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Patterson JG, Keller-Hamilton B, Wedel A, Vázquez-Otero C, Liu J, Lee D, Stevens EM, Wagener TL. Absolute and relative e-cigarette harm perceptions among young adult lesbian and bisexual women and nonbinary people assigned female at birth. Addict Behav 2023; 146:107788. [PMID: 37429104 PMCID: PMC10529580 DOI: 10.1016/j.addbeh.2023.107788] [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: 02/18/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Young adult lesbian and bisexual women report considerable e-cigarette disparities, which may be attributed to low harm perceptions. No studies have assessed differences in e-cigarette harm perceptions in this group, nor which factors might be intervention targets to influence harm perceptions. MATERIALS AND METHODS We investigated differences in and modifiable correlates of e-cigarette harm perceptions among young adult lesbian and bisexual women and non-binary people assigned female at birth. Young adult women and non-binary people assigned female at birth, aged 18-30 years old, and who self-identified as lesbian or bisexual (N = 471) reported absolute and relative harm perceptions of e-cigarettes to health in an online survey. We modeled associations between harm perceptions and individual, interpersonal, and contextual factors. RESULTS Bisexual (vs. lesbian) participants perceived higher absolute harm of e-cigarettes (Mean (M) = 7.61 vs M = 7.09, p = .03). Participants rated e-cigarettes as slightly less harmful than cigarettes, and there was no statistically significant difference by sexual orientation (Bisexual: M = 4.84 vs Lesbian: M = 4.36). In multivariable models, bisexual (vs. lesbian) participants and Hispanic/Latinx and Other race (vs. non-Hispanic White) participants reported higher absolute and relative e-cigarette harm perceptions. Greater sexual identify affirmation and greater perceived stress were associated with higher absolute and relative e-cigarette harm perceptions. CONCLUSIONS E-cigarette harm perceptions vary vis-à-vis individual-level factors. Self-identification as bisexual or minoritized race/ethnicity, greater sexual identity affirmation, and greater perceived stress was associated with increased harm perceptions. Understanding variations may inform targeted health communications to reduce e-cigarette use disparities.
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Affiliation(s)
- Joanne G Patterson
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, 1841 Neil Avenue, Columbus, OH 43120, USA; The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA.
| | - Brittney Keller-Hamilton
- The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Rd, Columbus, OH 43221, USA
| | - Amelia Wedel
- Department of Psychology, Syracuse University, 430 Hunting Hall, Syracuse, NY 13244, USA
| | - Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, One UTSA Circle, Main Building 2.306, San Antonio, TX 78249, USA
| | - Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 3145 Porter Drive, Palo Alto, CA 94304, USA
| | - Donghee Lee
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Elise M Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Theodore L Wagener
- The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Rd, Columbus, OH 43221, USA
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Zatoński MZ, Egbe CO, Robertson L, Gilmore A. Framing the policy debate over tobacco control legislation and tobacco taxation in South Africa. Tob Control 2023; 32:450-457. [PMID: 34824147 PMCID: PMC10314007 DOI: 10.1136/tobaccocontrol-2021-056675] [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: 03/22/2021] [Accepted: 11/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 2018, South Africa opened public consultations on its newly proposed tobacco control bill, resulting in substantial public debate in which a range of arguments, either in favour of or against the Bill, was advanced. These were accompanied by the recurring discussions about the annual adjustments in tobacco taxation. This study uses the concept of framing to examine the public debate in South African print media on the potential effects of the legislation, as well as tobacco tax regulations, between their proponents and detractors. METHODS A systematic search of news articles using multiple data sources identified 132 media articles published between January 2018 and September 2019 that met the inclusion criteria. RESULTS Seven overarching frames were identified as characterising the media debate, with the three dominant frames being Economic, Harm reduction and vaping, and Health. The leading Economic frame consisted primarily of arguments unsupportive of tobacco control legislation. Economic arguments were promoted by tobacco industry spokespeople, trade unions, organisations of retailers, media celebrities and think tanks-several of which have been identified as front groups or third-party lobbyists for the tobacco industry. CONCLUSION The dominance of economic arguments opposing tobacco control legislation risks undermining tobacco control progress. Local and global tobacco control advocates should seek to build relationships with media, as well as collate and disseminate effective counterarguments to those advanced by the industry.
