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Rahmani A, Najand B, Maharlouei N, Zare H, Assari S. COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans. J Racial Ethn Health Disparities 2024; 11:1223-1237. [PMID: 37490210 PMCID: PMC11101502 DOI: 10.1007/s40615-023-01601-w] [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: 12/09/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND COVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals. OBJECTIVES The study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic. METHODS This study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier. RESULTS Educational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals. CONCLUSION COVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.
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Affiliation(s)
- Arash Rahmani
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Babak Najand
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Najmeh Maharlouei
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA
| | - Shervin Assari
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA.
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
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Mammadli T, Hong C. Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:59-76. [PMID: 38600900 PMCID: PMC10903640 DOI: 10.1080/19317611.2024.2303517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
Objectives We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations. Methods Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature. Results Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances. Conclusion We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.
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Affiliation(s)
- Tural Mammadli
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Chenglin Hong
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
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Kim W, Kim AR, Ock M, Jeon YJ, Lee H, Kim D, Kim M, Yoo C. Effects of a supportive workplace environment on the success rate for smoking cessation camp. Ann Occup Environ Med 2023; 35:e48. [PMID: 38148920 PMCID: PMC10751216 DOI: 10.35371/aoem.2023.35.e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 12/28/2023] Open
Abstract
Background This study was conducted to identify the success rate for smoking cessation over time after participation in a therapeutic smoking cessation camp, and to identify how participant characteristics, including a supportive workplace environment for smoking cessation (SWESC), affect the success rate for smoking cessation. Methods In all, 296 participants at smoking cessation camps in Ulsan between 2015 and 2020 were investigated. The success rates of smoking cessation after weeks 4, 6, 12, and 24 at camp were investigated. The participants were grouped as workers with an SWESC, and workers without an SWESC, and variables (age, education, household income, marital status, drinking, exercise, body mass index, morbidity, job, number of counseling sessions, cigarettes smoked per day and smoking initiation age) were investigated. Multiple logistic regression analysis was conducted at each time point. In addition, Cox regression analysis was performed to evaluate the variables affecting the success rate for smoking cessation over time. Results The smoking cessation success rate of workers with an SWESC at week 24 (90.7%) was higher than that for workers without an SWESC (60.5%). Multiple logistic regression was performed to determine the relationship between each variable and the success rates for smoking cessation at week 6, 12, and 24. SWESC was confirmed as significant (p < 0.05) variables for increased success rate for smoking cessation at all 3 time points. After adjusting for all variables, the Cox proportional hazards survival analysis showed a hazard ratio of 6.17 for SWESC (p < 0.001,; 95% confidence interval: 3.08-12.38). Conclusions At a professional treatment smoking cessation camp, participants with an SWESC showed a significantly higher success rate for smoking cessation. Supportive workplace environment for workers' health is expected to be an important factor for smoking cessation projects as well as other health promotion projects at workplace.
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Affiliation(s)
- Woojin Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Ulsan Smoking Cessation Support Center, Korean Health Promotion Institute, Ulsan, Korea
| | - A Ram Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Heun Lee
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Daehwan Kim
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Minjun Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Cheolin Yoo
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Ulsan Smoking Cessation Support Center, Korean Health Promotion Institute, Ulsan, Korea
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Le TTT, Warner KE, Mendez D. The evolution of age-specific smoking cessation rates in the United States from 2009 to 2017: a Kalman filter based approach. BMC Public Health 2023; 23:2076. [PMID: 37875887 PMCID: PMC10594685 DOI: 10.1186/s12889-023-16986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Tracking the US smoking cessation rate over time is of great interest to tobacco control researchers and policymakers since smoking cessation behaviors have a major effect on the public's health. Recent studies have employed dynamic models to estimate the US cessation rate through observed smoking prevalence. However, none of those studies has provided annual estimates of the cessation rate by age group. Hence, the primary objective of this study is to estimate annual smoking cessation rates specific to different age groups in the US from 2009 to 2017. METHODS We employed a Kalman filter approach to investigate the annual evolution of age-group-specific cessation rates, unknown parameters of a mathematical model of smoking prevalence, during the 2009-2017 period using data from the 2009-2018 National Health Interview Surveys. We focused on cessation rates in the 25-44, 45-64 and 65 + age groups. RESULTS The findings show that cessation rates followed a consistent u-shaped curve over time with respect to age (i.e., higher among the 25-44 and 65 + age groups, and lower among 45-64-year-olds). Over the course of the study, the cessation rates in the 25-44 and 65 + age groups remained nearly unchanged around 4.5% and 5.6%, respectively. However, the rate in the 45-64 age group exhibited a substantial increase of 70%, from 2.5% to 2009 to 4.2% in 2017. The estimated cessation rates in all three age groups tended to converge to the weighted average cessation rate over time. CONCLUSIONS The Kalman filter approach offers a real-time estimation of cessation rates that can be helpful for monitoring smoking cessation behavior.
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Affiliation(s)
- Thuy T T Le
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA.
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - David Mendez
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
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Ruksakulpiwat S, Benjasirisan C, Ding K, Phianhasin L, Thorngthip S, Ajibade AD, Thampakkul J, Zhang AY, Voss JG. Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review. Patient Prefer Adherence 2023; 17:2161-2174. [PMID: 37667687 PMCID: PMC10475305 DOI: 10.2147/ppa.s420059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke. Objective To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH. Methods This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative. Results Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients. Conclusion Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sutthinee Thorngthip
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anuoluwapo D Ajibade
- College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Jai Thampakkul
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Kreuter MW, Garg R, Fu Q, Caburnay C, Thompson T, Roberts C, Sandheinrich D, Javed I, Wolff JM, Butler T, Grimes LM, Carpenter KM, Pokojski R, Engelbrecht K, Howard V, McQueen A. Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100529. [PMID: 37408953 PMCID: PMC10319314 DOI: 10.1016/j.lana.2023.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023]
Abstract
Background Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT03194958. Funding National Cancer Institute: R01CA201429.
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Affiliation(s)
- Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Dominique Sandheinrich
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer M. Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Robin Pokojski
- Community Partnerships, United Way of Greater St. Louis, St. Louis, MO, USA
| | | | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Wolff JM, McQueen A, Garg R, Thompson T, Fu Q, Brown DS, Kegler M, Carpenter KM, Kreuter MW. Expanding population-level interventions to help more low-income smokers quit: Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 129:107202. [PMID: 37080354 PMCID: PMC11440634 DOI: 10.1016/j.cct.2023.107202] [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: 01/11/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Low-income Americans have higher rates of smoking and a greater burden of smoking-related disease. In the United States, smokers in every state can access evidence-based telephone counseling through free tobacco quitlines. However, quitlines target smokers who are ready to quit in the next 30 days, which can exclude many low-income smokers. A smoke-free homes intervention may help engage smokers in tobacco control services who are not yet ready to quit. Previous research in low-income populations suggests that receiving a smoke-free homes intervention is associated with higher quit rates. This study tests whether, at a population level, expanding on quitlines to include a smoke-free homes intervention for smokers not ready to quit could engage more low-income smokers and increase long-term cessation rates. METHODS In a Hybrid Type 2 design, participants are recruited from 211 helplines in 9 states and randomly assigned to standard quitline or quitline plus smoke-free homes intervention arms. Participants in both arms are initially offered quitline services. In the quitline plus smoke-free homes condition, participants who decline the quitline are then offered a smoke-free homes intervention. Participants complete a baseline and follow-up surveys at 3 and 6 months. Those who have not yet quit at the 3-month follow-up are re-offered the interventions, which differ by study arm. The primary study outcome is self-reported 7-day point prevalence abstinence from smoking at 6-month follow-up. CONCLUSION This real-world cessation trial involving 9 state tobacco quitlines will help inform whether offering smoke-free homes as an alternative intervention could engage more low-income smokers with evidence-based interventions and increase overall cessation rates. This study has been registered at ClinicalTrials.gov (Study Identifier: NCT04311983).
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Affiliation(s)
- Jennifer M Wolff
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America.
| | - Amy McQueen
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America; Washington University in St. Louis, School of Medicine, Department of Medicine, United States of America
| | - Rachel Garg
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
| | - Tess Thompson
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
| | - Qiang Fu
- Tufts University, Department of Community Health, United States of America
| | - Derek S Brown
- Washington University in St. Louis, Brown School, United States of America
| | - Michelle Kegler
- Emory University, Rollins School of Public Health, United States of America
| | | | - Matthew W Kreuter
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
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Albasheer O, Alhazmi AH, Alharbi A, Makeen AM, Alqassim AY, Al-Musawa HI, Alabah AE, Alhazmi AK, Khormi NA, Hamzi YA, Sharhah EYA, Salami RM, Alshareef M, Suwaydi H, Elkhobby A. Effectiveness and determinants of smoking cessation in the Saudi Arabian Region of Jazan: A cross-sectional study. Tob Induc Dis 2023; 21:06. [PMID: 36721860 PMCID: PMC9865635 DOI: 10.18332/tid/156842] [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: 06/17/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Smoking cessation has significant health benefits. The purpose of this study is to assess the efficacy and related factors of smoking cessation therapies in the Jazan Region of Saudi Arabia. METHODS This is a cross-sectional study that took place at smoking cessation clinics in primary healthcare centers between January 2019 and January 2020. RESULTS This study enrolled a total of 103 people. The success rate for quitting smoking was 36% at three months, with a 13% relapse rate at six months. Age (p=0.017), occupation (p=0.046), daily cigarette intake (p=0.015), and number of visits (p=0.001) were all found to be significant determinants of smoking cessation. In the multivariate analysis, only the number of visits increased the likelihood to quit smoking (AOR=0.31; 95% CI: 0.15-0.63). Self-efficacy was cited as the primary reason for quitting smoking by 71% of the participants, whereas family support, smoking cessation therapies, and friends' support were cited as predictive variables by 18%, 10%, and 1% of the participants, respectively. CONCLUSIONS Smokers who received the smoking cessation intervention package were three times more likely to succeed in giving up smoking when compared to those who received the routine service. Regular follow-up during smoking cessation interventions significantly enhanced the quit rate. It is recommended that pharmacotherapy strategies and intense therapy performed face-to-face with a cessation counselor be combined to improve the quit rate.
