health risks as minor and distant. These findings can be used to develop or modify interventions to prevent and control smoking among urban Indian women.
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Affiliation(s)
- Devashri Salvi
- a Interdisciplinary School of Health Sciences , Savitribai Phule Pune University , Pune , Maharashtra , India
| | - Aarti Nagarkar
- a Interdisciplinary School of Health Sciences , Savitribai Phule Pune University , Pune , Maharashtra , India
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Kawabata T, Tomari Y, Takemura J. Factors Related to Smoking Initiation by Adolescents and a Causal Model for Early Smoking Initiation. Health (London) 2017. [DOI: 10.4236/health.2017.98082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Short SE, Mollborn S. Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances. Curr Opin Psychol 2015; 5:78-84. [PMID: 26213711 PMCID: PMC4511598 DOI: 10.1016/j.copsyc.2015.05.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied "social determinants" approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity.
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Affiliation(s)
- Susan E. Short
- Department of Sociology, Brown University, Box 1916, Providence, RI 02912, USA
| | - Stefanie Mollborn
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, UCB 483, Boulder, CO 80309-0483, USA
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Cruz S, Neff J, Chi DL. Transitioning from Pediatric to Adult Dental Care for Adolescents with Special Health Care Needs: Adolescent and Parent Perspectives--Part One. Pediatr Dent 2015; 37:442-6. [PMID: 26531087 PMCID: PMC4634122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to understand transitions from pediatric dental care to adult dental care for adolescents with special health care needs (ASHCNs) from parental and adolescent perspectives. METHODS Focus groups and interviews were conducted with 59 parents and 13 adolescent-parent dyads to identify factors associated with transitions to adult-centered dental care for ASHCNs. RESULTS Most parents believed ASHCNs were at risk for caries, but ASHCNs were not concerned about tooth decay. Parents of adolescents with complex SHCN believed it would be acceptable to continue seeing a pediatric dentist. Parents of Medicaid-enrolled ASHCNs reported lower efficacy in transitioning. ASHCNs desired personalized, adolescent-centered care and were motivated to transition when they felt out of place at the pediatric dentist office. Parents believed pediatric dentists play an important role in initiating and facilitating transitions. CONCLUSIONS Pediatric dentists are well positioned to implement family and adolescent-centered policies to ensure dental transitions for adolescents with special health care needs and their families.
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Affiliation(s)
- Stephanie Cruz
- Department of Pediatrics, University of Washington, Seattle, Wash., USA
| | - John Neff
- Department of Pediatrics, University of Washington, Seattle, Wash., USA
| | - Donald L Chi
- Department of Oral Health Sciences, at the University of Washington, Seattle, Wash., USA.
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Han J, Chen X. A Meta-Analysis of Cigarette Smoking Prevalence among Adolescents in China: 1981-2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4617-30. [PMID: 25922989 PMCID: PMC4454929 DOI: 10.3390/ijerph120504617] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systematic data regarding adolescent smoking are needed at the national level to support evidence-based tobacco control in China. The goal of this study was to estimate smoking prevalence among Chinese adolescents using published data. METHODS Published studies were located electronically from the commonly used databases in Chinese and English, complemented by manual searching. Forty-five studies were selected of the 9771 retrieved from the databases. These studies targeted adolescents aged 12-17 or middle/high school students, were conducted during the 1981-2010, and had adequate data for meta-analysis. The 45 selected studies covered 52 sites in different parts of China. Smoking rates were estimated using the sample-weighted and random effect method. RESULTS The estimated prevalence rate of lifetime smoking (ever smoked) varied within a narrow range (39.04%-46.03%) for males and progressively increased from 2.47% in 1981-1985 to 19.72% in 2001-2005 for females. The prevalence rate of current (30-day) smoking for males declined from 26.62% in 1981-1985 to 10.86% in 1996-2000 before increasing again. The prevalence of current smoking for females increased from 0.29% in 1981-1985 to 3.26% in 2006-2010. CONCLUSIONS The high levels of male smoking and the rapid increase in female smoking indicate growing burdens from tobacco-related diseases, underscoring the urgent need to strengthen adolescent tobacco control in China.
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Affiliation(s)
- Juan Han
- Department of Child and Adolescent and Maternal Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430032, China.
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI 48201, USA.
| | - Xinguang Chen
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI 48201, USA.
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA.
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Abstract
BACKGROUND Noncigarette tobacco products are increasingly popular among youth, especially cigarette smokers. Understanding multiple tobacco product use is necessary to assess the effects of tobacco products on population health. This study examines multiple tobacco product use and associated risk factors among US youth. METHODS Estimates of current use were calculated for cigarettes, cigars, smokeless tobacco, hookah, e-cigarettes, pipes, bidis, kreteks, snus, and dissolvable tobacco by using data from the 2012 National Youth Tobacco Survey (n = 24 658), a nationally representative sample of US middle and high school students. Associations between use patterns and demographic characteristics were examined by using multinomial logistic regression. RESULTS Among youth, 14.7% currently use 1 or more tobacco products. Of these, 2.8% use cigarettes exclusively, and 4% use 1 noncigarette product exclusively; 2.7% use cigarettes with another product (dual use), and 4.3% use 3 or more products (polytobacco use). Twice as many youth use e-cigarettes alone than dual use with cigarettes. Among smokers, polytobacco use was significantly associated with male gender (adjusted relative risk ratio [aRRR] = 3.71), by using flavored products (aRRR = 6.09), nicotine dependence (aRRR = 1.91), tobacco marketing receptivity (aRRR = 2.52), and perceived prevalence of peer use of tobacco products (aRRR = 3.61, 5.73). CONCLUSIONS More than twice as many youth in the United States currently use 2 or more tobacco products than cigarettes alone. Continued monitoring of tobacco use patterns is warranted, especially for e-cigarettes. Youth rates of multiple product use involving combustible products underscore needs for research assessing potential harms associated with these patterns.