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Affiliation(s)
- Mateusz Zygmunt Zatoński
- Department for Health, University of Bath, Bath, UK
- European Observatory of Health Inequalities, Calisia University, Kalisz, Poland
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Lindsay Robertson
- Department for Health, University of Bath, Bath, UK
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Anna Gilmore
- Department for Health, University of Bath, Bath, UK
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Titus AR, Gamarel KE, Thrasher JF, Elliott MR, Fleischer NL. Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA. Int J Behav Med 2023; 30:448-454. [PMID: 35579845 PMCID: PMC9669255 DOI: 10.1007/s12529-022-10099-1] [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] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults. METHODS We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013-2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults. RESULTS In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean = - 0.50, 95% CI = - 0.89, - 0.12; hospitality law change in mean = - 0.72, 95% CI = - 1.14,-0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited. CONCLUSIONS We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities.
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Affiliation(s)
- Andrea R Titus
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael R Elliott
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Titus AR, Thrasher JF, Gamarel KE, Emery SL, Elliott MR, Fleischer NL. Televised Anti-Tobacco Media and Smoking Outcomes Among Heterosexual and Sexual Minority Adults in the United States. HEALTH EDUCATION & BEHAVIOR 2023; 50:234-239. [PMID: 35972191 PMCID: PMC9931928 DOI: 10.1177/10901981221116783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of smoking is higher among sexual minority (SM) individuals compared with heterosexuals. The impact of televised anti-tobacco mass media campaigns on smoking outcomes among SMs is not known. AIMS We examined whether televised anti-tobacco advertising was differentially associated with current smoking and smoking intensity for SM and heterosexual adults. METHOD We combined county-level anti-tobacco advertising data (gross rating points) with restricted, geocoded individual-level National Health Interview Survey data on smoking (2013-2015). We estimated associations between advertising and smoking outcomes, including potential effect modification by SM status. RESULTS Greater anti-tobacco advertising exposure was associated with lower smoking prevalence (prevalence ratio [PR] = 0.97; 95% confidence interval [CI] = [0.94, 1.00]). Although the direction of the association differed for heterosexual and SM adults, differences were not statistically significant. No significant associations were observed with regard to smoking intensity. CONCLUSION Associations between anti-tobacco advertising and smoking were not significantly different for heterosexual and SM adults.
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Affiliation(s)
| | - James F Thrasher
- University of South Carolina, Columbia, SC, USA
- National Institute of Public Health, Cuernavaca, Mexico
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Grube JW, Lipperman-Kreda S, García-Ramírez G, Paschall MJ, Abadi MH. California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups. Tob Control 2022; 31:e126-e133. [PMID: 34193606 PMCID: PMC8716668 DOI: 10.1136/tobaccocontrol-2020-056219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups. METHODS Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018. RESULTS Multilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups. CONCLUSIONS Our findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.