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Affiliation(s)
- Osama Albasheer
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Abdulaziz H. Alhazmi
- Emerging and Epidemic Infectious Diseases Research Unit, Medical Research Center, Jazan University, Jazan City, Saudi Arabia,Microbiology and Parasitology Department, College of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Abdullah Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Anwar M. Makeen
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | - Amjad E. Alabah
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | - Nawaf A. Khormi
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Yazeed A. Hamzi
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | | | - Mohammed Alshareef
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
| | - Hassan Suwaydi
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
| | - Ahmed Elkhobby
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
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Lee JK, Kim YI, Kweon SS, Oh IJ, Kwon YS, Shin HJ, Choe YR, Park HY, Na YO, Park HK. Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp. Medicine (Baltimore) 2022; 101:e29886. [PMID: 35905242 PMCID: PMC9333467 DOI: 10.1097/md.0000000000029886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp. Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing. A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms. Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.
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Affiliation(s)
- Jae-Kyeong Lee
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
- *Correspondence: Yu-Il Kim, MD, Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea (e-mail: )
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yu-Ri Choe
- Department of Family Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Ha-Young Park
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Young-Ok Na
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hwa-Kyung Park
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
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Borrelli B, Endrighi R, Jurasic MM, Hernandez H, Jones E, Ospina J, Cabral HJ, Quintiliani LM, Werntz S. A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial. BMC Public Health 2022; 22:1074. [PMID: 35641925 PMCID: PMC9158367 DOI: 10.1186/s12889-022-13427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective smoking cessation programs exist but are underutilized by smokers, especially by disadvantaged smokers. Cessation interventions in dental settings have been shown to be effective, but are not consistently delivered due to provider burden and lack of training, especially on how to counsel smokers who are not motivated to quit. METHODS This study is a 2-arm, phase III longitudinal randomized controlled efficacy trial to motivate utilization of evidenced based treatments (EBTs) for smoking cessation (e.g., state quitline, clinic-based counseling, the National Cancer Institute's text message program, and pharmacotherapy). Patients attending an urban dental clinic (n = 376) will be randomized to an intervention group (INT; smoking cessation induction video delivered via VR headset during their teeth cleaning, brochure about EBTs, and a 4-week text message program) or control group (CTRL; relaxation video delivered via VR headset during teeth cleaning, the same brochure as INT, and assessment-only text messages). Assessments will occur at baseline, immediately after the clinic appointment, one-month post-appointment and 3-and 6 months later. We hypothesize INT will be more likely to contact EBTs vs CTRL and have greater utilization rates of EBTs. Secondary objectives are to test the efficacy of INT on point-prevalence smoking abstinence, quit smoking attempts, and motivation to quit vs. CTRL. DISCUSSION Incorporating smoking cessation into a dental clinic visit and targeting all smokers, regardless of motivation to quit, provides proactive reach to cigarette smokers who otherwise may not seek treatment for smoking. TRIAL REGISTRATION NCT04524533 Registered August 24, 2020.
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Affiliation(s)
- B Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA.
| | - R Endrighi
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - M M Jurasic
- Department of General Dentistry and Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - H Hernandez
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - E Jones
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - J Ospina
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - H J Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 02118, USA
| | - L M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, Boston Medical Center, Boston, MA, 02118, USA
| | - S Werntz
- President, Agile Health, Inc, Lincolnshire, IL, 60069, USA
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11
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Barriers to Cigarette Smoking Cessation in Pakistan: Evidence from Qualitative Analysis. J Smok Cessat 2021; 2021:9592693. [PMID: 34853617 PMCID: PMC8592749 DOI: 10.1155/2021/9592693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background With over 25 million tobacco users, Pakistan has one of the largest smoking populations in the world. Tobacco addiction comes with grave health consequences, especially for the poor and marginalized. Objective This study explores barriers to smoking cessation in marginalized communities of Islamabad and the possibility of their use of Harm Reduction Products (HRPs), primarily e-cigarettes. Methodology. The study has used primary data of 48 respondents from marginalized communities. Several domains have been employed to evaluate the barriers to smoking cessation in these communities. Using qualitative technique, data was organized and categorized into objective themes. Conclusion The experience of combustible smoking usually occurs in the 10-20 years' age bracket. Regular smokers in marginalized areas of Islamabad smoke 20 cigarettes or a pack per day. Their choice of cigarette brand is largely driven by affordability. Most smokers have made at least one attempt to quit smoking. Peer pressure and friendship are major barriers to smoking cessation. Lack of knowledge seems to be the major reason for not seeking medical assistance for quitting smoking. Knowledge about HRPs, especially e-cigarettes, can best be described as vague. Higher prices of the alternatives to combustible smoking are a major hurdle preventing their use for smoking cessation.
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12
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Danler C, Pfaff K. The impact of an unequal distribution of education on inequalities in life expectancy. SSM Popul Health 2021; 16:100954. [PMID: 34805476 PMCID: PMC8581344 DOI: 10.1016/j.ssmph.2021.100954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Prior research has found socio-economic determinants such as education to affect health outcomes. Yet, education is not distributed equally among the population. This article attempts to quantify the impact of unequal distribution of education on inequalities in life expectancy. We calculate a Gini coefficient of longevity from the life tables provided by the Human Mortality Database and a Gini coefficient of education using data on educational attainment from Barro and Lee (2013). We estimate linear regression models to examine the relationship between inequality in education and inequality in life expectancy at the country level for up to 31 European countries between 1970 and 2010. Results provide empirical evidence for a statistically significant positive association between educational inequality and inequalities of longevity. Confounding factors reflecting individual health behaviour such as cigarette or alcohol consumption do not exert a separate statistically significant effect on inequality in life expectancy. Findings are robust to alternative calculation of key variables, dropping a potential outlier, and an alternative estimation approach. These findings suggest that not only education, but also equality in education is a crucial factor for health outcomes. Continuing efforts should be directed towards the reduction of educational inequality in order to reduce inequality in longevity within a country.
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Affiliation(s)
- Clemens Danler
- Department of Socioeconomics, Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Wien, Austria
| | - Katharina Pfaff
- Department of Socioeconomics, Vienna University of Economics and Business, D4.3.026, Welthandelsplatz 1, 1020, Wien, Austria
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13
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Rahman T, Baker AL, Gould GS, Palazzi K, Lambkin D, Kennedy M. Factors Associated with Smoke-Free Pregnancy among Aboriginal and Torres Strait Women and Their Experience of Quitting Smoking in Pregnancy: A Mixed Method Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11240. [PMID: 34769756 PMCID: PMC8583423 DOI: 10.3390/ijerph182111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Smoke-free pregnancies have long-term health benefits for mothers and babies. This paper quantitatively examines factors associated with smoke-free pregnancies among Aboriginal and Torres Strait Islander women (hereafter Aboriginal women) and qualitatively explores their smoking cessation (SC) experiences during pregnancy. An Aboriginal-led online cross-sectional study on SC was conducted with Aboriginal women and in partnership with Aboriginal communities, between July and October 2020. The present analysis includes participants who made a pregnancy-related quit attempt (N = 103). Chi-squared tests, logistic regression models, and thematic analysis of free-form text responses were performed. The adjusted odds of having smoke-free pregnancies were 4.54 times higher among participants who used Aboriginal Health Services (AHS) (AOR = 4.54, p-value 0.018). Participants living in urban settings had 67% lower odds of having smoke-free pregnancies compared to their regional/remote counterparts (AOR = 0.33, p-value 0.020). Qualitative data revealed strong motivations to reduce tobacco-related harms to the fetus and variability in quitting experiences at different stages of and across pregnancies. Smoking cessation care (SCC) can support Aboriginal women meaningfully if their quitting experiences are considered in SCC development and implementation. Consistent funding for AHS-led SCC is needed to garner health benefits for Aboriginal peoples. More research into urban versus regional/remote differences in maternal SC is recommended.
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Affiliation(s)
- Tabassum Rahman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Amanda L. Baker
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - David Lambkin
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
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14
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Gut microbial changes of patients with psychotic and affective disorders: A systematic review. Schizophr Res 2021; 234:1-10. [PMID: 31952911 DOI: 10.1016/j.schres.2019.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many diverse inflammatory pathophysiologic mechanisms have been linked to mental disorders, and through the past decade an increasing interest in the gut microbiota and its relation to mental health has been arising. We aimed to systematically review studies of alterations in gut microbiota of patients suffering from psychotic disorders, bipolar disorder or depression compared to healthy controls. METHODS We systematically searched the databases CENTRAL, PubMed, EMBASE, PsycINFO and LILACS. Primary outcome was to compare the gut microbiota of patients suffering from psychotic disorders, bipolar disorder or depression with healthy controls. RESULTS We identified 17 studies, covering 744 patients and 620 healthy controls. The most consistent microbiota changes were a tendency towards higher abundance of Actinobacteria and lower abundance of Firmicutes at the phylum level, lower abundance of Lachnospiraceae at family level and lower abundance of Faecalibacterium at genus level for the mental disorders overall. However, we found that all studies had risk of bias and that the included studies displayed great variability in methods of storage, analysis of the fecal samples, reporting of results and statistics used. CONCLUSION Due to the many limitations of the included studies the findings should be interpreted with caution. Larger studies (especially of schizophrenia and major depressive disorder) are needed, but it is also of great importance to gather information of and control for factors that influence the result of a microbiota analysis including body mass index (BMI), smoking, alcohol consumption, diet habits, antibiotics, sample handling, wet laboratory methods and statistics.