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Affiliation(s)
- Youn Ok Lee
- RTI International, Public Health Research Division, Research Triangle Park, North Carolina
| | - Christine J Hebert
- RTI International, Public Health Research Division, Research Triangle Park, North Carolina
| | - James M Nonnemaker
- RTI International, Public Health Research Division, Research Triangle Park, North Carolina
| | - Annice E Kim
- RTI International, Public Health Research Division, Research Triangle Park, North Carolina
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Lisha NE, Delucchi KL, Ling PM, Ramo DE. Prevalence and Correlates of Social Smoking in Young Adults: Comparisons of Behavioral and Self-Identified Definitions. Nicotine Tob Res 2014; 17:1076-84. [PMID: 25385876 DOI: 10.1093/ntr/ntu242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/03/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Social smoking is an increasingly common pattern among emerging adults. Although distinct patterns have emerged between social smokers and non-social smokers, there is discrepancy about how to define the construct, with inconsistencies between self-identified social smoking and behavioral social smoking. We report prevalence and correlates of young adult smokers who self-identify and behave as social smokers (SELF + BEH), self-identified non-behavioral social smokers (SELF-ONLY), and non-social smokers (NON-SOCIAL). METHODS Young adults age 18-25 years who have smoked at least 1 cigarette in the past 30 days (N = 1,811) were recruited through Facebook for a national anonymous, online survey of tobacco and other substance use. Three social smoking items were used to categorize respondents into 1 of 3 smoking groups. Groups were examined for prevalence and differences on demographics, substance use, motivation to quit smoking and thoughts about tobacco abstinence. RESULTS SELF-ONLY (46%) was the largest group, followed by SELF + BEH (27%) and NON-SOCIAL (27%). SELF + BEH smoke less frequently, smoke fewer cigarettes per day, are less addicted to cigarettes, have a higher desire to quit, and perceive a lower quitting difficulty compared with SELF-ONLY. SELF + BEH and SELF-ONLY were more likely to be male, be marijuana users, and be addicted to marijuana than NON-SOCIAL. SELF + BEH exhibited a lower frequency of smoking, less cigarettes per day, were less addicted, and had more days co-using alcohol and cigarettes than NON-SOCIAL. CONCLUSION Identifying social smokers based on self-identification in addition to behavioral components appears to be important for designing smoking cessation interventions for emerging adults.
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Affiliation(s)
- Nadra E Lisha
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, CA
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, CA
| | - Pamela M Ling
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, CA
| | - Danielle E Ramo
- Department of Psychiatry, University of California, San Francisco, CA
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Abu Shomar RT, Lubbad IK, El Ansari W, Al-Khatib IA, Alharazin HJ. Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine. Cent Eur J Public Health 2014; 22:80-9. [PMID: 25230536 DOI: 10.21101/cejph.a4005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To assess university students' extent of smoking, knowledge of smoking health risks, and awareness of existing national anti-smoking laws. METHODS Self-administered questionnaire was employed across 7 universities (1,104 students, equal proportions of males and females) located in Gaza Strip, Palestine. RESULTS About 55% of participants reported ever smoking, 31% were current cigarette smokers, and 36% were 'strictly' (only) narghile (water pipe) smokers. Mean age of smoking initiation was 17 +/- 3.15 years. Smokers had less knowledge of smoking associated health risks than nonsmokers. Students' knowledge of existing anti-smoking laws was generally low (11.3-25.5%), and significantly more smokers had knowledge about existing laws (ban of advertisement of smoking, ban of smoking in public places, and ban of selling cigarettes to minors) than non-smokers. About 81% of current smokers tried to quit smoking at least once during their life, 53% felt ready to quit smoking if cessation assistance was provided, 17% were not ready to quit, and 30% were reluctant/felt unsure if they were ready to quit. Most students (94.3%) reported that there were no smoking cessation centres in Palestine, or did not know if such centres existed. Males were associated with almost all categories of smoking (e.g. smoking both cigarettes and narghile, or smoking narghile only). CONCLUSIONS There is a lack of knowledge about the existing national anti-smoking legislation among university students in Gaza, Palestine. Smoking cessation centres also seem non-existent in Gaza. Multi-level interventions and actions are required by policy makers, educators and non-governmental agencies to prevent smoking among university students in Gaza, and to educate them on tobacco cessation counselling, on the dangers of tobacco use, and about effective stress management strategies to help them to cope with stressors. Smoking cessation interventions are required to address both cigarette and narghile use. Efforts need to be invested in ensuring compliance with legislation and for follow-up activities to enforce the anti-smoking laws through coordinated actions across ministries and departments.
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