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Affiliation(s)
- Joel W Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Grisel García-Ramírez
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Mallie J Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Melissa H Abadi
- Pacific Institute for Research and Evaluation Louisville Center, Louisville, Kentucky, USA
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García-Ramírez G, Islam S, Wharton MK, Grube JW. Associations of California's Tobacco 21 Minimum Sales Age Law with Tobacco Use Among Sexual Minority Adolescents: A Trends Analysis. Nicotine Tob Res 2022; 24:1834-1839. [PMID: 35605007 PMCID: PMC9596995 DOI: 10.1093/ntr/ntac134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In 2016, California enacted a law (T21) prohibiting tobacco product sales to individuals under 21 years of age. Given tobacco use disparities among sexual minority (SM) youth, this study investigated whether California's T21 law was differentially associated with changes in tobacco use for SM and non-SM adolescents. AIMS AND METHODS Secondary analyses of California Healthy Kids Survey data from 2013-2014 to 2018-2019 for 7th, 9th, and 11th graders (N = 2 229 401). RESULTS Multilevel mixed-effects logistic regression analyses showed that SM students were more likely than non-SM students to report past-30-day and lifetime cigarette (odds ratio (OR) = 2.47; OR = 2.37), e-cigarette (OR = 1.21; OR = 1.10), smokeless tobacco use (OR = 1.95; OR = 1.56), and use of any tobacco product (OR = 1.94; OR = 1.61). Among SM youth, T21 was associated with significant reductions in lifetime e-cigarette use (OR = 0.66), and lifetime use of any tobacco products (OR = 0.75). These decreases generally were greater than or equivalent to those observed for non-SM youth. For 30-day e-cigarette and any tobacco use, SM youth showed no significant increases, whereas non-SM youth showed significant increases (OR = 1.06; OR = 1.11) following T21. T21 was associated with smaller increases in lifetime cigarette use (OR = 1.34), and larger increases for past-30-day and lifetime smokeless tobacco use (OR = 1.34; OR = 1.28) among SM students, to those observed for non-SM students. CONCLUSIONS California's T21 policy may help reduce tobacco use disparities among SM students who are more at risk for tobacco use than their non-SM peers. IMPLICATIONS Research on associations of T21 laws with tobacco use among sexual minority (SM) adolescents is lacking. The potential for unintended consequences of T21 for these adolescents raises concerns about increased health disparities. Importantly, our study generally found California's T21 was associated with reductions in tobacco use among SM students that were equivalent to or greater than those for non-SM students. Future research should investigate whether T21 laws and similar policies have differential effects for other marginalized groups and, if so, identify mechanisms that can be targeted in prevention efforts.
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Affiliation(s)
- Grisel García-Ramírez
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704-1365, USA
- School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
| | - Sabrina Islam
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704-1365, USA
- School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
| | - Mary K Wharton
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704-1365, USA
- School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
| | - Joel W Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704-1365, USA
- School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
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Farrow E, von Kaufmann F, Aguilar Perez F, Satherley P. Why population health approaches remain so critical for public health. Perspect Public Health 2022; 142:244-245. [PMID: 36120924 DOI: 10.1177/17579139221119028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eleanor Farrow
- Policy & Public Affairs Executive, Royal Society for Public Health, London, UK
| | | | | | - Philip Satherley
- Policy & Public Affairs Manager, Royal Society for Public Health, London, UK
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Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106305. [PMID: 35627843 PMCID: PMC9142070 DOI: 10.3390/ijerph19106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/16/2022]
Abstract
Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine delivery systems, other combustible (cigars and traditional pipe), and smokeless tobacco products. Using multinomial logistic regression, we estimated adjusted associations between sexual orientation discrimination and exclusive, dual, and polyuse. Experiencing discrimination in public places, being called names, and being bullied, assaulted, or threatened were associated with dual use, while experiencing discrimination when obtaining health care or insurance and when receiving health care were associated with polyuse. Each one-unit increase in the sexual orientation discrimination summary scale was associated with 5% and 10% higher odds of dual (95% CI: 1.01–1.10) and polyuse (95% CI: 1.02–1.18), respectively. To conclude, we advise health professionals to consider the salience of discrimination against SM adults and how these experiences lead to dual/polyuse.
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Feng GC, Zhu S, Zhao X. Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic. Front Public Health 2021; 9:684683. [PMID: 34497791 PMCID: PMC8419308 DOI: 10.3389/fpubh.2021.684683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.
