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Kratzer TB, Star J, Minihan AK, Bandi P, Scout NFN, Gary M, Riddle-Jones L, Giaquinto AN, Islami F, Jemal A, Siegel RL. Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming. Cancer 2024; 130:2948-2967. [PMID: 38818898 DOI: 10.1002/cncr.35355] [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: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. METHODS In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. RESULTS Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. CONCLUSIONS People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jessica Star
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Adair K Minihan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island, USA
| | - Monique Gary
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Lowe AT, Maki A, Figueroa C, Venugopal PD. Place-based estimates of cigarette butt litter raise environmental justice concerns in the United States. PLoS One 2024; 19:e0308930. [PMID: 39146265 PMCID: PMC11326580 DOI: 10.1371/journal.pone.0308930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
Littering of cigarette butts is a major environmental challenge. In 2022, ~124 billion cigarette butts were littered in the United States. This litter may pose an environmental justice concern by disproportionately affecting human and environmental health in communities of color or communities of low socioeconomic status. However, the lack of data on the distribution and magnitude of cigarette butt littering prevents an environmental justice analysis and limits the ability to tackle this environmental challenge. We conducted an environmental justice assessment of tobacco product waste, specifically cigarette butts, through spatially-explicit, place-based estimates across the contiguous U.S. We built a bottom-up model by synthesizing census tract-level population and smoking prevalence, state-level cigarette consumption, and published littering data to assess the spatial pattern of cigarette consumption and littering, and its implications for environmental injustice in >71,600 U.S. census tracts. Further, we compared the model output to urbanicity (rural-urban commuting area) and Social-Environmental Risk (SER; CDC Environmental Justice Index). Cigarette butt density was not uniformly distributed across the U.S. and ranged from 0-45.5 butts/m2, with an area-weighted average of 0.019 ± 0.0005 butts/m2. Cigarette butt density was 96 times higher in metropolitan vs. rural areas. Cigarette butt density increased significantly with SER, with 5.6 times more littered cigarette butts, and a steeper response to population density, in census tracts with the highest SER vs. the lowest SER. These results demonstrate the relative influences of location, smoking prevalence, and population density, and show that cigarette butt littering is a potential environmental justice concern in the U.S. This study provides information that may help devise targeted strategies to reduce cigarette butt pollution and prevent disproportionate impacts. The spatial data layer with place-based cigarette consumption and butt density is a tool that can support municipal, state, and federal level policy work and future studies on associations among cigarette butt pollution and environmental health outcomes.
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Affiliation(s)
- Alexander T Lowe
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Alexander Maki
- Division of Population Health Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Carla Figueroa
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - P Dilip Venugopal
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
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Simard BJ, Padon AA, Silver LD, Avalos LA, Soroosh AJ, Young-Wolff KC. Racial, ethnic, and neighborhood socioeconomic disparities in local cannabis retail policy in California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 131:104542. [PMID: 39096805 DOI: 10.1016/j.drugpo.2024.104542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities. METHODS Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015-2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction. RESULTS Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %). CONCLUSIONS Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed.
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Affiliation(s)
| | | | | | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | | | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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Ahuja N, Mahmood A, Kedia S, Dillon PJ. Predictors of U.S. Adults' Opinion Toward an R-Rating Policy for Movies With Cigarette Smoking. HEALTH EDUCATION & BEHAVIOR 2024; 51:573-582. [PMID: 38519853 DOI: 10.1177/10901981241239933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged ≥ 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = .008) and ≥65 years (aOR = 4.54, p <.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = .04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.
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Affiliation(s)
- Nikhil Ahuja
- Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA
| | - Asos Mahmood
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satish Kedia
- The University of Memphis School of Public Health, Memphis, TN, USA
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Chong GTF, Gansky SA. Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study. Community Dent Oral Epidemiol 2024. [PMID: 39031991 DOI: 10.1111/cdoe.12995] [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: 06/06/2023] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old. METHODS Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts. RESULTS Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation. CONCLUSIONS Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.
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Affiliation(s)
- Gabriel Tse Feng Chong
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco (UCSF), San Francisco, California, USA
- HQ Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco (UCSF), San Francisco, California, USA
- Center to Address Disparities in Children's Oral Health, UCSF, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, California, USA
- Research Coordinating Center to Reduce Disparities in Multiple Chronic Diseases, UCSF, San Francisco, California, USA
- Multiethnic Health Equity Research Center, UCSF, San Francisco, California, USA
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Berg CJ, Romm KF, LoParco CR, Rossheim ME, Cui Y, Platt E, Yang YT, Wang Y, Kasson E, Szlyk HS, McCready DM, Cavazos-Rehg PA. Young Adults' Experiences with Cannabis Retailer Marketing and Related Practices: Differences Among Sociodemographic Groups and Associations with Cannabis Use-related Outcomes. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02092-z. [PMID: 39009926 DOI: 10.1007/s40615-024-02092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Limited cannabis retail surveillance has been conducted, particularly assessing retailer practices in relation to consumer sociodemographic factors or use-related outcomes. This study examined young adults': exposure to promotions, health claims, warnings, and age restrictions at cannabis retailers; demographic correlates of retail exposures; and retail exposures in relation to use-related outcomes. STUDY DESIGN This study used the cross-sectional quantitative analysis. METHODS We analyzed 2023 survey data among 876 young adults in states with legal non-medical cannabis, reporting past-month cannabis use and past-year retailer visits. RESULTS In this sample (Mage = 27.1, 44.1% male, 31.7% sexual minority, 17.7% Black, 11.2% Asian, 25.1% Hispanic), 46.7% "at least sometimes" noticed free samples, 76.5% price promotions, 37.4% subpopulation-targeted promotions; 72.5% health claims on products/ads, 63.1% signage, and 70.5% from budtenders; 72.5% warnings on labels, 65.5% signage, and 38.9% from budtenders; and > 80% age verifications. Multivariable analyses identified sociodemographic correlates of exposure outcomes: greater promotion exposure was associated with Black race; greater health claim exposure with being heterosexual, Black, and less educated; less warning exposure with less education; and less age restriction exposure with being younger, male, and Black. Retail exposures were associated with use-related outcomes: more frequent cannabis use was associated with less health claim exposure; greater perceived social acceptability with greater promotion and age restriction exposure; greater perceived risk with greater warning and less age restriction exposure; more problematic use and driving after use with greater promotion and less age restriction exposure. CONCLUSIONS Cannabis retail exposure disparities and their associations with use-related outcomes highlight the importance of regulatory and prevention efforts.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA.
- George Washington Cancer Center, George Washington University, Washington, DC, USA.
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Matthew E Rossheim
- Department of Health Administration and Health Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Elizabeth Platt
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Y Tony Yang
- George Washington Cancer Center, George Washington University, Washington, DC, USA
- School of Nursing, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcey M McCready
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
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Do EK, Tulsiani S, Koris K, Hair EC. Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020-2022). Subst Use Misuse 2024:1-8. [PMID: 38963130 DOI: 10.1080/10826084.2024.2374974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. METHODS Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. RESULTS Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. CONCLUSION More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.
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Affiliation(s)
- Elizabeth K Do
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Elizabeth C Hair
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Global Public Health, New York University, New York, New York, USA
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Donaldson CD, Stupplebeen DA, Couch ET, Rojas AI, Farooq O, Zhang X, Gansky SA, Chaffee BW. Perceived discrimination and youth vaping: The role of intersectional identities. Drug Alcohol Depend 2024; 260:111313. [PMID: 38718463 PMCID: PMC11238823 DOI: 10.1016/j.drugalcdep.2024.111313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Electronic cigarettes (also termed e-cigarette or vapes) often contain nicotine, an addictive psychoactive substance, which can have harmful effects during adolescence. Frequent experiences of discrimination are one risk factor shown to increase susceptibility to tobacco use, especially for individuals that identify as a social minority. Applying Intersectionality Theory, this research examined the relationship between youth experiences of discrimination and vape use at the intersection of race/ethnicity and sexual orientation. METHOD Cross-sectional survey data from 4747 youth (ages 12-17) that participated in the 2022 Teens, Nicotine, and Tobacco Project (TNT) online survey were used to evaluate the impact of discrimination on vape use for lesbian, gay, bisexual, and/or queer/questioning (LGBQ+) youth of color. RESULTS Multivariable regression analyses showed that identifying as both a sexual and racial/ethnic minority was a risk factor for experiencing discrimination. Frequent discrimination and reporting discrimination due to sexual orientation was associated with a greater likelihood of ever and current vaping. Path models supported that discrimination mediated the relationship between intersectional identity and vape use. LGBQ+ youth of color reported more frequent discrimination, which was associated with a greater likelihood of ever/current vape use. CONCLUSIONS Intersectionality Theory aids in understanding how discrimination can exacerbate tobacco-related disparities for youth with multiple minority identities. Findings corroborate the importance of measuring discrimination in public health surveys. Effective tobacco interventions could incorporate strategies to cope with discrimination-related stress.