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15
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van Bruggen S, Kasteleyn MJ, Bonten TN, Chavannes NH, Numans ME, Rauh SP. Socioeconomic status is not associated with the delivery of care in people with diabetes but does modify HbA1c levels: An observational cohort study (Elzha-cohort 1). Int J Clin Pract 2021; 75:e13962. [PMID: 33368962 PMCID: PMC8243918 DOI: 10.1111/ijcp.13962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Structured primary diabetes care within a collectively supported setting is associated with better monitoring of biomedical and lifestyle-related target indicators amongst people with type 2 diabetes and with better HbA1c levels. Whether socioeconomic status affects the delivery of care in terms of monitoring and its association with HbA1c levels within this approach, is unclear. This study aims to understand whether, within a structured care approach, (1) socioeconomic categories differ concerning diabetes monitoring as recommended; (2) socioeconomic status modifies the association between monitoring as recommended and HbA1c. METHODS Observational real-life cohort study with primary care registry data from general practitioners within diverse socioeconomic areas, who are supported with the implementation of structured diabetes care. People with type 2 diabetes mellitus were offered quarterly diabetes consultations. "Monitoring as recommended" by professional guidelines implied minimally one annual registration of HbA1c, systolic blood pressure, LDL, BMI, smoking behaviour and physical activity. Regarding socioeconomic status, deprived, advantageous urban and advantageous suburban categories were compared to the intermediate category concerning (a) recommended monitoring; (b) association between recommended monitoring and HbA1c. RESULTS Aim 1 (n = 13 601 people): Compared to the intermediate socioeconomic category, no significant differences in odds of being monitored as recommended were found in the deprived (OR 0.45 (95% CI 0.19-1.08)), advantageous urban (OR 1.27 (95% CI 0.46-3.54)) and advantageous suburban (OR 2.32 (95% CI 0.88-6.08)) categories. Aim 2 (n = 11 164 people): People with recommended monitoring had significantly lower HbA1c levels than incompletely monitored people (-2.4 (95% CI -2.9; -1.8) mmol/mol). SES modified monitoring-related HbA1c differences, which were significantly higher in the deprived (-3.3 (95% CI -4.3; -2.4) mmol/mol) than the intermediate category (-1.3 (95% CI -2.2; -0.4) mmol/mol). CONCLUSIONS Within a structured diabetes care setting, socioeconomic status is not associated with recommended monitoring. Socioeconomic differences in the association between recommended monitoring and HbA1c levels advocate further exploration of practice and patient-related factors contributing to appropriate monitoring and for care adjustment to population needs.
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Affiliation(s)
- Sytske van Bruggen
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
- Hadoks (Elzha)The HagueThe Netherlands
| | - Marise J. Kasteleyn
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
| | - Tobias N. Bonten
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
| | - Simone P. Rauh
- Department of Epidemiology and BiostatisticsAmsterdam Public Health, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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16
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Duarte D, Choi K. Psychographic Profiling of Adult Tobacco Users and Implications for Mediated Message Tailoring. Am J Health Promot 2021; 35:483-490. [PMID: 33084349 PMCID: PMC9347182 DOI: 10.1177/0890117120967193] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate variations of psychographic profiles in adult tobacco users to inform message tailoring. DESIGN A cross-sectional design used data from the Simmons 2015 National Consumer Study. SETTING Data were voluntarily provided by US families through a mail survey on media, products, and services, brands, and attitudes. SUBJECTS US adult tobacco users (N = 4,609). MEASURES Participants answered questions about general opinion/attitudes and provided demographic and tobacco use information. ANALYSIS A factor analysis was conducted to determine the "best" latent psychographic factor structure based on model fit, factor loadings, and interpretability. A structural equation model was then applied to assess the associations between demographics, tobacco product use, and latent psychographic factors. RESULTS We identified 9 latent psychographic factors: (1) helplessness, (2) happiness, (3) achievements, (4) religion, (5) interest in art and culture, (6) conscience, (7) conformity, (8) family indulgence, and (9) creativity. Endorsement of these factors varied by demographics and tobacco product use. E.g. low income tobacco users showed stronger endorsement for "helplessness" (Adjusted Standardized Regression Coefficient [ASRC]: 0.42; 95% CI: 0.33, 0.51) and "religion" (ASRC: 0.24; 95% CI: 0.14, 0.33). Less educated tobacco users showed stronger endorsement for "conformity" (ASRC: 0.16; 95% CI: 0.07, 0.24). Young adults had significant positive associations for "achievements" (ASRC: 0.57; 95% CI: 0.48, 0.67). CONCLUSION Psychographic profiles of tobacco users vary by demographics and product use. Tailored anti-tobacco media campaigns to specific disparity groups matching their psychographic profiles may improve message effectiveness and reduce tobacco use disparities.
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Affiliation(s)
- Danielle Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Anderson DR, Horn S, Karlan D, Kowalski AE, Sindelar JL, Zinman J. Evaluation of Combined Financial Incentives and Deposit Contract Intervention for Smoking Cessation: A Randomized Controlled Trial. J Smok Cessat 2021; 2021:6612505. [PMID: 34306224 PMCID: PMC8279199 DOI: 10.1155/2021/6612505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/09/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We evaluate whether a combination of financial incentives and deposit contracts improves cessation rates among low- to moderate-income smokers. METHODS We randomly assigned 311 smokers covered by Medicaid at 12 health clinics in Connecticut to usual care or one of the three treatment arms. Each treatment arm received financial incentives for two months and either (i) nothing further ("incentives only"), (ii) the option to start a deposit contract with incentive earnings after the incentives ended ("commitment"), or (iii) the option to precommit any earned incentives into a deposit contract starting after the incentives ended ("precommitment"). Smoking cessation was confirmed biochemically at two, six, and twelve months. RESULTS At two, six, and twelve months after baseline, our estimated treatment effects on cessation are positive but imprecise, with confidence intervals containing effect sizes estimated by prior studies of financial incentives alone and deposit contracts alone. At two months, the odds ratio for quitting was 1.4 in the incentive-only condition (95% CI: 0.5 to 3.5), 2.0 for incentives followed by commitment (95% CI: 0.6 to 6.1), and 1.9 for incentives and precommitment (95% CI: 0.7 to 5.3). CONCLUSIONS A combined incentive and deposit contract program for Medicaid enrollees, with incentives offering up to $300 for smoking cessation and use of support services, produced a positive but imprecisely estimated effect on biochemically verified cessation relative to usual care and with no detectable difference in cessation rates between the different treatment arms.
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Affiliation(s)
- Daren R. Anderson
- Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Samantha Horn
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Dean Karlan
- Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | | | - Jody L. Sindelar
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Jonathan Zinman
- Department of Economics, Dartmouth College, Hanover, NH, USA
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Faro JM, Nagawa CS, Orvek EA, Smith BM, Blok AC, Houston TK, Kamberi A, Allison JJ, Person SD, Sadasivam RS. Comparing recruitment strategies for a digital smoking cessation intervention: Technology-assisted peer recruitment, social media, ResearchMatch, and smokefree.gov. Contemp Clin Trials 2021; 103:106314. [PMID: 33571687 DOI: 10.1016/j.cct.2021.106314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Choosing the right recruitment strategy has implications for the successful conduct of a trial. Our objective was to compare a novel peer recruitment strategy to four other recruitment strategies for a large randomized trial testing a digital tobacco intervention. METHODS We compared enrollment rates, demographic and baseline smoking characteristics, and odds of completing the 6-month study by recruitment strategy. Cost of recruitment strategies per retained participant was calculated using staff personnel time and advertisement costs. FINDINGS We enrolled 1487 participants between August 2017 and March 2019 from: Peer recruitment n = 273 (18.4%), Facebook Ads n = 505 (34%), Google Ads = 200 (13.4%), ResearchMatch n = 356 (23.9%) and Smokefree.govn = 153 (10.3%). Mean enrollment rate per active recruitment month: 1) Peer recruitment, n = 13.9, 2) Facebook ads, n = 25.3, 3) Google ads, n = 10.51, 4) Research Match, n = 59.3, and 5) Smokefree.gov, n = 13.9. Peer recruitment recruited the greatest number of males (n = 110, 40.3%), young adults (n = 41, 14.7%), participants with a high school degree or less (n = 24, 12.5%) and smokers within one's social network. Compared to peer recruitment (retention rate = 57%), participants from Facebook were less likely (OR 0.46, p < 0.01, retention rate = 40%), and those from ResearchMatch were more likely to complete the study (OR 1.90, p < 0.01, retention rate = 70%). Peer recruitment was moderate in cost per retained participant ($47.18) and substantially less costly than Facebook ($173.60). CONCLUSIONS Though peer recruitment had lower enrollment than other strategies, it may provide greater access to harder to reach populations and possibly others who smoke within one's social network while being moderately cost-effective. ClinicalTrials.gov: NCT03224520.