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Affiliation(s)
| | - Shan Zhu
- College of Communication, Shenzhen University, Shenzhen, China
| | - Xinshu Zhao
- Department of Communication, University of Macau, Macau, China
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Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999-2014. Nicotine Tob Res 2021; 23:1527-1535. [PMID: 33690865 PMCID: PMC8372649 DOI: 10.1093/ntr/ntab038] [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: 09/01/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little is known about the relationship between smoke-free laws and persistent disparities in secondhand smoke (SHS) exposure among nonsmoking adults in the United States. AIMS AND METHODS We constructed time-varying smoke-free law measures representing whether or not at least 50% of each US county's population was covered by smoke-free laws in workplaces and hospitality venues (restaurants/bars). We merged these data with restricted data on cotinine-derived SHS exposure among nonsmokers from the National Health and Nutrition Examination Survey, 1999-2014 (N = 25 444). Using logistic regression, we estimated associations between smoke-free law coverage and SHS exposure among all nonsmokers, and within age strata (25-39, 40-59, 60+). We explored differential associations by gender, race/ethnicity, education, and poverty-income ratio (PIR) by testing the significance of interactions terms for the full sample and within age strata. RESULTS In adjusted models, hospitality coverage was associated with lower odds of SHS exposure in the full sample (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.51-0.76), and within each age group, with ORs ranging from 0.58 (ages 25-39) to 0.67 (ages 60+). Workplace coverage was associated with lower SHS exposure only among younger adults (OR = 0.81; 95% CI = 0.65-0.99). Within the full sample and among adults ages 40-59, hospitality laws were associated with narrowing SHS exposure differentials between males and females. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females, but worsening exposure disparities by PIR. CONCLUSIONS Smoke-free laws may reduce SHS exposure among adult nonsmokers, but may be insufficient to improve disparities in SHS exposure. IMPLICATIONS In a repeated cross-sectional sample of adult nonsmokers, smoke-free laws in hospitality venues were consistently associated with lower odds of SHS exposure and appeared to narrow exposure differentials between males and females. Associations between workplace smoke-free laws and SHS exposure were variable by age. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females while exacerbating exposure differentials by PIR. Differential patterns of association highlight the need to examine the impacts of tobacco control policies on downstream health equity.
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Affiliation(s)
- Andrea R Titus
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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University Staff and Students' Attitudes towards a Completely Smoke-Free Campus: Shifting Social Norms and Organisational Culture for Health Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137104. [PMID: 34281036 PMCID: PMC8297203 DOI: 10.3390/ijerph18137104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/02/2022]
Abstract
A large university in Queensland, Australia with a diverse staff and student community introduced a campus wide smoke-free policy in 2016. The purpose of this enquiry was to understand attitudes about a new smoke-free policy, its potential impact and the shift in social norms and organizational culture to inform the next phase of implementation. An electronic survey was distributed to all staff and students approximately 12 weeks after the smoke-free policy was implemented. The survey consisted of multiple-choice questions about demographics, smoking behaviour, attitudes towards smoking and tobacco control, awareness of the smoke-free policy, and attitudes towards the effect of a completely smoke-free campus on quality of life, learning and enrolment. The survey was completed by 641 university staff and students. Respondents reported seeking out (80.4%) and socialising in smoke-free environments (86.6%) and supported smoke-free buildings (96.1%), indoor areas (91.6%), and outdoor areas (79%). The results revealed overwhelming support for a completely smoke-free campus (83%) and minority support for designated smoking areas (31%). Overall, respondents reflected positively towards a campus wide smoke-free policy. These findings suggest Queensland’s early adoption of tobacco control laws influenced the social environment, de-normalised smoking, changed behaviour, preference for smoke-free environments and shifted social norms. These findings provide convincing evidence for organisational change and suggest health promotion policy makers should progress the implementation of smoke-free policies nationally across the higher education sector.