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Affiliation(s)
- Candice D Donaldson
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA.
| | - David A Stupplebeen
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
| | - Adrianna I Rojas
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
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DuPont-Reyes MJ, Villatoro AP, Chowkwanyun M, Ortiz SE, Tang L. Communication Policy to Reduce Health Disparities: A Cross-Language Content Analysis of YouTube Television Advertising. Am J Prev Med 2024:S0749-3797(24)00173-9. [PMID: 38844149 DOI: 10.1016/j.amepre.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION This study aimed to identify disparate health-related marketing across English- and Spanish-language television networks in New York City, ultimately to inform policy that can counteract disproportionate health-related marketing that provides harmful content to and withholds beneficial information from Latinx populations. METHODS A 2-week composite sample of primetime English-language (National Broadcasting Company and Columbia Broadcasting System) and Spanish-language (Telemundo and Univision) television networks from YouTube television was randomly drawn from September 7, 2022 to September 27, 2022 in New York City. A total of 9,314 health-related television advertisements were identified for systematic media content analysis and coded into categories: alcohol, core or noncore foods/beverages, mental health/tobacco prevention, health insurance, medical centers, and pharmaceuticals. Analyses conducted in 2022-2024 included intercoder reliability and descriptive and rate difference estimates using total advertisement broadcasting time in the full sample and subsamples by language networks on YouTube television. RESULTS Spanish television networks broadcast greater health-adverse advertisements per hour for alcohol (rate difference=4.91; 95% CI=3.96, 5.85) and noncore foods/beverages (rate difference=13.43; 95% CI=11.52, 15.34) and fewer health-beneficial advertisements per hour for mental health/tobacco prevention (rate difference= -0.99; 95% CI= -1.45, -0.54), health insurance (rate difference= -1.00; 95% CI= -1.44, -0.57), medical centers (rate difference= -0.55; 95% CI= -1.23, 0.12), and pharmaceuticals (rate difference= -5.72; 95% CI= -7.32, -4.11) than New York City primetime English television networks. CONCLUSIONS Multilevel policy innovation and implementation are required to mitigate primetime television marketing strategies that contribute to health inequities.
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Affiliation(s)
- Melissa J DuPont-Reyes
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Alice P Villatoro
- Department of Public Health, College of Arts and Sciences, Santa Clara University, Santa Clara, California
| | - Merlin Chowkwanyun
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Selena E Ortiz
- Department of Health Policy and Administration, The PennState College of Health and Human Development, University Park, Pennsylvania
| | - Lu Tang
- Department of Communication and Journalism, College of Arts & Sciences, Texas A&M University, College Station, Texas
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Tan ASL, Roberts J, Liu J, P. Hanby E, Gundersen DA, Reynolds MJ, Winickoff JP, Gottlieb MA, Emmons KM. Key Informants' Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Nicotine Tob Res 2024; 26:S96-S102. [PMID: 38817028 PMCID: PMC11140222 DOI: 10.1093/ntr/ntad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/25/2023] [Accepted: 06/30/2023] [Indexed: 06/01/2024]
Abstract
INTRODUCTION The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment. AIMS AND METHODS This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups. RESULTS Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color. CONCLUSIONS Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions. IMPLICATIONS This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts.
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Affiliation(s)
- Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, USA
| | - Jane Roberts
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, USA
| | - Jessica Liu
- Harvard University, TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Elaine P. Hanby
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, USA
- Harvard University, TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | | | - Jonathan P Winickoff
- MassGeneral Hospital, Division of General Academic Pediatrics, Boston, MA, USA
- MGH Tobacco Research and Treatment Center, Boston, MA, USA
- American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, USA
| | - Mark A Gottlieb
- MGH Tobacco Research and Treatment Center, Boston, MA, USA
- Public Health Advocacy Institute, Northeastern University, Boston, MA, USA
| | - Karen M Emmons
- Harvard University, TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
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11
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Kong AY, Westneat SC, Anesetti-Rothermel A, van de Venne JG, Debnam C, Ribisl KM, Cohn AM, Rose SW. Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019. Nicotine Tob Res 2024; 26:S73-S81. [PMID: 38817025 PMCID: PMC11140226 DOI: 10.1093/ntr/ntad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.
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Affiliation(s)
- Amanda Y Kong
- Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan C Westneat
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Andrew Anesetti-Rothermel
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Judy G van de Venne
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | | | - Kurt M Ribisl
- Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
- Markey Cancer Center, Lexington, KY, USA
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12
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Dove MS, Gee KA, Tong EK. Flavored Tobacco Sales Restrictions and Youth E-cigarette Behavior: Impact by Tobacco Retailer Density in Diverse Communities in California. Nicotine Tob Res 2024; 26:S65-S72. [PMID: 38817027 PMCID: PMC11140225 DOI: 10.1093/ntr/ntad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area. AIMS AND METHODS We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile. RESULTS Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87). CONCLUSIONS Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups. IMPLICATIONS In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.
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Affiliation(s)
- Melanie S Dove
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis, USA
| | - Kevin A Gee
- School of Education, University of California, Davis, USA
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, USA
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13
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Schillo BA, D’Silva J, La Rose C, Kim Y, Emery S. Youth and Young Adult Awareness of and Perceptions About Tobacco Marketing as a Social Justice Issue. Nicotine Tob Res 2024; 26:S89-S95. [PMID: 38817026 PMCID: PMC11140218 DOI: 10.1093/ntr/ntad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Systemic racism and tobacco-industry targeting contribute to disparities in communities of color. However, understanding tobacco as a social justice issue and the industry's role in perpetuating inequities remains limited. This study explored youth and young adult awareness of tobacco marketing and perceptions of tobacco marketing as a social justice issue. AIMS AND METHODS Focus groups were conducted with youth and young adults in 2020 and 2021, including individuals who used tobacco and e-cigarettes and those who did not use either. Online surveys were conducted in 2021 with youth (n = 1227) and young adults (n = 2643) using AmeriSpeak's nationally representative panel, oversampling for black and Hispanic Americans and people who smoke. Perceptions of flavor bans, social justice, and industry marketing were assessed. RESULTS Most (>80%) survey respondents agreed that tobacco companies target youth. However, only 20% saw tobacco as a social justice issue. Focus group participants regardless of their tobacco or e-cigarette use, reported higher prevalence of tobacco advertising in their communities relative to survey respondents but did not view it as targeting communities of color. Black non-Hispanic (20.9%) and Hispanic (21.4%) survey respondents perceived tobacco as a social justice issue more than white non-Hispanic (16.1%) respondents. The majority (>60%) of survey respondents supported bans on menthol and flavored tobacco, regardless of race or ethnicity. CONCLUSIONS Respondents broadly supported menthol and flavored tobacco bans and recognized tobacco-industry influence on youth. Low awareness of tobacco as a social justice issue highlights the need to raise awareness of the underlying factors driving tobacco-related disparities. IMPLICATIONS The majority of young people see the tobacco industry as targeting them. Most young people support bans on menthol and flavored tobacco bans, with support across racial and ethnic groups. While few young respondents perceived tobacco as a social justice issue, some perceived tobacco companies as targeting low-income and communities of color. Black non-Hispanic and Hispanic respondents were more likely to perceive tobacco as a social justice issue than white non-Hispanic respondents. Efforts to raise awareness among young people of tobacco as a social justice issue may be key in addressing tobacco disparities and advancing support for flavor tobacco bans.
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Affiliation(s)
| | | | | | - Yoonsang Kim
- Social Data Collaboratory, NORC, University of Chicago, Chicago, IL, USA
| | - Sherry Emery
- Social Data Collaboratory, NORC, University of Chicago, Chicago, IL, USA
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14
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Hussaini SMQ, Fan Q, Barrow LCJ, Yabroff KR, Pollack CE, Nogueira LM. Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States. JCO Oncol Pract 2024; 20:678-687. [PMID: 38320228 DOI: 10.1200/op.23.00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. METHODS Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). RESULTS There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. CONCLUSION Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.
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Affiliation(s)
- S M Qasim Hussaini
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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15
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Patel M, Kierstead EC, Liu MS, Schillo B, Rose SW. Examining the relationship of flavored tobacco product policy restrictions and flavored tobacco product use, among adolescents and young adults in the U.S. Prev Med 2024; 182:107947. [PMID: 38574971 DOI: 10.1016/j.ypmed.2024.107947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/02/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This work examines the relationship between local flavor policy exposure and any tobacco product use and flavored tobacco product use among U.S. youth and young adults, as well as the equity potential of these policies by race/ethnicity. METHODS Participants were aged 15-36 (n = 10,893) surveyed from September-December 2019 using national, address- and probability-based sampling. Local flavor policies enacted before survey completion were linked to participant home address. Weighted cross-sectional multivariable logistic regression examined individual coverage by flavor policy vs. no flavor policy, with current any tobacco or flavored tobacco use, controlling for individual and county-level demographics, psychosocial variables, and other tobacco control policies. Interactions between race/ethnicity and any tobacco use and flavored tobacco use were assessed. RESULTS Those covered by a flavor policy vs. no policy had lower odds of any tobacco use (aOR = 0.74, 95% CI = 0.55-1.00) and current flavored tobacco use (aOR = 0.67, 95% CI = 0.48-0.93). Compared with Non-Hispanic (NH)-White individuals, NH-Black individuals (aOR = 1.08, CI = 1.04-1.12) had higher odds of any tobacco use, and non-Hispanic Asian individuals had lower odds of any tobacco use (aOR = 0.67, CI = 0.53-0.85). Hispanic individuals exposed to policy had lower odds of flavored tobacco use compared to NH-White peers. CONCLUSIONS Exposure to flavor restriction policies is associated with lower odds of any tobacco and flavored use among youth and young adults. Flavor restrictions may be beneficial in reducing tobacco use in youth from diverse racial/ethnic backgrounds. However, passing policies covering NH-Black individuals is needed to mitigate disparities in tobacco use by flavor policy coverage over time.
