Incarceration and Current Tobacco Smoking Among Black and Caribbean Black Americans in the National Survey of American Life

Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.

A prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology - JUSTICE study): a protocol paper

BACKGROUND

People who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population. Despite this, little is known regarding what pathways mediate the association between incarceration exposure and increased rates of CVD morbidity and especially what incarceration specific factors are associated with this risk. The objective of this study is to better understand CVD risk in people exposed to incarceration and the pathways by which accumulate cardiovascular risk over time.

METHODS AND ANALYSIS

The Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study is a prospective cohort study of individuals released from incarceration with known cardiovascular risk factors. We are recruiting 500 individuals within three months after release from jail/prison. At baseline we are assessing traditional risk factors for CVD, including diet, exercise, and smoking, and exposure to incarceration-related policies, psychosocial stress, and self-efficacy. Cardiovascular risk factors are measured at baseline through point of care testing. We are following these individuals for the 12 months following the index release from incarceration with re-evaluation of psychosocial factors and clinical risk factors every 6 months. Using these data, we will estimate the direct and indirect latent effects of incarceration on cardiovascular risk factors and the paths via which these effects are mediated. We will also model the anticipated 10-year burden of CVD incidence, health care use, and mortality associated with incarceration.

DISCUSSION

Our study will identify factors associated with CVD risk factor control among people released from incarceration. Our measurement of incarceration-related exposures, psychosocial factors, and clinical measures of cardiovascular risk will allow for identification of unique targets for intervention to modify CVD risk in this vulnerable population.

Incarceration exposure and electronic cigarette use during pregnancy: Findings from the pregnancy risk assessment monitoring system, 2016-2018

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth - either personally or vicariously through her husband or partner - and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners.

Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life

BACKGROUND

The misuse of prescription medications is an understudied topic among the non-Hispanic Black population in the U.S. Even less is known about the prevalence and correlates of misuse among African Americans and Afro-Caribbeans, despite documented differences in their substance use behaviors.

OBJECTIVES

We aimed to examine the prevalence and correlates of lifetime prescription drug misuse among African Americans and Afro Caribbeans using data from the National Survey of American Life.

METHODS

A national household probability sample of non-institutionalized African Americans and Afro Caribbeans from the Collaborative Psychiatric Epidemiology Surveys was used. Pooled and ethnicity-stratified logistic regressions were estimated.

RESULTS

Findings showed no significant differences between African Americans (6.36%) and Afro-Caribbeans (5.71%) in lifetime prescription drug misuse. Several correlates were found to be associated with misuse among only African American or Afro-Caribbean respondents.

CONCLUSIONS

While research has shown prescription drug misuse is an issue among Blacks overall, our results show that the role of ethnicity must not be overlooked, especially when tailoring prevention and intervention programs. Limitations of this study are discussed.

The SHARED Project: A Novel Approach to Engaging African American Men to Address Lung Cancer Disparities

Black men are disproportionately impacted by lung cancer morbidity and mortality. Low-dose helical computed tomography (LDCT) lung cancer screening has demonstrated benefits for reducing lung cancer deaths by identifying cancers at earlier, more treatable stages. Despite the known benefits, LDCT screening is underutilized in black men. Studies in racially heterogeneous populations have found correlations between screening behaviors and factors such as physician trust, physician referral, and a desire to reduce the uncertainty of not knowing if they had lung cancer; yet little is known about the factors that specifically contribute to screening behaviors in black men. Community engagement strategies are beneficial for understanding barriers to health-care engagement. One community engagement approach is the citizen scientist model. Citizen scientists are lay people who are trained in research methods; they have proven valuable in increasing communities' knowledge of the importance of healthy behaviors such as screening, awareness of research, building trust in research, and improving study design and ethics. This paper proposes an intervention, grounded in community-based participatory research approaches and social network theory, to engage black men as citizen scientists in an effort to increase lung cancer screening in black men. This mixed-methods intervention will examine the attitudes, behaviors, and beliefs of black men related to uptake of evidence-based lung cancer screening.