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Glenstrup S, Bast LS, Danielsen D, Andersen A, Tjørnhøj-Thomsen T. Places to Smoke: Exploring Smoking-Related Practices among Danish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E386. [PMID: 33419139 PMCID: PMC7825534 DOI: 10.3390/ijerph18020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022]
Abstract
Several established school smoking prevention initiatives involve restrictions on places to smoke. The focus on tobacco control in schools is due to the risk of smoking initiation during adolescence and the perception of this life stage as a period of time when health behavior is established. Hence, this period of time is considered to be ideal for health-promoting initiatives. This paper is part of an ethnographic study on adolescents' perceptions of tobacco use. Focus groups and field observations were used to explore adolescents' smoking-related practices related to smoking bans at schools. The findings show that smoking, as a place-based practice, is influenced by locally embedded rules and carries social implications resulting in a distinction between smokers and non-smokers. The distinction between smokers and non-smokers contributes to the retention of a stereotypical view of smokers and, moreover, stigmatizes smokers. According to this, restrictions on places to smoke within the school should be considered carefully in order to avoid stigma or ethical issues.
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Affiliation(s)
- Stine Glenstrup
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Lotus Sofie Bast
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Dina Danielsen
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Hedeager 3, 2. sal, 8200 Aarhus, Denmark;
| | - Tine Tjørnhøj-Thomsen
- Danish National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (L.S.B.); (D.D.); (T.T.-T.)
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Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences. Nicotine Tob Res 2020; 22:1476-1483. [PMID: 31418449 PMCID: PMC7443610 DOI: 10.1093/ntr/ntz141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
AIM To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England. METHODS Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies. RESULTS There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant. CONCLUSION Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact. IMPLICATIONS This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mirte A G Kuipers
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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14
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Abstract
Purpose
This paper aims to provide a gendered analysis of the WHO Framework Convention on Tobacco Control (FCTC) benchmarked upon the global commitments to women’s health and well-being in the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. It reviews evidence of the global consequences of neglecting women’s tobacco use and health, as well as analyzes persistent issues related to sex and gender that compromise the efficacy of tobacco control and science. Actionable recommendations are made to the Conference of the Parties to the FCTC and other key stakeholders.
Design/methodology/approach
This paper draws upon empirical studies, literature reviews and global health data at the varying intersections of gender, sex, tobacco and global health.
Findings
The global tobacco control framework and its implementation by state governments have been largely gender blind to date with dire health and economic consequences, including inequitable positive outcomes for men compared to women, and an increase in women’s smoking with associated morbidity and mortality. Gender equitable progress in combatting the tobacco epidemic will not be possible without resolving the gender bias, stigmatization, sexism and lack of intersectionality that plague tobacco control policy, research and interventions for cessation and harm reduction.
Originality/value
This paper provides an updated global overview of current trends in women’s tobacco use and comprehensively details the persistent structural barriers in tobacco control and science that limit their capacity to effectively analyze and address tobacco use and its impact on women.
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Phyo Y, Kumar AM, Kyaw KWY, Kaung KK, Nwe ML, Thida, Tharaphi. Prevalence of e-cigarette use among tobacco smokers in six states and regions of Myanmar. Addict Behav Rep 2020; 11:100248. [PMID: 32467837 PMCID: PMC7244904 DOI: 10.1016/j.abrep.2020.100248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emergence of electronic cigarettes (e-cigarettes) in the past decade has the potential to undermine the global tobacco control efforts and undo the successes achieved to date. There are also concerns that e-cigarettes may become a gateway for future tobacco use and its use is increasing globally. There is no published evidence on this issue from Myanmar. Hence, we aimed to assess prevalence of e-cigarette use among tobacco smokers and its associated socio-demographic factors in six states and regions of Myanmar. METHODS This was a secondary analysis of data collected as part of a programme evaluation conducted by the National Tobacco Control Programme of Myanmar in 2018, which involved sampling 100 smokers from each state/region. We used modified Poisson regression to measure associations. RESULTS There were 629 tobacco smokers included in the programme evaluation. Among them, 246 (39.2%, 95% CI: 24.0%-56.7%) smokers reported that they had heard of e-cigarettes and 73 (11.6%, 95% CI: 5.1%-24.3%) reported having ever used e-cigarettes. There was no e-cigarette use among female smokers. The prevalence of e-cigarette use was significantly higher among males, students, young adults aged 18-29 years, heavy smokers (greater than 20 cigarettes per day) and those who lived in the Mandalay region. CONCLUSION Our study provides preliminary evidence about e-cigarette use in Myanmar and fills an important knowledge gap. One limitation was small sample size, which is reflected by wide confidence intervals around the estimate. We recommend a national survey to obtain precise and nationally representative information.