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Affiliation(s)
- Jamie M Faro
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Catherine S Nagawa
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Elizabeth A Orvek
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Spinal Cord Injury Quality Enhancement Research Initiative (QUERI), Hines VAMC, Chicago, IL, United States; Department of Pediatrics and Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Amanda C Blok
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Thomas K Houston
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Ariana Kamberi
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jeroan J Allison
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sharina D Person
- Division of Biostatistics and Health Services Research, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Rasmussen M, Hovhannisyan K, Adami J, Tønnesen H. Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions. Eur Addict Res 2021; 27:123-130. [PMID: 33080594 PMCID: PMC8006577 DOI: 10.1159/000510608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. OBJECTIVE The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. METHODS We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. RESULTS A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. CONCLUSIONS Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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Affiliation(s)
- Mette Rasmussen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark,*Mette Rasmussen, Department of Health Sciences, Clinical Health Promotion Unit, WHO-CC, Lund University, Södra Förstadsgatan 35, SE–20502 Malmö (Sweden),
| | - Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Tønnesen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
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20
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Lee C, Harari L, Park S. Early-Life Adversities and Recalcitrant Smoking in Midlife: An Examination of Gender and Life-Course Pathways. Ann Behav Med 2020; 54:867-879. [PMID: 32329785 DOI: 10.1093/abm/kaaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases. PURPOSE We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations. METHODS Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking). RESULTS For women, low SES (odds ratio [OR] = 1.29; 1.06-1.55) and family instability (OR = 1.73; 1.14-2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10-2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems. CONCLUSIONS The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.
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Affiliation(s)
- Chioun Lee
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Lexi Harari
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Soojin Park
- Graduate School of Education, University of California-Riverside, Riverside, CA, USA
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Hamzeh B, Farnia V, Moradinazar M, Pasdar Y, Shakiba E, Najafi F, Alikhani M. Pattern of cigarette smoking: intensity, cessation, and age of beginning: evidence from a cohort study in West of Iran. Subst Abuse Treat Prev Policy 2020; 15:83. [PMID: 33109215 PMCID: PMC7590452 DOI: 10.1186/s13011-020-00324-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is a social epidemic and one of the main risk factors for premature deaths and disabilities worldwide. In the present study, we investigated the Pattern of Cigarette Smoking: intensity, cessation, and age of the beginning. METHODS Data collected from the recruitment phase of Ravansar (a Kurd region in western Iran) Non-Communicable Disease (RaNCD) cohort study was analyzed by using Chi-square test, univariate and multivariate logistic regressions, Poisson regression, and linear regression. RESULTS Totally 10,035 individuals (47.42% males) participated in the study. Mean age was lower for males (47.45 yr) than for females (48.36 yr). Prevalence of smoking was 20% (36.4% of males and 5.23% of females). Compared to female participants, males showed a 7-fold higher prevalence of smoking and started smoking about 4 years earlier. Being married, having a lower BMI, living in rural areas, and being exposed to secondhand smoke (SHS) were predictors of higher smoking prevalence rates. Furthermore, current exposure to SHS, higher smoking intensity, later smoking initiation, male gender, younger age, lower education, and lower BMI were related to lower likelihood of stopping smoking. Heavy smokers began to smoke about 4 years earlier than casual smokers did. Finally, being divorced/ widow/ widower/ single and childhood exposure to SHS were found to increase the likelihood of becoming a smoker. CONCLUSIONS Based on present research results, health programs specific to smoking cessation should take socio-demographic factors, smoking history, and current smoking behavior into account.
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Affiliation(s)
- Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Nutritional Sciences Department, School of Public Health Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Lathen LS, Plears ML, Shartle EL, Conner KL, Fiore MC, Christiansen BA. The HUD smoke-free rule: Perceptions of residents post-implementation. Prev Med Rep 2020; 19:101159. [PMID: 32728524 PMCID: PMC7381686 DOI: 10.1016/j.pmedr.2020.101159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022] Open
Abstract
The new HUD no smoking policy has had a favorable impact on smokers. The new HUD no smoking policy has reduced second hand smoke exposure. There remain needs for education, policy enforcement and on-site cessation help.
In July 2018, the U.S. Department of Housing and Urban Development (HUD) implemented a new Public health Agency rule prohibiting the use of tobacco in and within 25 feet of HUD housing. A convenience sample of 574 residents living in Milwaukee, Wisconsin multi-unit HUD complexes completed a survey from May through July 2019, designed to assess their perceptions of the new policy and its impact. Knowledge of the policy was strong, although continued educational efforts are needed. Attitudes about the policy were generally positive, although smokers held more negative attitudes than non-smokers. Some residents desired more and fairer policy enforcement. Most residents reported that smoke incursions were reduced post policy compared to pre policy, although such incursions still occurred. The policy has had a favorable health impact on smokers; over 80% made at least one positive change in their smoking, including 6.4% who said the policy motivated them to quit. There was no evidence that residents with mobility challenges were differentially affected by the policy. Overall, the HUD smoke-free policy was well received, reduced self-reported exposure to smoke and led most smokers to make positive changes in their smoking. Additional education on the policy, improved enforcement, and cessation services are needed.
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Affiliation(s)
| | | | - Emile L Shartle
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Karen L Conner
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Michael C Fiore
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
| | - Bruce A Christiansen
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
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Dahne J, Wahlquist AE, Smith TT, Carpenter MJ. The differential impact of nicotine replacement therapy sampling on cessation outcomes across established tobacco disparities groups. Prev Med 2020; 136:106096. [PMID: 32320705 PMCID: PMC7255419 DOI: 10.1016/j.ypmed.2020.106096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/15/2022]
Abstract
Cigarette smoking is increasingly concentrated among marginalized populations with limited access to evidence-based cessation treatment. This includes racial/ethnic minorities, lower income individuals, those with lower educational attainment, and residents of rural areas. To reach Healthy People 2020 objectives, successful cessation interventions must narrow these disparities. Nicotine replacement therapy (NRT) sampling is an easily translatable and scalable intervention that could enhance treatment access and thus narrow disparities. The present study examined individual-level demographic moderators of the impact of NRT sampling on cessation-related behaviors including: 1) use of a cessation medication, 2) making a 24-hour quit attempt, 3) floating abstinence, and 4) 7-day point prevalence abstinence at 6-months. Study participants included N = 1245 adult smokers enrolled in the Tobacco Intervention in Primary Care Treatment Opportunities for Providers (TIP TOP) study, a recently concluded large-scale clinical trial of NRT sampling relative to standard care within 22 primary care clinics across South Carolina. Generalized linear models examined individual-level demographic moderators of treatment effect. Results suggest that NRT sampling may be more effective among some of the most disadvantaged groups of smokers, including smokers with lower income and education, as well those who live in more rural areas. The effects of NRT sampling did not differ by race. In sum, NRT sampling is a low-cost, low-burden intervention that could be disseminated broadly to reach large numbers of smokers and potentially narrow cessation disparities.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
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Hägg SA, Ljunggren M, Janson C, Holm M, Franklin KA, Gislason T, Johannessen A, Jõgi R, Olin AC, Schlünssen V, Lindberg E. Smokers with insomnia symptoms are less likely to stop smoking. Respir Med 2020; 170:106069. [PMID: 32843184 DOI: 10.1016/j.rmed.2020.106069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances. METHODS A questionnaire was sent to randomly selected men and women in Northern Europe in 1999-2001 (RHINE II) and was followed up by a questionnaire in 2010-2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR). RESULTS Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4-0.8), difficulty maintaining sleep (0.7; 0.5-0.9), early morning awakening (0.6; 0.4-0.8), any insomnia symptom (0.6; 0.5-0.8) or excessive daytime sleepiness (0.7; 0.5-0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2-2.3). CONCLUSIONS Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.
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Affiliation(s)
- Shadi Amid Hägg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karl A Franklin
- Department of Surgery and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Shoots-Reinhard B, Erford B, Romer D, Evans AT, Shoben A, Klein EG, Peters E. Numeracy and memory for risk probabilities and risk outcomes depicted on cigarette warning labels. Health Psychol 2020; 39:721-730. [PMID: 32496078 DOI: 10.1037/hea0000879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Greater numeracy is associated with higher likelihood to quit smoking. We examined whether numeracy supports learning of numeric health-risk information and, in turn, greater risk perceptions and quit intentions. METHOD Adult smokers (N = 696) viewed text warnings with numeric risk information four times each in one of three warning-label types (text-only, low-emotion pictorial [i.e., with image], high-emotion pictorial). They completed posttest measures immediately or 6 weeks later. Emotional reactions to warnings were reported the second time participants viewed the warnings. Numeracy, memory for risk probabilities and risk outcomes, risk perceptions, and quit intentions were assessed postexposures. RESULTS Memory for risk probabilities and risk outcomes depended on warning-label type and posttest timing. Consistent with memory-consolidation theory, memory for high- versus low-emotion labels was lower immediately, but declined less for high-than low-emotion labels. Label memory was similar between conditions at 6 weeks. Numeracy predicted overall superior memory (especially for risk probabilities) controlling for health literacy and education. It also indirectly predicted greater risk perceptions and quit intentions via memory. In exploratory analyses, however, the superior recall of risk probabilities of smoking among those higher in numeracy was associated with lower risk perceptions. CONCLUSIONS Numeracy is associated with superior risk memory, which relates to greater risk perceptions and quit intentions. More numerate and educated smokers may be better able to quit due to their superior learning of smoking's risks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract
AbstractIntroductionQuitlines are standard care for smoking cessation; however, retaining clients in services is a problem. Little is known about factors that may predict dropout.AimsTo examine predictors of retention while in-program and at follow-up for clients enrolling in a state quitline.MethodsThis was a retrospective analysis of quitline enrolled clients from 2011 to 2017 (N = 49,347). Client retention in-program was categorized as (a) low adherence to treatment (receiving zero coaching calls), moderate (1–2 calls), and high adherence (3+ calls). Dropout at follow-up included participants who were not reached for the 7-month follow-up.ResultsMore than half the sample dropped out during treatment; 61% were not reached for follow-up. Women (odds ratio (OR) = 1.21; 95% confidence interval (CI) = [1.16, 127]) and those with high levels of nicotine dependence (OR = 1.03; 95% CI = [1.02, 1.04]) were more likely to have moderate adherence to treatment (1–2 coaching calls). Dropout at follow-up was more likely among clients who used nicotine replacement therapy (OR = 1.14; 95% CI = [1.09, 1.19]) and less likely among those who had high treatment adherence (OR = 0.41; 95% CI = [0.39, 0.42]).ConclusionGiven the relapsing nature of tobacco use and the harms related to tobacco use, quitlines can improve their impact by offering tailored services to enhance client engagement and retention in-treatment and at follow-up.