Substance abuse in adolescents before admission to Peruvian juvenile detention centers: results from a national census in Peru, 2016

Objectives To estimate the prevalence of drug use before admission to juvenile detention centers (JDC) in Peru and determine individual, family and social influences on behavior. Methods A cross-sectional analysis was performed using data from the 2016 National Population Census in Juvenile Detention Centers (NPCJDC). A total of 1960 Peruvian adolescent offenders were included. Generalized linear models of the Poisson family with a log link function were used to determine if characteristics before admission to a JDC were associated with drug use. These characteristics included employment, depression, neighborhood gang activity, having friends with a criminal record, a history of multiple admissions to a JDC, a history of running away from home, physical abuse during childhood and family history of drug use and incarceration. Results More than half of young offenders reported using drugs before entering a JDC (59%) in Peru. The drug most frequently consumed was cannabis (86.6%), followed by cocaine and/or crack (11.6%), and inhalants and/or pills (1.8%). Smoking cigarettes [prevalence ratios (PR): 1.12, p = 0.003], using alcohol (PR: 1.22, p = 0.003), neighborhood gang activity (PR: 1.28, p < 0.001), having friends with a criminal record (PR: 1.62, p < 0.001), running away from home (PR: 1.20, p < 0.001) and a family history of incarceration (PR: 1.09, p = 0.010) were associated with drug use prior to admission to a JDC. Conclusion Drug use before admission to a JDC was high among young offenders in Peru, with marijuana being the drug most frequently used. Having friends with a criminal record and neighborhood gang activity had the greatest association with drug use in young offenders.

Smoking patterns and preferences for technology assisted smoking cessation interventions among adults with opioid and alcohol use disorders

Background

Smoking remains a major public health burden among persons with opioid and/or alcohol use disorder.

Methods

A 49-item semi-structured survey was conducted among urban, inpatient detoxification program patients eliciting demographic and clinical characteristics, smoking profile, technology use patterns, and preferences for adopting technology-based smoking cessation interventions. Multivariate logistic regression models further evaluated the association between participant demographic and clinical characteristics and technology preferences.

Results

Participants were mostly male (91%), and admitted for detoxification for alcohol (47%), heroin (31%), or both alcohol and heroin (22%). Past 30-day smoking was reported by 78% of the sample. Mobile phone ownership was common (89%); with an average past-year turnover of 3 mobile phones and 3 phone numbers. Computer ownership was low (28%) and one third reported daily internet use (34%). Telephone (41%) and text message-based interventions (40%) were the most popular platforms to facilitate smoking cessation.

Conclusions

Despite concurrent AUD-OUD, most respondents had attempted to quit smoking in the last year and preferred telephone- and text message-based interventions to facilitate smoking cessation. High turnover of mobile phones, phone numbers, and limited access to computers pose barriers to dissemination of technology-based smoking cessation interventions in this vulnerable population.

African-American Women's Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

BACKGROUND

Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African-Americans. Substance use may be shaped by social contextual influences from families and peers in African-American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African-American women.

OBJECTIVES

This study explores the effects of African-American women's social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use.

METHODS

Survey data was collected in-person from 521 African-American women. Multivariate logistic models identified the significant correlates of women's daily use of tobacco and marijuana in the past six months.

RESULTS

52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one's health was protective against daily marijuana use.

CONCLUSIONS

Findings stress the need for prevention and intervention efforts for African-American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.