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Affiliation(s)
- Minal Patel
- American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA 30144, USA.
| | - Elexis C Kierstead
- Truth Initiative Schroeder Institute, 900 G St. NW, Washington, D.C., 20006, USA
| | - Michael Shiyang Liu
- Truth Initiative Schroeder Institute, 900 G St. NW, Washington, D.C., 20006, USA
| | - Barbara Schillo
- Truth Initiative Schroeder Institute, 900 G St. NW, Washington, D.C., 20006, USA
| | - Shyanika W Rose
- Department of Behavioral Science, College of Medicine and the Center for Health Equity Transformation, University of Kentucky, 760 Press Avenue, Lexington, KY 40536, USA; Markey Cancer Center, 800 Rose St., Lexington, KY, USA
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16
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Eggers ME, Nonnemaker JM, Kelly LK, Ortega-Peluso C, Anker E, Lee J, Fajobi O, Swires NB. It's Not Just: Evaluation of a Media Campaign to Motivate Action Around Targeting of Menthol Tobacco in Black Communities. Prev Chronic Dis 2024; 21:E24. [PMID: 38603518 PMCID: PMC11048315 DOI: 10.5888/pcd21.230237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Introduction For more than 60 years, tobacco companies have aggressively marketed menthol tobacco products in Black communities. In 2021, New York State Department of Health-funded grantees launched a media campaign aimed toward civically engaged New York adults to educate and mobilize community action to prevent targeted marketing of menthol tobacco. This study examined audience reactions to the campaign and associations between campaign awareness and key outcomes. Methods Following campaign implementation, we administered 2 online, cross-sectional surveys to 2,000 civically engaged New York adults to assess campaign awareness, audience reactions, and campaign-related attitudes and behaviors. We examined sociodemographic differences in audience reactions and assessed multivariate associations between campaign awareness and key outcomes. Results Overall, 40% of respondents were aware of the campaign. Perceived advertisement (ad) effectiveness was higher among Black, Hispanic, and nonsmoking respondents and those aware of the campaign. Negative reactions to ads were higher at wave 1, among non-Hispanic White and male respondents, and among current smokers. Campaign awareness was positively associated with campaign-related beliefs. The association between campaign awareness and support for a menthol ban varied by survey wave and race, with positive associations at wave 2 and among non-Hispanic White respondents only. Among wave 2 respondents only, campaign awareness was positively associated with actions to reduce the targeting of menthol in Black communities. Conclusion Media campaigns can play an important role in raising awareness of menthol tobacco product targeting in Black communities and building public support for local and statewide menthol restrictions that may be implemented before federal product standards are in place.
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Affiliation(s)
- Matthew E Eggers
- RTI International, 3040 E Cornwallis Dr, Research Triangle Park, NC 27709
| | | | - Lisa K Kelly
- New York State Department of Health, Albany, New York
| | | | | | - Jennifer Lee
- New York State Department of Health, Albany, New York
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Hoetger C, White A, Bono RS, Hall CJ, Hood KB, Everhart RS, Nana-Sinkam P, Barnes AJ, Cobb CO. Perceptions of African American Youth and Adults Regarding Tobacco Use-Related Factors in Their Community: A Mixed-Methods Approach in Richmond, Virginia. FAMILY & COMMUNITY HEALTH 2024; 47:176-190. [PMID: 38372334 PMCID: PMC10878718 DOI: 10.1097/fch.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The US Food and Drug Administration is poised to restrict the availability of menthol cigarettes and flavored cigars, products disproportionately used by Black/African American (B/AA) individuals. We examined B/AA youth and adult perceptions regarding factors contributing to tobacco use, as well as prevention/cessation resources. METHODS In 2 mixed-methods studies in Richmond, Virginia, we conducted cross-sectional surveys among youth (n = 201) and adult (n = 212) individuals who were primarily B/AA and reported past 30-day cigar smoking or nontobacco use, followed by focus groups with a subset (youth: n = 30; adults: n = 24). Focus groups were analyzed using a thematic analysis framework, and descriptive survey data provided context to themes. RESULTS Among focus group participants, 20% of youth and 75% of adults reported current cigar smoking. Six themes emerged across the groups: advertising/brands, sensory experiences, costs, social factors, youth-related factors, and dependence/cessation. Youth and adults perceived cigars as popular; cigar use was attributed to targeted advertising, flavors, affordability, and accessibility. While adults expressed concern regarding youth tobacco use, youth did not perceive tobacco prevention programs as helpful. Adults and youth reported limited access to community tobacco prevention/cessation programs. DISCUSSION Expanded tobacco prevention and cessation resources for B/AA people who smoke could leverage federal regulatory actions to ban tobacco products targeted toward this group and decrease disparities in tobacco-related morbidity and mortality.
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Affiliation(s)
- Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Universitat of Witten/Herdecke, Institute for Integrative Health Care and Health Promotion, Witten, Germany
| | - Augustus White
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Rose S. Bono
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin J. Hall
- Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | - Andrew J. Barnes
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Cheng YJ, Tsai J, Cornelius ME, Mahoney M, Neff LJ. Sociodemographic and Temporal Differences in Menthol Cigarette Use Among US Adults Who Smoke, 1999-2018. Prev Chronic Dis 2024; 21:E20. [PMID: 38547020 PMCID: PMC10996389 DOI: 10.5888/pcd21.230291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Introduction Monitoring menthol cigarette use allows for identification of potential health disparities. We examined sociodemographic and temporal differences in menthol cigarette use among US adults who smoke. Methods We analyzed data from the 1999-2018 National Health and Nutrition Examination Survey for adults aged 20 years or older who smoke (N = 11,431) using binary logistic regression. Results Among US adults who smoke, 28.8% used menthol cigarettes. After adjusting for age, sex, race and ethnicity, education, income-to-poverty ratio, and health status, the prevalence of menthol use among adults who smoke increased on average by 3.8% (95% CI, 2.7%-4.9%) annually. Non-Hispanic Black adults had the highest average prevalence of menthol cigarette use, 73.0% (95% CI, 70.9%-75.2%), and Mexican American adults had higher average annual increase in menthol cigarette use, 7.1% (95% CI, 4.0%-10.3%). Adults with fair or poor health status had a 4.3% annual increase in menthol cigarette use (95% CI, 2.5%-6.1%). The adjusted prevalence ratios of menthol cigarette use were 1.61 (95% CI, 1.39-1.83) for adults aged 20-29 years compared with those aged 65 years or older, 1.41 (95% CI, 1.32-1.49) for female adults compared with male adults, and 1.17 (95% CI, 1.07-1.27) for high school graduates or higher compared with those with no high school diploma. Conclusion Non-Hispanic Black adults who smoke had the highest prevalence of menthol cigarette use among all racial and ethnic groups; the prevalence of menthol cigarette use among adults who smoke increased especially among Mexican American adults, younger adults, and adults who reported fair to poor health status.
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Affiliation(s)
- Yiling J Cheng
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S107-7, Atlanta, GA 30341
| | - James Tsai
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica E Cornelius
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret Mahoney
- Katmai Government Services, Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, Georgia
| | - Linda J Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chaffee BW, Couch ET, Donaldson CD, Farooq O, Cheng NF, Ameli N, Zhang X, Gansky SA. Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations. Subst Use Misuse 2024; 59:1240-1248. [PMID: 38509707 PMCID: PMC11045304 DOI: 10.1080/10826084.2024.2330912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.
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Affiliation(s)
- Benjamin W. Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Elizabeth T. Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Candice D. Donaldson
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Nancy F. Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Stuart A. Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
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Zavala-Arciniega L, Hirschtick JL, Meza R, Fleischer NL. Dual and polytobacco use disparities at the intersection of age, sex, race and ethnicity, and income among US adults. Results from the 2018-2019 TUS-CPS. Prev Med Rep 2024; 39:102631. [PMID: 38352240 PMCID: PMC10862062 DOI: 10.1016/j.pmedr.2024.102631] [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: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Aim We aim to describe disparities in dual and polytobacco use at the intersection of age, sex, race and ethnicity, and income. Methods We used the 2018-2019 Tobacco Use Supplement to the Current Population Survey to estimate the prevalence of combinations of dual (two products) and polytobacco (three or more products) use for cigarettes, e-cigarettes, cigars, and smokeless tobacco (n = 135,268). We created five mutually exclusive categories: 1) cigarettes and e-cigarettes, 2) cigarettes and cigars, 3) cigarettes and smokeless tobacco, 4) dual/polyuse without cigarettes, and 5) polyuse with cigarettes. We estimated the dual/polyuse prevalence at the intersection of age (18-34, 35-54, 55+ years), sex (male, female), race and ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, and Non-Hispanic Other), and annual household income (<$50,000, $50,000-$99,999, ≥$100,000), resulting in 72 sociodemographic categories. We used a visualization tool that allowed for detailed characterization and identification of dual and polytobacco use disparities. Results Females were in three of the top four groups with the highest cigarette and e-cigarette dual use. Cigarette and cigar dual use was disproportionately high among low-income Non-Hispanic Black male adults aged 35-54 and 18-34. The highest prevalence of both polyuse with cigarettes and dual/polyuse without cigarettes was among low-income, Non-Hispanic White male adults aged 18-34 years. Conclusion We identified the population groups disproportionately using two or more tobacco products. This information is helpful for surveillance and for the implementation of tobacco control policies aimed at decreasing disparities in tobacco use.