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Duarte DA, Chen-Sankey JC, Dang K, Orozco L, Jewett B, Choi K. "Isn't there a bunch of side effects?": A focus group study on the beliefs about cessation treatments of non-college educated young adult smokers. J Subst Abuse Treat 2020; 112:36-41. [PMID: 32199544 DOI: 10.1016/j.jsat.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
Smoking remains more prevalent among non-college educated and racial/ethnic minority young adults in the U.S. These smokers are less likely than their college educated/non-Hispanic white counterparts to use cessation treatments approved by the U.S. Food and Drug Administration (FDA). Alternative cessation methods (e.g., e-cigarettes) have also grown in popularity among smokers. Therefore, we conducted a focus group study to explore perceptions and beliefs about various cessation treatments among, racially/ethnically diverse, non-college educated young adult smokers. Seventy-five 18-29-year-old current smokers without a 4-year college education were recruited from the U.S. Washington, D.C. metropolitan area and attended one of twelve focus groups to discuss their awareness, beliefs, experiences, and intention for future use of cessation treatments. Focus groups were stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic) and educational attainment (≤ high school vs. some college without obtaining a bachelor's degree). We used a thematic approach to analyze the discussions. We found that few participants were aware of cessation counseling or cessation related programs. Many participants reported previously using nicotine replacement therapies and e-cigarettes to quit smoking. Participants had little intention to use prescription medications due to perceived side effects. Participants' awareness, beliefs, and intentions of using other cessation treatments varied by race/ethnicity and educational attainment. In conclusion, our findings, if confirmed by subsequent quantitative studies, suggest that targeted media campaigns may be needed to explain the contents and benefits of behavioral cessation programs to non-college educated young adult smokers. Targeted media messages aim to overcome negative perceptions related to nicotine replacement therapy and prescription medications among non-college educated young adult smokers, especially those from racial/ethnic minority populations, may promote successful smoking cessation in this population.
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Affiliation(s)
- Danielle A Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Kathleen Dang
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr, Chapel Hill, NC 27599, USA.
| | - Leah Orozco
- Department of Biology, College of the Holy Cross, 1 College St, Worcester, MA 01610, USA.
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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Jayakumar N, Chaiton M, Zhang B, Selby P, Schwartz R. Sex Differences in Use of Smoking Cessation Services and Resources: A Real-World Study. Tob Use Insights 2020; 13:1179173X20901500. [PMID: 32030067 PMCID: PMC6977215 DOI: 10.1177/1179173x20901500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives: Smoking cessation interventions with sex considerations have been found to effectively increase cessation rates. However, evidence is limited and weak. This study examined sex differences in the use of smoking cessation services or resources among Ontario adults. Methods: Data are from the Smokers’ Panel, an ongoing online survey of Ontario adult smokers and recent quitters. The analysis included 1009 male and 1765 female participants. Bivariate analysis was used to examine differences in sociodemographic characteristics and smoking-related variables by use of cessation services/resources. Logistic regression was then used to identify sociodemographic characteristics and smoking-related variables associated with the use of cessation services/resources. Results: The analysis shows that there were significant sex differences in the use of individual interventions. Female participants were more likely to use nicotine patch (63% vs 58%; adjusted odds ratio, AOR: 1.39, 95% confidence interval [CI]: 1.16-1.67), varenicline (29% vs 24%; AOR: 1.37, 95% CI: 1.13-1.66), Smokers’ Helpline phone (14% vs 10%; AOR: 1.39, 95% CI: 1.07-1.79), Smokers’ Helpline online (27% vs 21%; AOR 1.43, 95% CI: 1.18-1.74), self-help materials (23% vs 16%; AOR: 1.81 95% CI: 1.46-2.26), and alternative methods (23% vs 19%; AOR: 1.40, 95% CI: 1.14-1.73) compared with male participants, after adjusting for covariates. Conclusion: Consistent with other findings, the study shows sex differences in the use of smoking cessation services or resources among adult smokers. Women are more likely to use recommended cessation resources such as nicotine patch, varenicline, and Smokers’ Helpline than men. Health professionals should use this increased willingness to help female smokers quit. However, men may be underserved and more men-specific interventions need to be developed and evaluated.
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Affiliation(s)
- Navitha Jayakumar
- Ontario Tobacco Research Unit, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Chaiton
- Ontario Tobacco Research Unit, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Michael Chaiton, Ontario Tobacco Research Unit, 155 College Street, Toronto, ON M5T 3M7, Canada.
| | - Bo Zhang
- Ontario Tobacco Research Unit, Toronto, ON, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Stallings-Smith S, Ballantyne T. Ever Use of E-Cigarettes Among Adults in the United States: A Cross-Sectional Study of Sociodemographic Factors. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019864479. [PMID: 31328601 PMCID: PMC6647205 DOI: 10.1177/0046958019864479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
E-cigarette use among adolescents is well-documented, but less is known about adult users of e-cigarettes. The purpose of this study was to examine associations between sociodemographic factors and e-cigarette use in a nationally representative sample of adults in the United States. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for years 2015-2016 were analyzed to assess e-cigarette use among 5989 adults aged ≥18 years. Multivariable logistic regression was conducted to examine associations between the sociodemographic exposures of age, sex, race, marital status, education level, employment status, and poverty-income ratio and the outcome of e-cigarette use. The weighted prevalence of ever use of e-cigarettes was 20%. Compared with adults aged ≥55 years, odds of e-cigarette use were 4.77 times (95% confidence interval [CI] = 3.63-6.27) higher among ages 18 to 34 years and 2.16 times (95% CI = 1.49-3.14) higher among ages 35 to 54 years. Higher odds of e-cigarette use were observed among widowed/divorced/separated participants compared with those who were married/living with a partner, among participants with less than high school (odds ratio [OR] = 1.47; 95% CI = 1.08-2.00) or high school/general educational development (GED) education (OR=1.41; 95% CI = 1.12-1.77) compared with those with college degrees/some college, and among those with incomes below the poverty level (OR=1.31; 95% CI = 1.01-1.69) compared with above the poverty level. For non-smokers of conventional cigarettes, higher odds of e-cigarette use were observed among males compared with females, Mexican Americans/Other Hispanics compared with non-Hispanic whites, and non-working participants compared with those who were working. Overall findings indicate that individuals who are widowed/divorced/separated, individuals with lower education, and with incomes below the poverty level are likely to report ever use of e-cigarettes. As increasing evidence demonstrates negative health consequences, e-cigarette initiation may ultimately contribute to additional smoking-related health inequalities even among non-smokers of conventional cigarettes.
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Yao Y, Nakamura R, Sari N. The educational gap in tar and nicotine content in purchases of cigarettes: An observational study using large-scale representative survey data from Japan. Prev Med 2019; 129:105828. [PMID: 31479656 DOI: 10.1016/j.ypmed.2019.105828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
The intensity of tobacco use is commonly measured by the number of cigarettes, which is inaccurate because it masks the heterogeneity and substances contained in tobacco. Unlike existing studies, this study adopted the tar and nicotine content of purchased cigarettes as proxies for smoking intensity and elicited socioeconomic disparities from the participants regarding tobacco use. Using a nationally representative consumer panel survey of Japan from 2010 to 2014, we found that socioeconomic disparities in smoking are more pronounced when tar and nicotine content in cigarettes is considered. University graduates purchased 26% fewer cigarettes, and 40% less tar or nicotine than their secondary school-educated counterparts. Low education groups purchased more tar-rich cigarettes, which cost less than low-tar cigarettes. The public health recommendations for reducing socioeconomic health inequalities might be understated because they are drawn from evidence based on the number of cigarettes smoked.
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Affiliation(s)
- Ying Yao
- Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan.
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Canada
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Ozbay N, Shevorykin A, Smith P, Sheffer CE. The association between gender roles and smoking initiation among women and adolescent girls. JOURNAL OF GENDER STUDIES 2019; 29:664-684. [PMID: 33414576 PMCID: PMC7787365 DOI: 10.1080/09589236.2019.1693985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/11/2019] [Indexed: 06/12/2023]
Abstract
Smoking cigarettes is a leading global cause of preventable death and disease. Men historically smoke more than women, but the prevalence of smoking among women in low and middle-income countries is increasing at an alarming rate. Understanding the factors that influence smoking initiation among women and girls is needed to address the growing epidemic of women smokers and the looming impact on women's health worldwide. We assume that smoking initiation is embedded in socio-culturally influenced gendered context and use a social cognitive model with a gendered lens as a framework for organizing and synthesizing the research. Guided by this framework, we identified gaps in the literature and make recommendations for future research in this review paper. The results suggest that psychological and environmental determinants are rooted in fluctuating cultural influences and values, but few research studies provide a gendered analysis or systematically examine these factors in the context of gender and culture. Sex/gender is a significant construct through which women and girls experience the psychological, environmental, and other influences on smoking initiation. Much more research is needed to understand the psychological and environmental influences as well as the intersection of gender roles and other social categories on female smoking initiation.