Perceived Discrimination and Substance Use among Caribbean Black Youth; Gender Differences

Although perceived discrimination in Black youth is a risk factor for a wide range of negative mental health outcomes, recent research has suggested some gender differences in these associations. Gender differences in vulnerability to perceived discrimination among Caribbean Black youth is, however, still unknown. The current cross-sectional study investigated gender variations in the association between perceived discrimination and substance use (SU) in a national sample of Caribbean Black youth. Data came from the National Survey of American Life-Adolescents (NSAL-A), 2003⁻2004. This analysis included 360 Caribbean Black youth (165 males and 195 females) who were between 13 and 17 years old. Sociodemographic factors, perceived discrimination, and SU were measured. Logistic regressions were used for data analysis. Among Caribbean Black youth, a positive association was found between perceived discrimination and SU (odds ratio (OR) = 1.15 (95% confidence interval (CI) = 1.02⁻1.29)). A significant interaction was found between gender and perceived discrimination on smoking (OR = 1.23 (95% CI = 1.07⁻1.41)) suggesting that the association between perceived discrimination and smoking is larger for male than female Caribbean Black youth. The interaction between gender and perceived discrimination on SU was not statistically significant (OR = 1.32 (95% CI = 0.94⁻1.86)). While perceived discrimination increases SU in Caribbean Black youth, this effect is stronger for males than females, especially for smoking. While discrimination should be reduced at all levels and for all populations, clinicians may specifically address discrimination for SU prevention and treatment among male Caribbean Black youth.

Canadian federal penitentiaries as obesogenic environments: a retrospective cohort study

BACKGROUND

Very little is known about how incarceration influences a person's weight in Canada. We sought to determine how inmates' weights change during their incarceration in Canadian federal penitentiaries.

METHODS

We performed a retrospective, longitudinal cohort study to examine weight change in Canadian federal penitentiaries. To participate, inmates had to have been incarcerated for at least 6 months at the time of the study. Current anthropometric data were measured or taken from medical records, then compared with anthropometric data from the beginning of incarceration (mean follow-up of 5.0 ± 8.3 yr). We examined 3 outcomes: change in weight (kg), change in body mass index (BMI) and rate of weight change (kg/yr) during incarceration.

RESULTS

A total of 1420 inmates participated in this study. Almost three-quarters (73.0%, n = 1037)) of participants gained weight during incarceration. Inmates gained a median of 6.2 (95% confidence interval [CI] 5.6-6.9) kg, and BMI increased by 2.0 (95% CI 1.8-2.2). Obesity rates increased by 71%, from 26.6% of participants (n = 378) on admission to 45.4% of participants at follow-up (n = 645). The proportion of inmates with a BMI in the normal range (18.5-24.9) decreased by 52%. Weight gain was found to be associated with older age, region (Ontario v. Atlantic), ethnicity (Aboriginal inmates showed the highest weight gain), longer incarceration, and longer total sentence. However, weight gain was not associated with sex, feeding system or spoken language.

INTERPRETATION

The Canadian correctional environment can be considered obesogenic, with most inmates experiencing undesirable and rapid weight gain during their incarceration. Rates of obesity increased dramatically during incarceration, and could put inmates at increased risk of obesity-related health problems.

How Incarceration Influences Native-Born Black Men's Risk of Obesity

Objective

To build upon research that investigates the health significance of familial and former incarceration with special emphasis on obesity risk among native-born Black (ie, African American) men.

Methods

We analyzed data from the 2001-2003 National Survey of American Life (NSAL), focusing on native-born Black men (n=1140), the demographic group that bears the brunt of mass incarceration. The outcome of interest was obesity as measured by body mass index (BMI)>30. Principal predictors were familial and former incarceration, and their statistical interaction.

Results

In survey-adjusted binomial logistic regression models, familial incarceration appeared an unimportant predictor; whereas, former incarceration associated with a lower risk of obesity. However, former incarceration modifies the association between familial incarceration and obesity, such that native-born Black men experiencing both familial and former incarceration were significantly more likely to be obese.

Conclusions

Public health researchers should treat former incarceration with greater care in studies including native-born Black men because time spent incarcerated has lingering physical health significance.