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Affiliation(s)
- Luis Zavala-Arciniega
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jana L. Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Nancy L. Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
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21
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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. RESEARCH SQUARE 2024:rs.3.rs-3953025. [PMID: 38464035 PMCID: PMC10925470 DOI: 10.21203/rs.3.rs-3953025/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Philip Morris International's (PMI) IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale (POS) marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. Methods We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of POS that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a POS display ban and plain packaging became effective in Israel (January 2020). The survey included 69 POS (21 Arab, 48 Jewish neighborhoods) and the audits included 129 POS (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between POS in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. Results Most marketing strategies, such as promotions to customers, were uniform across POS in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p<0.05) and reported personal communication with a PMI representative (80.0% vs. 51.2%, p<0.05). Additionally, PMI representatives assisted POS in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. POS in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p<0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p<0.05). Conclusions There were not many notable differences in IQOS marketing across POS in Arab vs. Jewish neighborhoods, but PMI utilized marketing elements of cultural significance, especially for POS in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco POS marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Hagai Levine
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Carla J Berg
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Lorien C Abroms
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | | | - Yan Wang
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Cassidy R LoParco
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Daniel Elbaz
- Hebrew University of Jerusalem Faculty of Medicine
| | - Yuxian Cui
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Yael Bar-Zeev
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
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22
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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024; 44:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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23
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Williams RM, Whealan J, Taylor KL, Adams-Campbell L, Miller KE, Foley K, Luta G, Brandt H, Glassmeyer K, Sangraula A, Yee P, Camidge K, Blumenthal J, Modi S, Kratz H. Multilevel approaches to address disparities in lung cancer screening: a study protocol. Implement Sci Commun 2024; 5:15. [PMID: 38365820 PMCID: PMC10870584 DOI: 10.1186/s43058-024-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization. METHODS Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity). DISCUSSION The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates. TRIAL REGISTRATION ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.
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Affiliation(s)
- Randi M Williams
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
| | - Julia Whealan
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Lucile Adams-Campbell
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | - Kristie Foley
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Heather Brandt
- Epidemiology and Cancer Control Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Katharine Glassmeyer
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Anu Sangraula
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Peyton Yee
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kaylin Camidge
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Heather Kratz
- The Catholic University of America, Washington, DC, USA
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24
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Nogueira L, Florez N. The Impact of Climate Change on Global Oncology. Hematol Oncol Clin North Am 2024; 38:105-121. [PMID: 37580192 DOI: 10.1016/j.hoc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.
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Affiliation(s)
- Leticia Nogueira
- Surveillance and Health Equity Sciences, American Cancer Society, Palm Harbor, FL, USA.
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25
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Rossheim ME, LoParco CR, Walker A, Livingston MD, Trangenstein PJ, Olsson S, McDonald KK, Yockey RA, Luningham JM, Kong AY, Henry D, Walters ST, Thombs DL, Jernigan DH. Delta-8 THC Retail Availability, Price, and Minimum Purchase Age. Cannabis Cannabinoid Res 2024; 9:363-370. [PMID: 36342930 PMCID: PMC11071109 DOI: 10.1089/can.2022.0079] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Retail sales of Delta-8 tetrahydrocannabinol (THC) products have increased in the U.S. market since the passing of the 2018 Farm Bill, and there is currently little regulation of marketing/sales and limited related safety standards in many states. After thousands of calls to poison control centers (40% for individuals under 18 years old and 70% requiring health care facility evaluation), the Food and Drug Administration issued warnings on Delta-8 THC products, stating their psychoactive effects and that some manufacturers may synthesize Delta-8 using unsafe household chemicals. The current study describes the Delta-8 THC retail sales environment in Fort Worth, Texas. Given its relatively inexpensive manufacturing and that low prices are a major determinant of cannabis use, the price of Delta-8 THC products was examined. This study also examined whether retail outlets in areas with greater socioeconomic deprivation had higher odds of selling Delta-8 THC products. This is important because if Delta-8 THC retailers are disproportionately located in more socioeconomically deprived communities, residents of these communities can more easily access these products and may have higher risk of adverse consequences. Methods: Potential Delta-8 THC retailers were selected by identifying lists of current retail locations with alcohol, cannabidiol, and/or tobacco licenses in Fort Worth. Trained research assistants called outlets in September and October 2021 to query about sales of products containing Delta-8 THC. The response rate was 69% (n=1,223). Outlets' 9-digit zip codes were merged with Area Deprivation Index scores. Products and purported minimum age were described. Chi-squared and Student's t-tests were used. Results: Eleven percent of outlets (n=133) reported selling Delta-8 THC. Ninety-six percent sold vapes and/or "flower" (i.e., hemp leaves coated with Delta-8 THC distillate) and 76% sold edibles. Among the least expensive products available, edibles cost, on average, $8.58 less than flower/vapes (p<0.001). Outlets that sold Delta-8 THC were located in areas with greater deprivation (p=0.02). Most reported a minimum purchase age of 21; however, 4% reported 18 years or no minimum age. Conclusions: Delta-8 THC retail outlets were disproportionately located in areas with more socioeconomic deprivation. Legal intervention such as zoning, minimum age, and tax laws may help reduce Delta-8 THC-related disparities.
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Affiliation(s)
- Matthew E. Rossheim
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Cassidy R. LoParco
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Andrew Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Melvin D. Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Sofia Olsson
- School of Medicine, Texas Christian University, Fort Worth, Texas, USA
| | - Kayla K. McDonald
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Robert A. Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Justin M. Luningham
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Amanda Y. Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Doug Henry
- Department of Anthropology, University of North Texas, Denton, Texas, USA
| | - Scott T. Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Dennis L. Thombs
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - David H. Jernigan
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachusetts, USA
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26
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Halvorson-Fried SM, Kong AY, D'Angelo H, Delamater PL, Ribisl KM. Spatial Clustering of Tobacco Retailers Near US Public Schools. Nicotine Tob Res 2024; 26:185-193. [PMID: 37632567 PMCID: PMC10803112 DOI: 10.1093/ntr/ntad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Previous studies have found that tobacco retailers cluster near schools. However, all retail outlets may be located near each other and near schools due to existing infrastructure and zoning policies. We assessed whether tobacco retailers cluster near schools in the United States more than expected when accounting for existing retail locations. AIMS AND METHODS We identified 322 056 probable tobacco retailers, 95 110 public schools, and more than 3.8 million businesses comparable to tobacco retailers in land use and business type. We created 500 simulated tobacco retailer datasets by randomly selecting from the larger list of businesses. For each simulated dataset, we calculated the distance from schools to the nearest tobacco retailer (proximity) and the count of tobacco retailers within 800 m of schools (density). Observed proximity and density values were compared to 95% coverage intervals from the 500 simulations. We stratified analyses by urbanicity, percentage of students in the free and reduced-priced lunch program (FRLP), and percentage of Hispanic/Latino, non-Hispanic Black, and non-Hispanic white students. RESULTS Tobacco retailers were closer to schools in rural areas, cities, and towns and more dense around schools in rural areas, cities, and suburbs compared to random locations in potential retail space. Schools with more students receiving FRLP had higher density than expected while schools with fewer students receiving FRLP had lower density than expected. Within rural areas, clustering did not vary across sociodemographic groups. Within non-rural areas, there were inequities in clustering by racial, ethnic, and socioeconomic school composition. CONCLUSIONS Tobacco retailers cluster near schools after accounting for existing business patterns. There are inequities in clustering by sociodemographic school composition. IMPLICATIONS This study provides compelling evidence that tobacco retailers cluster near US public schools and that there are racial, ethnic, and socioeconomic inequities in clustering, even when accounting for overall retail location patterns. Given that public schools tend to reflect neighborhood demographics, policies to limit tobacco retailers near schools may reduce both school-based and neighborhood-based inequities.
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Affiliation(s)
- Sarah M Halvorson-Fried
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda Y Kong
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Heather D'Angelo
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Paul L Delamater
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Geography, University of North Carolina, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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27
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LoParco CR, Kong AY, Yockey RA, Sekhon V, Olsson S, Rossheim ME. Factors Associated with Delta-8 THC Retail Availability in Fort Worth, Texas, 2021-2022. Subst Use Misuse 2024; 59:840-846. [PMID: 38247162 PMCID: PMC11072389 DOI: 10.1080/10826084.2024.2305793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: Delta-8 THC is a federally unregulated psychoactive cannabis product rising in popularity. However, little is known regarding its retail availability. Method: We assessed Delta-8 THC retail by calling locations with alcohol, tobacco, and/or consumable hemp retail licenses in Fort Worth, Texas, before and after Texas announced ongoing litigation surrounding Delta-8 THC legality. We linked census block area deprivation index (ADI) scores (1-10; 10 = most disadvantaged) to locations. Logistic regression models examined associations between license type, ADI, ADI*license type interaction, and Delta-8 availability at each time. Results: Retail availability was 11% at Time 1 (n = 133/1,223) and 9% at Time 2 (n = 94/1,026). Alcohol (aORTime1 = 0.18, 95%CI = 0.12,0.28; aORTime2 = 0.14, 95%CI = 0.08,0.24), tobacco (aORTime1 = 15.13, 95%CI = 6.78,33.74; aORTime2 = 12.39, 95%CI = 4.97,30.91), and consumable hemp licenses (aORTime1 = 21.85, 95%CI = 7.91,60.39; aORTime2 = 22.93, 95%CI = 6.92,75.98) were associated with Delta-8 THC retail availability; ADI scores were borderline but not statistically significant. The multiplicative interaction at Time 2 indicated locations with both high ADI scores and alcohol retail licenses had higher odds of selling Delta-8 THC. Differential associations between ADI and Delta-8 THC availability were observed based on those with (b = 0.007) or without (b = -0.023) alcohol retail licenses. Conclusions: Both timepoints had similar proportions of Delta-8 THC retailers, indicating that despite the uncertain legal landscape in Texas, interest in Delta-8 did not appear to be declining. Geographic socioeconomic disparities were observed among locations with alcohol retail licenses. Future regulations may include minimum distances from specific locations (e.g., schools), particularly in more disadvantaged areas. Increasing the compliance of Texas Delta-8 THC retailers to have the required hemp license is important for surveillance and product safety.