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Affiliation(s)
- Nurbanu Ozbay
- Department of Psychology, The City College of New York, NY
| | - Alina Shevorykin
- Department of Mental Health Counseling and Psychology, Pace University, Pleasantville, NY
| | - Philip Smith
- City University of New York School of Medicine, New York, NY
- Department of Kinesiology and Health, Miami University, Oxford, OH
| | - Christine E. Sheffer
- City University of New York School of Medicine, New York, NY
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Coleman SRM, Gaalema DE, Nighbor TD, Kurti AA, Bunn JY, Higgins ST. Current cigarette smoking among U.S. college graduates. Prev Med 2019; 128:105853. [PMID: 31654730 PMCID: PMC6879857 DOI: 10.1016/j.ypmed.2019.105853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 01/28/2023]
Abstract
Although U.S. college graduates are at relatively low risk for smoking, 12-15% of U.S. smokers (~8 million people) are college graduates. Few studies have examined smoking risk among college graduates. To address that gap, the present study examined smoking risk among U.S. college graduates and those who did not graduate from college in a nationally representative sample of adults (National Survey on Drug Use and Health 2011-2017, n = 202,137). We examined smoking risk in association with well-established risk factors: alcohol abuse/dependence, drug abuse/dependence, mental illness, age, sex, race/ethnicity, and poverty status, using group contrasts and Classification and Regression Tree (CART) modeling. Smoking prevalence among U.S. college graduates and non-graduates was 10% and 26%, respectively. College graduates initiated any smoking and daily smoking at a later age and were lighter smokers than smokers who did not graduate college. Within college graduate and non-graduate groups, prevalence rates varied by orders of magnitude across different risk-factor profiles (ranges = 3-37% and 14-73% among graduates and non-graduates, respectively). Past year drug abuse/dependence was a robust predictor of smoking prevalence in both populations. For college graduates, past year alcohol abuse/dependence and mental illness were stronger predictors of smoking compared to those who did not graduate college, for whom race/ethnicity and age were stronger predictors. Overall, smoking risk increases to surprisingly high levels, even among college graduates, when select risk factors co-occur, particularly psychiatric conditions. Socio-demographic risk factors appear to be less robust predictors of smoking risk among college graduates relative to those who did not graduate college.
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Affiliation(s)
- Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America.
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychological Science, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Allison A Kurti
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Janice Y Bunn
- Department of Mathematics and Statistics, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychological Science, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
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Prediction of Lung Cancer Screening Eligibility Using Simplified Criteria. Ann Am Thorac Soc 2019; 16:1280-1285. [DOI: 10.1513/annalsats.201903-239oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Brooks DR, Burtner JL, Borrelli B, Heeren TC, Evans T, Davine JA, Greenbaum J, Scarpaci M, Kane J, Rees VW, Geller AC. Twelve-Month Outcomes of a Group-Randomized Community Health Advocate-Led Smoking Cessation Intervention in Public Housing. Nicotine Tob Res 2019; 20:1434-1441. [PMID: 29145626 DOI: 10.1093/ntr/ntx193] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/08/2017] [Indexed: 12/31/2022]
Abstract
Background Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence. Methods We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified. Results Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect. Conclusions An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success. Implications In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.
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Affiliation(s)
- Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Joanna L Burtner
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Belinda Borrelli
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Tegan Evans
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jonathan Greenbaum
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Matthew Scarpaci
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Rösing CK, Gomes SC, Carvajal P, Gómez M, Costa R, Toledo A, Solanes F, Romanelli H, Gamonal J, Oppermann RV. Impact of smoking on gingival inflammation in representative samples of three South American cities. Braz Oral Res 2019; 33:e090. [PMID: 31531553 DOI: 10.1590/1807-3107bor-2019.vol33.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/22/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.
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Affiliation(s)
- Cassiano Kuchenbecker Rösing
- Federal University of Rio Grande do Sul - UFRGS, Department of Conservative Dentistry, Faculty of Dentistry, Porto Alegre, RS, Brazil
| | - Sabrina Carvalho Gomes
- Federal University of Rio Grande do Sul - UFRGS, Department of Conservative Dentistry, Faculty of Dentistry, Porto Alegre, RS, Brazil
| | - Paola Carvajal
- University of Chile, Faculty of Dentistry, Laboratory of Periodontal Biology, Santiago, Chile
| | - Mariel Gómez
- Maimónides University, School of Dentistry, Career of Specialist in Periodontics, Buenos Aires, Argentine
| | - Ricardo Costa
- Federal University of Rio Grande do Sul - UFRGS, Department of Conservative Dentistry, Faculty of Dentistry, Porto Alegre, RS, Brazil
| | - Andres Toledo
- Maimónides University, School of Dentistry, Career of Specialist in Periodontics, Buenos Aires, Argentine
| | - Fernando Solanes
- University of Chile, Faculty of Dentistry, Laboratory of Periodontal Biology, Santiago, Chile
| | - Hugo Romanelli
- Maimónides University, School of Dentistry, Career of Specialist in Periodontics, Buenos Aires, Argentine
| | - Jorge Gamonal
- University of Chile, Faculty of Dentistry, Laboratory of Periodontal Biology, Santiago, Chile
| | - Rui Vicente Oppermann
- Federal University of Rio Grande do Sul - UFRGS, Department of Conservative Dentistry, Faculty of Dentistry, Porto Alegre, RS, Brazil
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Brady BR, Nair US, Gerald JK, Yuan NP, Krupski LA, Thomson CA. Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tob Prev Cessat 2019; 5:20. [PMID: 32411883 PMCID: PMC7205044 DOI: 10.18332/tpc/109537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION At tobacco quitlines, coaching and cessation medications are commonly structured around setting a date for making a quit attempt. However, limited literature evaluating this practice suggests that callers do not routinely set quit-date goals. High quality goal setting may increase the frequency of caller quit attempts. In this study, we examine the quality of quit-date goal setting and its association with in-program quit attempts and the timing of callers’ first quit attempt. METHODS Using call recordings, we scored the quality of quit-date goal setting among 90 callers enrolled at Arizona Smokers’ Helpline between August and December 2017. The primary exposure was quality of quit-date goal setting assessed using the Lorencatto et al. rating scale. Coding reliability was assessed using Cohen’s kappa. Multivariable logistic regression was used to examine the association between quality of goal setting and in-program quit attempts (>24 h tobacco free). RESULTS The mean quality goal setting score was 3.1 (range: -3 to 7). Sixty-nine callers (77%) set a quit date and 39 (43%) made a quit attempt. Compared to callers who experienced low-quality goal setting, the adjusted odds of in-program quitting for high quality goal setting was AOR=3.98 (95% CI: 1.55–10.20) and for making a quit attempt within two weeks OR=6.23 (95% CI: 1.52–25.49). CONCLUSIONS Quit-date goal setting is an important element of quitline services and callers benefit from high quality quit-date goal setting. Quitlines should establish quality improvement measures to ensure that coaches are trained to provide high quality quit-date goal setting opportunities to all callers.
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Affiliation(s)
| | - Uma S Nair
- University of Arizona, Tucson, United States
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The Role of the Subjective Importance of Smoking (SIMS) in Cessation and Abstinence. J Smok Cessat 2019; 14:1-11. [PMID: 33791042 DOI: 10.1017/jsc.2018.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Each year about two thirds of U.S. smokers make a quit attempt. Yet, less than 5% remain abstinent three months post-quit date. One factor that may affect abstinence is negative feelings about the self-associated with being a smoker (disequilibrium), particularly if smoking is important to the sense of self and one is trying to quit. Aims We evaluated a multivariate structural equation model proposing that smoking's subjective importance to a smoker would influence carbon monoxide verified smoking abstinence at 24 weeks (post-quit date). Further, we assessed whether the relation would be moderated by the smoker's experience of disequilibrium. Methods Participants were 440 regular smokers taking part in a clinical trial assessing the effectiveness of different durations of nicotine replacement therapy use. Participants completed the subjective importance of smoking survey at baseline and were assessed for carbon monoxide verified seven-day point prevalence abstinence at 24 weeks. Results Using exploratory structural equation modelling, the subjective importance of smoking was associated with point prevalence abstinence at 24 weeks, but only for smokers with high disequilibrium. Conclusions The results of this study suggest that experiencing negative feelings about being a smoker could motivate smokers to remain abstinent, despite the importance of smoking to the smoker's sense of self.
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Cosanella T, Youkhaneh N, Bennett N, Morrell HER. Demographic Moderators of the Relationship Between Adverse Childhood Experiences and Cigarette Smoking. Subst Use Misuse 2019; 54:2229-2240. [PMID: 31339418 DOI: 10.1080/10826084.2019.1642358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.