Burden and Determinants of Smoking among Prisoners with Respiratory Tract Infection: A Cross-Sectional Study of Nine Major Prison Setups in Northern Ethiopia

Background

Morbidity, mortality and a wide range of associated risk factors are disproportionately clustered among prisoners compared to the general population. Smoking is one of the risk factors for the increased burden of unfavorable health outcomes particularly among prisoners. However, little is known about the level and determinants of smoking among the incarcerated population in Ethiopia.

Methods

We collected data from 738 prisoners in nine major prison setups in Tigray region by nurses and clinical officers. Data were entered in to Epi Data 3.1 and exported to stata 13.0 for cleaning and further analysis. Multivariable logistic regression model was fitted to identify determinants of smoking at p value of less than 5%.

Result

The prevalence of smoking was 21 per cent (95%CI = 18.2%, 24.1). Urban residence (AOR = 2.15; 95%CI = 1.20, 3.84), previous history of incarceration (AOR = 1.91; 95%CI = 1.08, 3.40) and alcohol use before incarcerated (AOR = 4.20; 95%CI = 2.57, 6.87) were significantly associated with risk of smoking. In contrast, risk of smoking was significantly lower for farmers (AOR = 0.20; 95% CI = 0.08, 0.49), prisoners with family support (AOR = 0.52; 95% CI = 0.32, 0.87) and for those who were jailed in Shire prison site (AOR = 0.43; 95%CI = 0.20, 0.95).

Conclusion

Our work clearly indicates that the observed smoking prevalence calls for the need of comprehensive and interdisciplinary interventions targeting prisoners.

Smoking and the Reduced Life Expectancy of Individuals With Serious Mental Illness

INTRODUCTION

People with serious mental illness experience substantially reduced life expectancy, likely due in part to their higher smoking rates relative to the general population. However, the extent to which smoking affects their life expectancy, independent of mental illness, is unknown. This study quantifies the potential contribution of smoking to reduced life expectancy among individuals with serious psychological distress (SPD), a measure that screens for serious mental illness in national surveys.

METHODS

A cohort of 328,110 U.S. adults was examined using the 1997-2009 National Health Interview Surveys linked to the 2011 National Death Index. Cox models were used to estimate mortality hazard ratios for current smoking, former smoking, and SPD and construct life tables by smoking and SPD status. The smoking-attributable fraction of deaths by SPD status was calculated. Analyses were conducted in 2015.

RESULTS

Among those with SPD, being a current smoker doubles the risk of death. Current smokers with SPD lose 14.9 years of life relative to never smokers without SPD. Among never smokers, having SPD reduces life expectancy by 5.3 years. Thus, smoking may account for up to two thirds of the difference in life expectancy between smokers with SPD and never smokers without SPD. One third of deaths among those with SPD can be attributed to smoking.

CONCLUSIONS

The life expectancy difference between current smokers with SPD and never smokers without SPD is primarily due to smoking. Aiding individuals with serious mental illness to avoid smoking will translate into sizeable gains in life expectancy.

Disparities at the intersection of marginalized groups

PURPOSE

Mental health disparities exist across several dimensions of social inequality, including race/ethnicity, socioeconomic status and gender. Most investigations of health disparities focus on one dimension. Recent calls by researchers argue for studying persons who are marginalized in multiple ways, often from the perspective of intersectionality, a theoretical framework applied to qualitative studies in law, sociology, and psychology. Quantitative adaptations are emerging but there is little guidance as to what measures or methods are helpful.

METHODS

Here, we consider the concept of a joint disparity and its composition, show that this approach can illuminate how outcomes are patterned for social groups that are marginalized across multiple axes of social inequality, and compare the insights gained with that of other measures of additive interaction. We apply these methods to a cohort of young men from the National Longitudinal Survey of Youth, examining disparities for black men with low early life SES vs. white men with high early life SES across several outcomes that predict mental health, including unemployment, wages, and incarceration.

RESULTS AND CONCLUSIONS

We report striking disparities in each outcome, but show that the contribution of race, SES, and their intersection varies.