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Affiliation(s)
- C. R. LoParco
- University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
- George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA
| | - A. Y. Kong
- The University of Oklahoma Health Sciences Center, College of Medicine, 800 Stanton L Young Blvd, Oklahoma City, OK, 73117, USA
- The University of Oklahoma Health Sciences Center, Stephenson Cancer Center, TSET Health Promotion Research Center, 655 Research Pkwy #400, Oklahoma City, OK, 73104, USA
| | - R. A. Yockey
- University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - V. Sekhon
- Harrisburg University of Science and Technology, 326 Market St, Harrisburg, PA, 17101, USA
| | - S. Olsson
- Texas Christian University, School of Medicine, 2800 South University Dr, Fort Worth, TX, 76129, USA
| | - M. E. Rossheim
- University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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28
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Nogueira LM, Yabroff KR. Climate change and cancer: the Environmental Justice perspective. J Natl Cancer Inst 2024; 116:15-25. [PMID: 37813679 DOI: 10.1093/jnci/djad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023] Open
Abstract
Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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29
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Marinello S, Valek R, Powell LM. Analysis of social media compliance with cannabis advertising regulations: evidence from recreational dispensaries in Illinois 1-year post-legalization. J Cannabis Res 2024; 6:2. [PMID: 38173010 PMCID: PMC10762945 DOI: 10.1186/s42238-023-00208-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In the USA, an increasing number of states have legalized commercial recreational cannabis markets, allowing a private industry to sell cannabis to those 21 and older at retail locations known as dispensaries. Research on tobacco and alcohol suggests this new industry will use aggressive marketing tactics to attract new users and promote greater intensity of use. Of concern is that cannabis company advertising campaigns may be appealing to youth, promote false or misleading health claims, and disproportionately target low-income and minority communities. In this study, we evaluated recreational cannabis dispensary compliance with advertising regulations on social media in the state of Illinois. METHODS Primary data were collected from a census of recreational dispensary Facebook and Twitter business pages during the first year of recreational sales in 2020. A quantitative content analysis was conducted to systematically analyze the data; a codebook that detailed a protocol for classifying posts was developed prior to the analysis using advertising regulations outlined in the Illinois Cannabis Regulation and Tax Act. Violations of advertising regulations were organized into three categories: advertisements that may be appealing to youth (< 21 years old), advertisements that make health claims, and other advertising violations. The data were analyzed cross-sectionally and longitudinally. Additionally, differences in compliance were assessed by dispensary and neighborhood characteristics. RESULTS The results of the analysis revealed substantial and persistent non-compliance throughout the entire study period. Overall, nearly one third of posts had at least one violation and approximately one in ten posts met the criteria for appealing to youth or contained health claims. The majority of posts with health claims included health claims that were not qualifying conditions for medical cannabis access in the state of Illinois. No differences in compliance by neighborhood and dispensary characteristics were found. CONCLUSIONS The findings from this study suggest that systematic monitoring and enforcement is needed to ensure compliance with advertising regulations.
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Affiliation(s)
- Samantha Marinello
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL, 60612-4394, USA.
| | - Rebecca Valek
- Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Ave, Portland, OR, 97201-5200, USA
| | - Lisa M Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL, 60612-4394, USA
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Sheikhattari P, Barsha RAA, Apata J, Assari S. Race by Education Intersectional Differences in Exposure to Tobacco Advertisement in Baltimore City. JOURNAL OF LUNG HEALTH AND DISEASES 2023; 7:9-17. [PMID: 38264144 PMCID: PMC10805540 DOI: 10.29245/2689-999x/2023/2.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Objective This study aimed to examine the intersectional effects of race and educational attainment on tobacco advertising exposure among adults in Baltimore, given the growing evidence on differential influence of education for Black and White populations. Methods A survey was conducted in Baltimore, collecting data on educational attainment, demographics, and tobacco advertising exposure among adults (n = 3028, 22.7% 18 - 29, 17.9% 30 - 39, 23.4% 40 - 49, 20.9% 50-59, and 11.1% 60+ years old). The sample included both Black and White adult individuals. Logistic regression analyses were employed to assess the association between educational attainment and tobacco advertising exposure, without and with interaction with race, adjusting for relevant covariates such as age, gender, and employment. Sensitivity analysis also controlled for smoking status. Results The study results indicated that while high educational attainment is associated with less exposure to tobacco ads, highly educated Black adults report significantly higher tobacco advertising exposure compared to highly educated White adults. Same results were observed after controlling for smoking status. Conclusion Educational attainment may not exhibit a large protective effect against environmental risks such as tobacco ad exposure for Black populations, possibly because of segregation and racism that hinder highly educated Black people ability to move to low-risk neighborhoods.
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Affiliation(s)
- Payam Sheikhattari
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Rifath Ara Alam Barsha
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Jummai Apata
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Shervin Assari
- 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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Kim H, Lee D. Tax incidence for menthol cigarettes by race: Evidence from Nielsen Homescan data. JOURNAL OF HEALTH ECONOMICS 2023; 92:102829. [PMID: 37865028 DOI: 10.1016/j.jhealeco.2023.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Abstract
We use Nielsen Homescan data to examine whether the incidence of cigarette taxes on menthol products varies with race. We find that taxes are shifted at significantly lower rates to Black smokers of menthol cigarettes than any other smokers. One possible explanation is that the industry targets price promotions to Black menthol smokers because they tend to be more responsive to cigarette prices relative to other smokers. We find evidence that Black smokers receive significantly more price discounts for menthol products than white menthol smokers. Our findings indicate that increasing cigarette taxes would effectively reduce menthol smoking among Black Americans because tax pass-through rate for Black menthol smokers is still substantially above zero.
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Affiliation(s)
- Hyunchul Kim
- Department of Economics, Sungkyunkwan University (SKKU), 25-2, Sungkyunkwan-Ro, Jongno-Gu, Seoul, 03063, South Korea.
| | - Dongwon Lee
- Department of Economics, Sungkyunkwan University (SKKU), 25-2, Sungkyunkwan-Ro, Jongno-Gu, Seoul, 03063, South Korea.
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Jenks JD, Prattes J, Wurster S, Sprute R, Seidel D, Oliverio M, Egger M, Del Rio C, Sati H, Cornely OA, Thompson GR, Kontoyiannis DP, Hoenigl M. Social determinants of health as drivers of fungal disease. EClinicalMedicine 2023; 66:102325. [PMID: 38053535 PMCID: PMC10694587 DOI: 10.1016/j.eclinm.2023.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Disparities in social determinants of health (SDOH) play a significant role in causing health inequities globally. The physical environment, including housing and workplace environment, can increase the prevalence and spread of fungal infections. A number of professions are associated with increased fungal infection risk and are associated with low pay, which may be linked to crowded and sub-optimal living conditions, exposure to fungal organisms, lack of access to quality health care, and risk for fungal infection. Those involved and displaced from areas of armed conflict have an increased risk of invasive fungal infections. Lastly, a number of fungal plant pathogens already threaten food security, which will become more problematic with global climate change. Taken together, disparities in SDOH are associated with increased risk for contracting fungal infections. More emphasis needs to be placed on systematic approaches to better understand the impact and reducing the health inequities associated with these disparities.
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Affiliation(s)
- Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, United States of America
| | - Juergen Prattes
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Sebastian Wurster
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Danila Seidel
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
| | - Matteo Oliverio
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Carlos Del Rio
- Emory Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Hatim Sati
- Department of Global Coordination and Partnership on Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | - Oliver A. Cornely
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Koln), University of Cologne, Cologne, Germany
| | - George R. Thompson
- University of California Davis Center for Valley Fever, Sacramento, CA, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Dimitrios P. Kontoyiannis
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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Barsha RAA, Assari S, Hossain MB, Apata J, Sheikhattari P. Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City. J Racial Ethn Health Disparities 2023; 10:3178-3187. [PMID: 37755685 PMCID: PMC10645619 DOI: 10.1007/s40615-023-01805-0] [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: 06/23/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. AIM This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. METHODS This cross-sectional study used data from a community survey conducted in 2012-2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. RESULTS The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08-0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07-0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05-3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07-10.80) were weaker for Back individuals than those who were White. CONCLUSION Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities' diminished return of education for tobacco use.