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Affiliation(s)
- Taylor Cosanella
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Nicolette Youkhaneh
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Nicole Bennett
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Holly E R Morrell
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
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Zhu SH, Anderson CM, Wong S, Kohatsu ND. The Growing Proportion of Smokers in Medicaid and Implications for Public Policy. Am J Prev Med 2018; 55:S130-S137. [PMID: 30454667 DOI: 10.1016/j.amepre.2018.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION This study examined survey data from before and after California expanded its Medicaid program under the Affordable Care Act. It assessed changes in the insurance status of smokers, the proportion of smokers in Medicaid, and the health and well-being of those smokers relative to their counterparts in other insurance groups. METHODS The study compared two data sets from the California Health Interview Study, the 2011-2012 (N=42,935) and 2016 (N=21,055) surveys. Measures include health insurance status, smoking status, chronic health conditions, frequency of doctors' visits, and psychological distress. Data were analyzed in 2018. RESULTS From 2011-2012 to 2016, the estimated number of California smokers in Medicaid nearly doubled from 738,113 to 1,447,945, and the proportion of smokers covered by Medicaid increased from 19.3% to 41.5%. Compared with those with private insurance, smokers in Medicaid were more likely to have chronic disease, have made five or more doctors' visits in the past year, and be in severe psychological distress. In 2016, a total of 51.4% of all adult smokers with chronic disease conditions and 57.8% of those in severe psychological distress were covered by Medicaid. CONCLUSIONS With Medicaid covering a much higher proportion of smokers, especially of those smokers with chronic disease and in psychological distress, state Medicaid programs and plans must make tobacco cessation a top priority. They should encourage clinicians to ask, advise, and assist all smokers, track progress in reducing smoking prevalence, employ mass communication strategies to drive quit attempts, improve access to medications, and develop or expand programs to help smokers quit. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center, University of California, San Diego, La Jolla, California.
| | | | - Shiushing Wong
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Neal D Kohatsu
- Kohatsu Consulting, Carmichael, CaliforniaAt the time of study, Dr. Kohatsu was with the Department of Health Care Services, Sacramento, California
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Goding Sauer A, Fedewa SA, Kim J, Jemal A, Westmaas JL. Educational attainment & quitting smoking: A structural equation model approach. Prev Med 2018; 116:32-39. [PMID: 30170014 DOI: 10.1016/j.ypmed.2018.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/20/2018] [Accepted: 08/26/2018] [Indexed: 11/15/2022]
Abstract
In the United States, disparities in smoking prevalence and cessation by socioeconomic status are well documented, but there is limited research on reasons why and none conducted in a national sample assessing multiple potential mechanisms. We identified smoking and cessation-related behavioral and environmental variables associated with both educational attainment and quitting success. We used a structural equation model of cross-sectional data from respondents ≥25 years from the United States 2010-2011 Tobacco Use Supplement-Current Population Survey. Quitting success was defined as former (n = 2607) versus continuing smokers (n = 7636); categories of educational attainment were ≤high school degree, some college/college degree, and advanced degree. Results indicated that using nicotine replacement therapy (NRT) >1 month and having a home smoking restriction were associated with both educational attainment and quitting success. Those with lower educational attainment versus those with an advanced degree were less likely to report using NRT >1 month (≤high school: β = -0.50, p < 0.001; college: β = -0.24, p = 0.019). Use of NRT >1 month, in turn, was positively associated with quitting success (β = 0.25, p < 0.001). Those with lower educational attainment were also less likely to report a home smoking restriction (≤high school: β = -0.42, p < 0.001; college: β = -0.21, p = 0.009). Having a home smoking restriction was positively associated with quitting success (β = 0.50, p < 0.001). Results were similar with income substituted for education. Using NRT >1 month and having a home smoking restriction are two strategies that may explain the association between low education and lower cessation success; these strategies should be further tested for their potential ability to mitigate this association.
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Affiliation(s)
- Ann Goding Sauer
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America.
| | - Stacey A Fedewa
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
| | - Jihye Kim
- Bagwell College of Education, Kennesaw State University, 580 Parliament Garden Way, Kennesaw, GA 30144, United States of America
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
| | - J Lee Westmaas
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
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Borsari L, Storani S, Malagoli C, Filippini T, Tamelli M, Malavolti M, Nicolini F, Vinceti M. Impact of Referral Sources and Waiting Times on the Failure to Quit Smoking: One-Year Follow-Up of an Italian Cohort Admitted to a Smoking Cessation Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1234. [PMID: 29891823 PMCID: PMC6025586 DOI: 10.3390/ijerph15061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/01/2018] [Accepted: 06/09/2018] [Indexed: 11/21/2022]
Abstract
In Italy, the National Health Service offers specialized evidence-based support to smokers who would like to quit through smoking cessation (SC) services. We conducted a two-year prospective study, involving all 288 subjects treated for smoking cessation at the SC service of Reggio Emilia, to assess the association of referral sources and waiting times with the risk of treatment failure, by following participants up to one year after the quit date. We performed Cox-regression analysis, including demographic and smoking-related characteristics as confounding variables. The treatment failure rate at 12 months was 59.4% (171/288), including only 12 subjects lost to follow-up. The main mode of entry was self-referral (42.4%), followed by 32.6% from general practice, 17.4% from hospital and 7.6% from other sources. Only 27.8% participants were involved in the SC-program within 60 days of the first contact, as the guidelines suggest. The risk of treatment failure at 12 months showed little association with the type of referral source, while it correlated with waiting times ≥ 60 days (hazard ratio = 1.59; 95% confidence interval 1.10⁻2.29). This study provides evidence of long-term high quit rates from a SC service, with few subjects lost to follow-up and biochemical verification of almost all abstinent subjects. Timeliness in care provision could further improve the outcome.
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Affiliation(s)
- Lucia Borsari
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy.
| | - Simone Storani
- Local Health Authority of Reggio Emilia-IRCCS, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Marco Tamelli
- Promotion Health Researcher, League against Cancer, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Marcella Malavolti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Fausto Nicolini
- Local Health Authority of Reggio Emilia-IRCCS, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Eisenbaum E, DiNitto DM, Bishop-Fitzpatrick L. Gender differences in tobacco use among U.S. Special Olympics athletes. Disabil Health J 2018; 11:466-470. [PMID: 29428208 DOI: 10.1016/j.dhjo.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/11/2018] [Accepted: 01/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The rise in women's tobacco use and subsequent health complications has generated an increase in gender-related tobacco use research. However, no research has examined gender's influence on tobacco use among people with intellectual and developmental disabilities (IDD). OBJECTIVE To examine 1) tobacco use prevalence rates among men and women with IDD, and 2) correlates of tobacco use among men and women with IDD. METHODS This study examined gender differences in tobacco use among a sample of 3587 adult U.S. Special Olympics athletes who participated in health screenings from 2007 to 2014. The athletes were aged 18-89 (M = 32.86); 55.8% were male. Prevalence rates were calculated for men and women, and logistic regression analyses were conducted to examine tobacco use's association with age, blood pressure, body mass index, family member tobacco use, and daily fruit and vegetable consumption for each gender. RESULTS Women's tobacco use prevalence was 4.1%, and men's was 9.4%. The only variable significantly associated with women's tobacco use was family member use, while men's tobacco use was associated with age, systolic blood pressure, family member tobacco use, and fruit and vegetable consumption. CONCLUSION Results shed light on possible courses of action for reducing tobacco use among women and men with IDD. Further research is needed to develop effective prevention and intervention approaches appropriate for people with IDD.
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Affiliation(s)
- Elaine Eisenbaum
- University of Kentucky, Human Development Institute, 120 Graham Avenue, Lexington, KY 40508, USA.
| | - Diana M DiNitto
- The University of Texas at Austin, School of Social Work, 1925 San Jacinto Blvd, Stop D3500, Austin, TX 78712-1405, USA.
| | - Lauren Bishop-Fitzpatrick
- University of Wisconsin-Madison, School of Social Work, 1350 University Ave., Madison, WI 53706, USA.
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The Relationship between Neighborhood Disorder, Social Networks, and Indoor Cigarette Smoking among Impoverished Inner-City Residents. J Urban Health 2017; 94:534-541. [PMID: 28560613 PMCID: PMC5533668 DOI: 10.1007/s11524-017-0170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impoverished urban neighborhoods tend to have higher rates of smoking and higher rates of exposure to secondhand smoke as compared to more affluent neighborhoods. Contextual factors of neighborhood disorder and social network and household composition may have an impact on indoor smoking behaviors. The TIDE study examined psychosocial factors associated with smoking behaviors among impoverished inner-city smokers in Baltimore, Maryland. Among a community-recruited sample of 413 smokers who lived with others, most (73%) reported that they or others smoked in their residence. Cohabitation with children, elderly, and those with asthma and other respiratory condition was not associated with indoor smoking. Neighborhood disorder, the proportion of social network members who smoked with the study participant, and the proportion of household members who smoked were all independently associated with smoking indoors. The study findings suggest the importance of addressing neighborhood and social network factors when developing programs for promoting indoor smoking bans as well as cessation and prevention programs.