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Affiliation(s)
- Rifath Ara Alam Barsha
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Shervin Assari
- 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.
| | - Mian B Hossain
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Jummai Apata
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Payam Sheikhattari
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
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Liu M, Aggarwal R, Zheng Z, Yeh RW, Kazi DS, Joynt Maddox KE, Wadhera RK. Cardiovascular Health of Middle-Aged U.S. Adults by Income Level, 1999 to March 2020 : A Serial Cross-Sectional Study. Ann Intern Med 2023; 176:1595-1605. [PMID: 37983825 DOI: 10.7326/m23-2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Although cardiovascular mortality has increased among middle-aged U.S. adults since 2011, how the burden of cardiovascular risk factors has changed for this population by income level over the past 2 decades is unknown. OBJECTIVE To evaluate trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher-income middle-aged adults and how social determinants contribute to recent associations between income and cardiovascular health. DESIGN Serial cross-sectional study. SETTING NHANES (National Health and Nutrition Examination Survey), 1999 to March 2020. PARTICIPANTS Middle-aged adults (aged 40 to 64 years). MEASUREMENTS Age-standardized prevalence of hypertension, diabetes, hyperlipidemia, obesity, and cigarette use; treatment rates for hypertension, diabetes, and hyperlipidemia; and rates of blood pressure, glycemic, and cholesterol control. RESULTS The study population included 20 761 middle-aged adults. The prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults had an increase in hypertension over the study period (37.2% [95% CI, 33.5% to 40.9%] to 44.7% [CI, 39.8% to 49.5%]) but no changes in diabetes or obesity. In contrast, higher-income adults did not have a change in hypertension but had increases in diabetes (7.8% [CI, 5.0% to 10.6%] to 14.9% [CI, 12.4% to 17.3%]) and obesity (33.0% [CI, 26.7% to 39.4%] to 44.0% [CI, 40.2% to 47.7%]). Cigarette use was high and stagnant among low-income adults (33.2% [CI, 28.4% to 38.0%] to 33.9% [CI, 29.6% to 38.3%]) but decreased among their higher-income counterparts (18.6% [CI, 13.5% to 23.7%] to 11.5% [CI, 8.7% to 14.3%]). Treatment and control rates for hypertension were unchanged in both groups (>80%), whereas diabetes treatment rates improved only among the higher-income group (58.4% [CI, 44.4% to 72.5%] to 77.4% [CI, 67.6% to 87.1%]). Income-based disparities in hypertension, diabetes, and cigarette use persisted in more recent years even after adjustment for insurance coverage, health care access, and food insecurity. LIMITATION Sample size limitations could preclude detection of small changes in treatment and control rates. CONCLUSION Over 2 decades in the United States, hypertension increased in low-income middle-aged adults, whereas diabetes and obesity increased in their higher-income counterparts. Income-based disparities in hypertension, diabetes, and smoking persisted even after adjustment for other social determinants of health. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Michael Liu
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (M.L., R.W.Y., D.S.K., R.K.W.)
| | - Rahul Aggarwal
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Heart and Vascular Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (R.A.)
| | - Zhaonian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.Z.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (M.L., R.W.Y., D.S.K., R.K.W.)
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (M.L., R.W.Y., D.S.K., R.K.W.)
| | - Karen E Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri (K.E.J.M.)
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (M.L., R.W.Y., D.S.K., R.K.W.)
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Roy AM, George A, Attwood K, Alaklabi S, Patel A, Omilian AR, Yao S, Gandhi S. Effect of neighborhood deprivation index on breast cancer survival in the United States. Breast Cancer Res Treat 2023; 202:139-153. [PMID: 37542631 PMCID: PMC10504126 DOI: 10.1007/s10549-023-07053-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To analyze the association between the Neighborhood Deprivation Index (NDI) and clinical outcomes of locoregional breast cancer (BC). METHODS Surveillance, Epidemiology and End Results (SEER) database is queried to evaluate overall survival (OS) and disease-specific survival (DSS) of early- stage BC patients diagnosed between 2010 and 2016. Cox multivariate regression was performed to measure the association between NDI (Quintiles corresponding to most deprivation (Q1), above average deprivation (Q2), average deprivation (Q3), below average deprivation (Q4), least deprivation (Q5)) and OS/DSS. RESULTS Of the 88,572 locoregional BC patients, 27.4% (n = 24,307) were in the Q1 quintile, 26.5% (n = 23,447) were in the Q3 quintile, 17% (n = 15,035) were in the Q2 quintile, 13.5% (n = 11,945) were in the Q4 quintile, and 15.6% (n = 13,838) were in the Q5 quintile. There was a predominance of racial minorities in the Q1 and Q2 quintiles with Black women being 13-15% and Hispanic women being 15% compared to only 8% Black women and 6% Hispanic women in the Q5 quintile (p < 0.001). In multivariate analysis, in the overall cohort, those who live in Q2 and Q1 quintile have inferior OS and DSS compared to those who live in Q5 quintile (OS:- Q2: Hazard Ratio (HR) 1.28, Q1: HR 1.2; DSS:- Q2: HR 1.33, Q1: HR 1.25, all p < 0.001). CONCLUSION Locoregional BC patients from areas with worse NDI have poor OS and DSS. Investments to improve the socioeconomic status of areas with high deprivation may help to reduce healthcare disparities and improve breast cancer outcomes.
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Affiliation(s)
- Arya Mariam Roy
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Anthony George
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Sabah Alaklabi
- Division of Oncology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Archit Patel
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Shipra Gandhi
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
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Kaur M, Berg KA, Perzynski AT. Place and Pulmonary Health Inequality. Ann Am Thorac Soc 2023; 20:1400-1401. [PMID: 37772944 PMCID: PMC10559130 DOI: 10.1513/annalsats.202308-669ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Manpreet Kaur
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
| | - Kristen A Berg
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
- Population Health Equity Research Institute, The MetroHealth System, Cleveland, Ohio
| | - Adam T Perzynski
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
- Population Health Equity Research Institute, The MetroHealth System, Cleveland, Ohio
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Pravosud V, Holmes LM, Lempert LK, Ling PM. Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices. EVALUATION REVIEW 2023; 47:763-785. [PMID: 36943027 PMCID: PMC10542911 DOI: 10.1177/0193841x231164908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.
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Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Louisa M. Holmes
- The Pennsylvania State University, Departments of Geography and Demography, University Park, PA, USA
| | - Lauren K. Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Lusk JB, Hoffman MN, Clark AG, Mahoney H, Blass B, Bae J, Ashana DC, Cox CE, Hammill BG. Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries. Ann Am Thorac Soc 2023; 20:1416-1424. [PMID: 37343304 DOI: 10.1513/annalsats.202304-310oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
Rationale: Understanding how systemic forces and environmental exposures impact patient outcomes is critical to advancing health equity and improving population health for patients with pulmonary disease. This relationship has not yet been assessed at the population level nationally. Objectives: To determine whether neighborhood socioeconomic deprivation is independently associated with 30-day mortality and readmission for hospitalized patients with pulmonary conditions, after controlling for demographics, access to healthcare resources, and characteristics of admitting healthcare facilities. Methods: This was a retrospective, population-level cohort study of 100% of United States nationwide Medicare inpatient and outpatient claims from 2016-2019. Patients were admitted for one of four pulmonary conditions (pulmonary infections, chronic lower respiratory disease, pulmonary embolism, and pleural and interstitial lung diseases), defined by diagnosis-related group. The primary exposure was neighborhood socioeconomic deprivation, measured by the area deprivation index. The main outcomes were 30-day mortality and 30-day unplanned readmission, defined by Centers for Medicare and Medicaid Services methodologies. Generalized estimating equations were used to estimate logistic regression models for the primary outcomes, addressing clustering by hospital. A sequential adjustment strategy was first adjusted for age, legal sex, Medicare-Medicaid dual eligibility, and comorbidity burden, then adjusted for metrics of access to healthcare resources, and finally adjusted for characteristics of the admitting healthcare facility. Results: After full adjustment, patients from low socioeconomic status neighborhoods had greater 30-day mortality after admission for pulmonary embolism (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.13-1.40), respiratory infections (OR, 1.20; 95% CI, 1.16-1.25), chronic lower respiratory disease (OR, 1.31; 95% CI, 1.22-1.41), and interstitial lung disease (OR, 1.15; 95% CI, 1.04-1.27) when compared to patients from the highest SES neighborhoods. Low neighborhood socioeconomic status was also associated with 30-day readmission for all groups except the interstitial lung disease group. Conclusions: Neighborhood socioeconomic deprivation may be a key factor driving poor health outcomes for patients with pulmonary diseases.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine
- Duke University Fuqua School of Business
| | | | - Amy G Clark
- Duke University Department of Population Health Sciences
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences
| | | | - Jonathan Bae
- Duke University Health System, and
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Christopher E Cox
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Bradley G Hammill
- Duke University School of Medicine
- Duke University Department of Population Health Sciences
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Pacek LR, Sawdey MD, Nguyen KH, Cooper M, Park-Lee E, Gross AL, Donaldson EA, Cullen KA. Trends and Associations of Past-30-Day Cigar Smoking in the U.S. by Age, Race/Ethnicity, and Sex, NSDUH 2002-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6716. [PMID: 37754576 PMCID: PMC10531240 DOI: 10.3390/ijerph20186716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
Cigar smoking remains a public health issue in the United States (U.S.), with a heterogeneous prevalence based on sociodemographic characteristics. Nationally representative data suggest changes in cigar smoking over time, with some evidence for sociodemographic differences. Using data from the 2002-2019 National Survey on Drug Use and Health (NSDUH), the prevalence of past-30-day cigar smoking was examined overall and stratified by sociodemographic characteristics; joinpoint regression examined the trends. Logistic regression analyses identified the correlates of cigar smoking using 2020 NSDUH data. From 2002 to 2004, the prevalence of cigar smoking remained stable (5.33-5.73%), but declined from 2004 to 2019 (5.73-4.29%). Cigar smoking declined in some periods between 2002-2019 among the non-Hispanic White, Hispanic, ages 12-17, ages 18-20, ages 21-25, age ≥ 35, and male subgroups, but remained unchanged among the non-Hispanic Other, ages 26-34, and female subgroups. Cigar smoking increased among non-Hispanic Black persons overall from 2002 to 2019 (6.67-8.02%). Past-30-day cigarette smoking and drug or alcohol use disorder was associated with an increased likelihood of cigar use, while female sex was associated with a decreased likelihood of cigar use, across all age groups. Though a decline in the prevalence of past-30-day cigar smoking is seen in the general population, the same is not evident among all sociodemographic subgroups. Our findings have the potential to inform tobacco cessation efforts within clinical practice, as well as regulatory efforts to reduce cigar use.
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Affiliation(s)
- Lauren R. Pacek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (M.D.S.); (K.H.N.); (M.C.); (E.P.-L.); (A.L.G.); (E.A.D.); (K.A.C.)
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Donovan EM, Azadi M, Akbar M, Schillo BA. Examining the Comprehensiveness of Amended Flavored Tobacco Product Sales Restrictions. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:646-653. [PMID: 37071073 DOI: 10.1097/phh.0000000000001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
CONTEXT Flavored tobacco products contribute significantly to youth tobacco initiation and tobacco use disparities. In the last decade, 362 jurisdictions have enacted policies restricting the sale of flavored tobacco products; however, many policies are not fully comprehensive due to menthol and adult-only retailer exemptions. Although several of these restrictions have been amended since their original passage, to date, little is known about how amendments have affected policy comprehensiveness. OBJECTIVE To describe how amendments to flavored tobacco product sales restrictions affect policy comprehensiveness. DESIGN We identified flavored tobacco product sales restrictions that had been amended at least once using an internal database of US state and local flavored tobacco product sales restrictions. To characterize policy comprehensiveness, we applied a 6-level flavored tobacco policy classification scheme-level 6 being most comprehensive-to amended restrictions. We conducted a descriptive analysis of each initial policy and its most recent amendment to identify changes in retailer, product, and flavor inclusions, as well as overall comprehensiveness. MAIN OUTCOME MEASURES Comprehensiveness of amended flavored tobacco product sales restrictions. RESULTS As of March 31, 2022, no states and 50 localities had amended their flavored tobacco product sales restriction. Amendments largely increased policy comprehensiveness; most laws prior to amendment were categorized as level 1 (n = 28, 56.0%), while after amendment, the plurality were categorized as level 6 (n = 25, 50.0%). Most commonly, amendments removed menthol exemptions (n ≥ 30, 60.0%) and adult-only retailer exemptions (n = 12, 24.0%). CONCLUSIONS Several local flavored tobacco product sales restrictions have been amended. Nearly all amendments increased policy comprehensiveness, primarily by removing exemptions for menthol products and exemptions for adult-only retailers. While policy advocates remain focused on passing comprehensive policies at initial passage, amendments have served as a tool to strengthen existing sales restrictions. This study along with ongoing flavored tobacco product sales restriction surveillance can inform policy advocacy and evaluation efforts.
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Affiliation(s)
- Emily M Donovan
- Truth Initiative Schroeder Institute, Washington, District of Columbia (Mss Donovan and Azadi and Dr Schillo); and Truth Initiative, Washington, District of Columbia (Ms Akbar)
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McGinnes H, Kingsley M, Song G, Rosewarne J, Gonthier S, Doane J, Henley P. Evaluation of a Statewide Flavored Tobacco Restriction on Use, Access, and Cessation Among Black and White Tobacco Users in Massachusetts. Am J Health Promot 2023; 37:905-914. [PMID: 37295390 DOI: 10.1177/08901171231183308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate the impact of a statewide flavored tobacco restriction among Massachusetts residents who use menthol or flavored tobacco and to assess differences in impact between Black and White users, as the tobacco industry has targeted menthol to Black users. DESIGN An online survey was distributed through a panel provider and household mailings. SETTING Eleven Massachusetts communities with higher-than-state-average Black, Indigenous or People of Color populations. SUBJECTS Black (n = 63) and White (n = 231) non-Hispanic residents who used menthol or other flavored tobacco products in the past year. MEASURES Impact of the law on use, access, and quitting behaviors. ANALYSIS Outcomes were assessed between Blacks and Whites using Pearson chi-square tests. RESULTS Over half (53% of White, 57% of Black) of respondents believed the law made it more difficult to access menthol products; two-thirds (67% of White,64% of Black) accessed menthol products in another state. Black users were significantly more likely to report purchasing menthol products off the street (P ≤ .05). One-third (28% of White, 32% of Black) believed the law made it easier to quit, and one-third (27% of White, 34% of Black) completely quit in the past year. CONCLUSIONS Flavored tobacco restrictions may positively and equitably impact cessation. Cross-border access and off-the-street purchasing suggest the need for greater cessation support and underscore the importance of a national policy.
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Affiliation(s)
- Hannah McGinnes
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, MA, USA
| | - Melody Kingsley
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, MA, USA
| | - Glory Song
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, MA, USA
| | | | | | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, MA, USA
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Benson KRK, Diamantidis CJ, Davenport CA, Sandler RS, Boulware LE, Mohottige D. Racial Differences in Over-the-Counter Non-steroidal Anti-inflammatory Drug Use Among Individuals at Risk of Adverse Cardiovascular Events. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01743-x. [PMID: 37594625 DOI: 10.1007/s40615-023-01743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Black Americans are disproportionately affected by adverse cardiovascular events (ACEs). Over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) confer increased risk for ACEs, yet racial differences in the use of these products remain understudied. This study sought to determine racial differences in OTC NSAID and high-potency powdered NSAID (HPP-NSAID) use. METHODS AND MATERIALS This retrospective analysis examined participants at risk of ACEs (defined as those with self-reported hypertension, diabetes, heart disease, or smoking history ≥ 20 years) from the North Carolina Colon Cancer Study, a population-based case-control study. We used multivariable logistic regression models to assess the independent associations of race with any OTC NSAID use, HPP-NSAID use, and regular use of these products. RESULTS Of the 1286 participants, 585 (45%) reported Black race and 701 (55%) reported non-Black race. Overall, 665 (52%) reported any OTC NSAID use and 204 (16%) reported HPP-NSAID use. Compared to non-Black individuals, Black individuals were more likely to report both any OTC NSAID use (57% versus 48%) and HPP-NSAID use (22% versus 11%). In multivariable analyses, Black (versus non-Black) race was independently associated with higher odds of both NSAID use (OR 1.4, 95% CI (1.1, 1.8)) and HPP-NSAID use (OR 1.8 (1.3, 2.5)). CONCLUSIONS Black individuals at risk of ACEs had higher odds of any OTC NSAID and HPP-NSAID use than non-Black individuals, after controlling for pain and socio-economic status. Further research is necessary to identify potential mechanisms driving this increased use.
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Affiliation(s)
- Kathryn R K Benson
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Clarissa J Diamantidis
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, USA
| | - Clemontina A Davenport
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Robert S Sandler
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - L Ebony Boulware
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dinushika Mohottige
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA.
- Department of Population Health, Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, 1425 Madison Avenue Floor 2, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Barbara T. Murphy Division of Nephrology, 1425 Madison Avenue Floor 2, New York, NY, 10029, USA.
- Division of Data-Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Tsui J, Sloan K, Sheth R, Ewusi Boisvert E, Nieva J, Kim AW, Pang RD, Sussman S, Kirkpatrick M. Implementation planning for equitable tobacco treatment services: a mixed methods assessment of contextual facilitators and barriers in a large comprehensive cancer center. Transl Behav Med 2023; 13:539-550. [PMID: 36940412 PMCID: PMC10848232 DOI: 10.1093/tbm/ibac122] [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: 03/22/2023] Open
Abstract
Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population characteristics and multilevel context specific to settings serving diverse patients are needed to improve tobacco cessation among cancer patients. We examined tobacco use screening and implementation needs for tobacco treatment services to inform equitable and accessible delivery within a large comprehensive cancer center in the greater Los Angeles region. We conducted a multi-modal, mixed methods assessment using electronic medical records (EMR), and clinic stakeholder surveys and interviews (guided by the Consolidated Framework for Implementation Research). Approximately 45% of patients (n = 11,827 of 26,030 total) had missing tobacco use history in their EMR. Several demographic characteristics (gender, age, race/ethnicity, insurance) were associated with greater missing data prevalence. In surveys (n = 32), clinic stakeholders endorsed tobacco screening and cessation services, but indicated necessary improvements for screening/referral procedures. During interviews (n = 13), providers/staff reported tobacco screening was important, but level of priority differed as well as how often and who should screen. Several barriers were noted, including patients' language/cultural barriers, limited time during visits, lack of smoking cessation training, and insurance coverage. While stakeholders indicated high interest in tobacco use assessment and cessation services, EMR and interview data revealed opportunities to improve tobacco use screening across patient groups. Implementing sustainable system-level tobacco cessation programs at institutions requires leadership support, staff training, on routine screening, and intervention and referral strategies that meet patients' linguistic/cultural needs.
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Affiliation(s)
- Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajiv Sheth
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jorge Nieva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Matthew Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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van Deelen TRD, Veldhuizen EM, van den Putte B, Kunst AE, Kuipers MAG. Socioeconomic differences in tobacco outlet presence, density, and proximity in four cities in the Netherlands. BMC Public Health 2023; 23:1515. [PMID: 37558979 PMCID: PMC10413623 DOI: 10.1186/s12889-023-16347-7] [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: 03/21/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Previous studies found that tobacco outlets were unevenly distributed by area socioeconomic status (SES). However, evidence from continental Europe is limited. This study aims to assess differences in tobacco outlet presence, density and proximity by area SES in the Netherlands. METHODS All tobacco outlets in four Dutch cities (Amsterdam, and medium-sized cities Eindhoven, Haarlem, and Zwolle) were mapped between September 2019 and June 2020. We estimated associations between average property value of neighbourhoods (as an indicator of SES, grouped into quintiles) and (1) tobacco outlet presence in the neighbourhood (yes/no), (2) density (per km2), and (3) proximity to the closest outlet (in meters), using logistic and linear regression models. RESULTS 46% of neighbourhoods contained at least one tobacco outlet. Tobacco outlets were mostly situated in city centres, but the distribution of tobacco outlets varied per city due to differences in urban structures and functions. In the medium-sized cities, each quintile higher neighbourhood-SES was associated with lower tobacco outlet presence (OR:0.71, 95%CI:0.59;0.85), lower density (B:-1.20 outlets/km2, 95%CI:-2.20;-0.20) and less proximity (B:40.2 m, 95%CI 36.58;43.83). Associations were the other way around for Amsterdam (OR:1.22, 95%CI:1.05;1.40, B:3.50, 95%CI:0.81;6.20, and B:-18.45, 95%CI:-20.41;-16.49, respectively). Results were similar for most types of tobacco outlets. CONCLUSION In medium-sized cities in the Netherlands, tobacco outlets were more often located in low-SES neighbourhoods than high-SES. Amsterdam presented a reverse pattern, possibly due to its unique urban structure. We discuss how licensing might contribute to reducing tobacco outlets in low-SES neighbourhoods.