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Zhu SH, Anderson CM, Zhuang YL, Gamst AC, Kohatsu ND. Smoking prevalence in Medicaid has been declining at a negligible rate. PLoS One 2017; 12:e0178279. [PMID: 28542637 PMCID: PMC5479677 DOI: 10.1371/journal.pone.0178279] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 05/10/2017] [Indexed: 12/03/2022] Open
Abstract
Background In recent decades the overall smoking prevalence in the US has fallen steadily. This study examines whether the same trend is seen in the Medicaid population. Methods and findings National Health Interview Survey (NHIS) data from 17 consecutive annual surveys from 1997 to 2013 (combined N = 514,043) were used to compare smoking trends for 4 insurance groups: Medicaid, the Uninsured, Private Insurance, and Other Coverage. Rates of chronic disease and psychological distress were also compared. Results Adjusted smoking prevalence showed no detectable decline in the Medicaid population (from 33.8% in 1997 to 31.8% in 2013, trend test P = 0.13), while prevalence in the other insurance groups showed significant declines (38.6%-34.7% for the Uninsured, 21.3%-15.8% for Private Insurance, and 22.6%-16.8% for Other Coverage; all P’s<0.005). Among individuals who have ever smoked, Medicaid recipients were less likely to have quit (38.8%) than those in Private Insurance (62.3%) or Other Coverage (69.8%; both P’s<0.001). Smokers in Medicaid were more likely than those in Private Insurance and the Uninsured to have chronic disease (55.0% vs 37.3% and 32.4%, respectively; both P’s<0.01). Smokers in Medicaid were also more likely to experience severe psychological distress (16.2% for Medicaid vs 3.2% for Private Insurance and 7.6% for the Uninsured; both P’s<0.001). Conclusions The high and relatively unchanging smoking prevalence in the Medicaid population, low quit ratio, and high rates of chronic disease and severe psychological distress highlight the need to focus on this population. A targeted and sustained campaign to help Medicaid recipients quit smoking is urgently needed.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Christopher M. Anderson
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Anthony C. Gamst
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
- Department of Mathematics, University of California, San Diego, La Jolla, California, United States of America
| | - Neal D. Kohatsu
- Department of Health Care Services, Sacramento, California, United States of America
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Factors Associated with Cessation Activities amongst a Multiethnic Sample of Transit Workers. J Smok Cessat 2016. [DOI: 10.1017/jsc.2016.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Transit workers are a blue-collar occupational group with elevated rates of smoking despite access to free or low-cost cessation services available through their health insurance as a union-negotiated employee benefit. Little is known about the influences on cessation participation in this workforce.Aims: The purpose of this study is to analyse the factors associated with past-year cessation activities amongst a multiethnic sample of transit workers.Methods: Cross-sectional tobacco surveys were completed by 935 workers at an Oakland, California, USA-based public transit agency. Data from 190 current smokers (68% African American; 46% female) were analysed. Adjusted odds ratios were calculated to identify factors associated with past-year cessation activity.Results: Approximately 55% of smokers stopped smoking for one day or longer during the past year in order to quit. Nearly half reported that the most common barrier to quitting was, ‘Not mentally ready to quit because I like smoking’. Workers in the contemplation/precontemplation stage for intention to quit were less likely to have engaged in cessation activities than those in the action/preparation stage (AOR = 0.34). Frequency of coworker encouragement for quitting was positively associated with past-year cessation activities (AOR = 3.25). Frequency of insomnia symptoms was negatively associated with cessation activity participation (AOR = 0.34).Conclusions: Most transit workers who smoke made a past-year quit attempt. Gaining insight into factors associated with participation in cessation activities can aid worksite efforts to promote cessation and reduce tobacco-related disparities.
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Méndez D, Tam J, Giovino GA, Tsodikov A, Warner KE. Has Smoking Cessation Increased? An Examination of the US Adult Smoking Cessation Rate 1990–2014. Nicotine Tob Res 2016; 19:1418-1424. [DOI: 10.1093/ntr/ntw239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/12/2016] [Indexed: 01/07/2023]
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Wang X, Li X, Vaartjes I, Neal B, Bots ML, Hoes AW, Wu Y. Does education level affect the efficacy of a community based salt reduction program? - A post-hoc analysis of the China Rural Health Initiative Sodium Reduction Study (CRHI-SRS). BMC Public Health 2016; 16:759. [PMID: 27515930 PMCID: PMC4982434 DOI: 10.1186/s12889-016-3454-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary salt reduction program was affected by the level of education of participants. METHODS The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province. RESULTS Daily salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to salt (all p > 0.05). CONCLUSIONS The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations. TRIAL REGISTRATION The trial was registered with clinicaltrial.gov ( NCT01259700 ).
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Affiliation(s)
- Xin Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing, 100088 People’s Republic of China
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bruce Neal
- The George Institute for Global Health, Australia, Sydney, Australia
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing, 100088 People’s Republic of China
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Movsisyan NK, Sochor O, Kralikova E, Cifkova R, Ross H, Lopez-Jimenez F. Current and past smoking patterns in a Central European urban population: a cross-sectional study in a high-burden country. BMC Public Health 2016; 16:571. [PMID: 27417391 PMCID: PMC4946191 DOI: 10.1186/s12889-016-3216-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many studies have examined the socioeconomic variations in smoking and quitting rates across the European region; however, data from Central and East European countries, where the tobacco burden is especially high, are sparse. This study aimed to assess the patterns in current and past smoking prevalence based on cross-sectional data from a Central European urban population sample. METHODS Data from 2160 respondents aged 25-64 years in Brno, Czech Republic were collected in 2013-2014 using the Czech post-MONICA survey questionnaire to assess the prevalence of cardiovascular risk factors, including smoking status. The age- and sex-stratified randomized sample was drawn using health insurance registries. Descriptive statistics and quit ratios were calculated, and chi-square and multivariate logistic analyses conducted to examine relationships between current and past smoking and demographic (age, gender, marital status) and socioeconomic variables (education, income, occupation). RESULTS The prevalence of current and past smoking was 23.6 and 31.3 % among men and 20.5 and 23.2 % among women, respectively. Education reliably predicted smoking and quitting rates in both genders. Among men, being unemployed was associated with greater odds of smoking (OR 3.6; 1.6-8.1) and lower likelihood of quitting (OR 0.2: 0.1-0.6); the likelihood of quitting also increased with age (OR 1.8; 1.2-2.8). Among women, marital status (being married) decreased the odds of current smoking (OR 0.6; 0.4-0.9) and increased the odds of quitting (OR 2.2; 1.2-3.9). Quit ratios were the lowest in the youngest age group (25-34 years) where quitting was more strongly associated with middle income (OR 2.7; 95 % CI 1.2-5.9) than with higher education (OR 2.9; 95 % CI 0.9-8.2). CONCLUSIONS Interventions to increase cessation rates and reduce smoking prevalence need to be gender-specific and carefully tailored to the needs of the disadvantaged groups of the population, especially the less well-off young adults. Future studies should examine the equity impact of the tobacco control policies and be inclusive of the Central and East European countries.
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Affiliation(s)
- Narine K. Movsisyan
- />International Clinical Research Center, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
| | - Ondrej Sochor
- />International Clinical Research Center, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
- />International Clinical Research Center, Department of Cardiovascular Diseases, St. Anne’s University Hospital Brno, Masaryk University, Brno, Czech Republic
- />Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Eva Kralikova
- />International Clinical Research Center, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
- />Institute of Hygiene and Epidemiology, First Faculty of Medicine of Charles University and General University Hospital, Prague, Czech Republic
- />Centre for Tobacco Dependence of the 3rd Medical Department, First Faculty of Medicine of Charles University and General University Hospital, Prague, Czech Republic
| | - Renata Cifkova
- />International Clinical Research Center, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
- />Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Hana Ross
- />International Clinical Research Center, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
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Skalamera J, Hummer RA. Educational attainment and the clustering of health-related behavior among U.S. young adults. Prev Med 2016; 84:83-9. [PMID: 26740348 PMCID: PMC4758886 DOI: 10.1016/j.ypmed.2015.12.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We documented health-related behavior clustering among US young adults and assessed the extent to which educational attainment was associated with the identified clusters. METHODS Using data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we performed latent class analysis on 8 health-related behaviors (n=14,338), documenting clustering of behavior separately by gender. Subsequently, we used multinomial logistic regression and estimated associations between educational attainment and the health-related behavior clusters. RESULTS Twenty-eight percent of young women grouped into the most favorable health behavior cluster, while 22% grouped into a very high-risk cluster. A larger percentage of young men (40%) grouped into the highest risk cluster. Individuals with educational attainment at the college and advanced degree levels exhibited much lower risk of being in the unhealthy behavioral clusters than individuals with lower educational attainment, net of a range of confounders. CONCLUSION Substantial fractions of US young adults, particularly those with less than college degrees, exhibit unhealthy behavior profiles. Efforts to improve health among young adults should focus particular attention on the clustering of poor health-related behavior, especially among individuals who have less than a college degree.
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Affiliation(s)
- Julie Skalamera
- University of Texas at Austin, Population Research Center, 305 East 23rd Street, G1800, Austin, TX 78712-1699, USA.
| | - Robert A Hummer
- Carolina Population Center and Department of Sociology, University of North Carolina, Chapel Hill, 206 W. Franklin Street, Room 208, Chapel Hill, NC 27516, USA
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Gorini G, Carreras G, Cortini B, Verdi S, Petronio MG, Sestini P, Chellini E. Impact of National Smoke-Free Legislation on Educational Disparities in Smoke-Free Homes: Findings from the SIDRIAT Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015. [PMID: 26213956 PMCID: PMC4555243 DOI: 10.3390/ijerph120808705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Families with lower socioeconomic status are less likely to adopt household smoking bans (HSB). The aim of this study was to determine whether socioeconomic disparities in HSB prevalence in Italy decreased 7–9 years after the introduction of the Italian ban on smoking in public places. A longitudinal, 12-year, two-wave study was conducted on a sample of 3091 youths aged 6–14 years in 2002; 1763 (57%) were re-interviewed in 2012–2014. A Poisson regression with a robust error variance was used to assess the association between socioeconomic disparities and HSB prevalence. The adoption of HSBs significantly increased from 60% in 2002 to 75% in 2012–2014, with the increase recorded in youths with ≥1 smoking parent only (from 22% at baseline to 46% at follow-up). The presence of HSBs at baseline was more likely in families with ≥1 graduate parent compared to those with no graduate parents (prevalence ratio (PR) = 1.34, 95% confidence interval (CI) = 1.15–1.57), either in families with ≥1 smoking parent (PR = 1.36, 95% CI = 1.17–1.58) or in families with non-smoking parents (PR = 1.61, 95% CI = 1.01–2.56). Conversely, at follow-up socioeconomic disparities dropped since families with no graduate parents were 1.5-fold more likely to introduce a HSB between the two waves. The Italian ban on smoking in public places may have increased the adoption of smoke-free homes in families with smoking and non-graduate parents, causing the drop of the socioeconomic gap in smoke-free homes.
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Affiliation(s)
- Giuseppe Gorini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence 50141, Italy.
| | - Giulia Carreras
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence 50141, Italy.
| | - Barbara Cortini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence 50141, Italy.
| | - Simona Verdi
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence 50141, Italy.
| | | | - Piersante Sestini
- Section of Phthisiology and Diseases of Respiratory Tract, Siena University, Siena 53100, Italy.
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence 50141, Italy.
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