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Affiliation(s)
- Tessa R D van Deelen
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands.
| | - Els M Veldhuizen
- Department of Geography and Planning, University of Amsterdam, Amsterdam, Postbus, Amsterdam, 15629, 1001 NC, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Postbus, Amsterdam, 15791, 1001 NG, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands
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Berg CJ, Romm KF, Pannell A, Sridharan P, Sapra T, Rajamahanty A, Cui Y, Wang Y, Yang YT, Cavazos-Rehg PA. Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities. Addict Behav 2023; 143:107696. [PMID: 36966547 PMCID: PMC10674052 DOI: 10.1016/j.addbeh.2023.107696] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA.
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexandria Pannell
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Priyanka Sridharan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tanvi Sapra
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aishwarya Rajamahanty
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Y Tony Yang
- George Washington Cancer Center, George Washington University, Washington, DC, USA; Department of Community of Policy, Populations and Systems, School of Nursing, George Washington University, Washington, DC, USA
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46
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Dutra LM, Farrelly MC, Bradfield B, Mekos D, Jones C, Alexander T. Awareness of and receptivity to FDA's point-of-sale tobacco public education campaign. PLoS One 2023; 18:e0288462. [PMID: 37440511 DOI: 10.1371/journal.pone.0288462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of the study was to assess awareness of and receptivity to FDA's point-of-sale (POS) tobacco public education campaign for adult cigarette smokers called Every Try Counts; it was the first multi-county POS campaign in the U.S. The design was a county-level treatment-control three-wave longitudinal design. The setting was 15 treatment and 15 control counties. Subjects were smokers ages 25 to 54 (N = 3,628). 4,145 individuals screened in as eligible; 3,628 (87.5% response rate) completed the Wave 1 questionnaire (Wave 2: n = 2,812; Wave 3: n = 2,571; retention 70.9%). Measures were self-reported brand and ad awareness (saw any ad a few times or more) and receptivity (5-item perceived effectiveness scale). The analysis included descriptive analyses of receptivity; bivariate analyses of awareness by treatment group; and covariate- and time-adjusted logistic regression models to determine changes in awareness attributable to the campaign. Receptivity was moderate and differed significantly by race/ethnicity. As was the case for all waves, at wave 3, ad awareness was significantly higher in treatment (53.3%) than control counties (36.1%, p < .05). In regression models, brand (OR = 1.53, 95% CI: 1.26-1.86) and ad (OR = 1.74, 95% CI: 1.39-2.16) awareness were significantly higher in treatment than control counties. Every Try Counts generated a moderate level of receptivity and attention from cigarette smokers. Limitations include self-reports of campaign awareness and generalizability to a small number of U.S. counties.
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Affiliation(s)
- Lauren M Dutra
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Matthew C Farrelly
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Brian Bradfield
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Debra Mekos
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Chaunetta Jones
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Tesfa Alexander
- Public Health Systems Innovation and Transformation, MITRE Corporation, Rockville, Maryland, United States of America
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Muchlis N, Yusuf RA, Rusydi AR, Mahmud NU, Hikmah N, Qanitha A, Ahsan A. Cigarette Smoke Exposure and Stunting Among Under-five Children in Rural and Poor Families in Indonesia. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231185210. [PMID: 37434666 PMCID: PMC10331105 DOI: 10.1177/11786302231185210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
Cigarette smoke exposure in mothers and children is highly prevalent in Asia, especially among rural and poor families. Second-hand smoke exposure might affect the nutritional status of children. Despite the emerging double burden of malnutrition and the very high prevalence of smoking in Indonesia, few studies have examined the effects of parental smoking on children's nutritional status. This study aims to measure the relationship between family smoking behavior and the occurrence of stunting in children under 5 years. This cross-sectional study used a purposive sampling technique, with 221 households with children aged 0 to 59 months from poor areas in Indonesia. Exposure to cigarette smoke is assessed using The Secondhand Smoke Exposure Scale questionnaire. The outcome measured is child stunting (height-for-age Z-score). The prevalence of stunting was estimated at 145 (65.6%). Children living with smoking parents were counted for 157 (71%), and most smoking exposure comes from fathers 147 (67.4%). The predictors of stunting in children under 5 years were a smoker father with (AOR 1.8; 95% CI 1.281-4.641), both parents are smokers increasing the risk of stunting with (COR 3.591; 95% CI 1.67-3.77), being exposed of smoke for more than 3 hours a day increase the risk of stunted children (COR 2.05; 95% CI 1.214-3.629), and using traditional cigarette or kretek expand the risk of stunting (AOR 3.19; 95% CI 1.139-67.785). The findings demonstrate the negative impact of parental smoking on children's growth, reinforcing the importance of reducing smoking prevalence by imposing a smoke-free home policy in the stunting prevention strategy.
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Affiliation(s)
- Nurmiati Muchlis
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Rezky Aulia Yusuf
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
- Save The Teenager Indonesia, Makassar,
Indonesia
| | - Arni Rizqiani Rusydi
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Nur Ulmy Mahmud
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Nurul Hikmah
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Andriany Qanitha
- Faculty of Medicine, Universitas
Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Abdillah Ahsan
- Faculty of Economics and Business,
University of Indonesia, Depok, West Java, Indonesia
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Prom-Wormley EC, Wells JL, Landes L, Edmondson AN, Sankoh M, Jamieson B, Delk KJ, Surya S, Bhati S, Clifford J. A scoping review of smoking cessation pharmacogenetic studies to advance future research across racial, ethnic, and ancestral populations. Front Genet 2023; 14:1103966. [PMID: 37359362 PMCID: PMC10285878 DOI: 10.3389/fgene.2023.1103966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
Abstinence rates among smokers attempting to quit remain low despite the wide availability and accessibility of pharmacological smoking cessation treatments. In addition, the prevalence of cessation attempts and abstinence differs by individual-level social factors such as race and ethnicity. Clinical treatment of nicotine dependence also continues to be challenged by individual-level variability in effectiveness to promote abstinence. The use of tailored smoking cessation strategies that incorporate information on individual-level social and genetic factors hold promise, although additional pharmacogenomic knowledge is still needed. In particular, genetic variants associated with pharmacological responses to smoking cessation treatment have generally been conducted in populations with participants that self-identify as White race or who are determined to be of European genetic ancestry. These results may not adequately capture the variability across all smokers as a result of understudied differences in allele frequencies across genetic ancestry populations. This suggests that much of the current pharmacogenetic study results for smoking cessation may not apply to all populations. Therefore, clinical application of pharmacogenetic results may exacerbate health inequities by racial and ethnic groups. This scoping review examines the extent to which racial, ethnic, and ancestral groups that experience differences in smoking rates and smoking cessation are represented in the existing body of published pharmacogenetic studies of smoking cessation. We will summarize results by race, ethnicity, and ancestry across pharmacological treatments and study designs. We will also explore current opportunities and challenges in conducting pharmacogenomic research on smoking cessation that encourages greater participant diversity, including practical barriers to clinical utilization of pharmacological smoking cessation treatment and clinical implementation of pharmacogenetic knowledge.
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Affiliation(s)
- Elizabeth C. Prom-Wormley
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Jonathan L. Wells
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori Landes
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Amy N. Edmondson
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Mariam Sankoh
- Department of Integrative Life Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Brendan Jamieson
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Kayla J. Delk
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Sanya Surya
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Shambhavi Bhati
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - James Clifford
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, United States
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Sutfin EL, Lazard AJ, Wagoner KG, King JL, Ross JC, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. Point-of-Sale Health Communication Campaigns for Cigarillos and Waterpipe Tobacco: Effects and Lessons Learned from Two Cluster Randomized Trials. HEALTH COMMUNICATION 2023; 38:1201-1212. [PMID: 34781799 PMCID: PMC9107525 DOI: 10.1080/10410236.2021.1996910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16-25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (p < .01). There were also significant increases in knowledge about ammonia and cyanide in cigarillo smoke and arsenic in WT smoke (p < .05) in the sub-sample who reported exposure to the campaign. No differences were found in outcome expectancies, product attitudes, worry about chemical exposure, or behavioral intentions in either campaign. Garnering attention for communication campaigns in saturated POS environments, often dominated by tobacco advertising, is challenging. Our study demonstrates the feasibility of anti-tobacco campaigns at the POS and points to several lessons learned for future POS campaigns.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Allison J. Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Kimberly G. Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Jessica L. King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, U.T., United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Elizabeth N. Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside, Riverside, C.A., United States
| | - Seth M. Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
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Hassan AM, Nogueira L, Lin YL, Rogers JE, Nori-Sarma A, Offodile AC. Impact of Heatwaves on Cancer Care Delivery: Potential Mechanisms, Health Equity Concerns, and Adaptation Strategies. J Clin Oncol 2023:JCO2201951. [PMID: 37098249 DOI: 10.1200/jco.22.01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Anaeze Chidiebele Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
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