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Affiliation(s)
- Ye Phyo
- National Tobacco Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Ajay M.V. Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (deemed to be University), Mangaluru, India
| | - Khine Wut Yee Kyaw
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Kyaw Kan Kaung
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Mya Lay Nwe
- National Tobacco Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thida
- Department of Medical Research (Pyin Oo Lwin), Ministry of Health and Sports, Myanmar
| | - Tharaphi
- International Union Against Tuberculosis and Lung Disease, Singapore
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16
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Aleshire ME, Fallin-Bennett A, Bucher A, Hatcher J. LGBT friendly healthcare providers' tobacco treatment practices and recommendations. Perspect Psychiatr Care 2019; 55:546-553. [PMID: 31093993 DOI: 10.1111/ppc.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers' (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. DESIGN AND METHODS In-depth, semistructured phone interviews were conducted with 13 healthcare providers. FINDINGS Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. PRACTICE IMPLICATIONS Holistic tobacco treatment services are needed to address LGBT-specific barriers to tobacco cessation, such as stress, identity-related factors, and inadequate healthcare access.
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Affiliation(s)
- Mollie E Aleshire
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina
| | | | - Amanda Bucher
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Jennifer Hatcher
- College of Public Health, University of Arizona-Phoenix, Phoenix, Arizona
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17
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Abstract
Many smokers are aware that smoking is a dangerous health behavior and eventually try to quit smoking. Unfortunately, most quit attempts end in failure. Traditionally, the addictive nature of smoking has been attributed to the pharmacologic effects of nicotine. In an effort to offer a more comprehensive, biobehavioral analysis of smoking behavior and motivation, some researchers have begun to consider the role of social factors in smoking. In line with recent recommendations to integrate social and pharmacological analyses of smoking, we reviewed the experimental literature examining the effects of nicotine and nicotine withdrawal on social functioning. The review identified 13 studies that experimentally manipulated nicotine and assessed social functioning, 12 of which found support for nicotine's enhancement of social functioning. Although few experiments have investigated social functioning, they nevertheless offer compelling evidence that nicotine enhances social functioning in smokers and suggest that nicotine deprivation may hamper social functioning in those dependent on nicotine. Future directions for investigating social outcomes and context in those who use nicotine products are discussed with a focus on leveraging advances in social and developmental psychology, animal research, sociology, and neuroimaging to more comprehensively understand smoking behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Lea M Martin
- Department of Psychology, University of Pittsburgh
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18
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O'Connor RJ, Rees VW, Rivard C, Hatsukami DK, Cummings KM. Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use. Subst Abus 2017; 38:330-336. [PMID: 28481713 DOI: 10.1080/08897077.2017.1326999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reducing the social acceptability of smoking is associated with lowered smoking prevalence. However, denormalization strategies can also contribute to the stigmatization that some smokers may feel about their smoking. Smoking stigma may be more acute if smokers are also members of other stigmatized groups, such as racial/ethnic minorities. This study examined correlates of smoking self- and felt-stigma and discrimination, among current smokers. METHODS Participants were recruited in the United States via a national commercial consumer panel to complete a cross-sectional, Web-based survey. Participants were 1528 current cigarette smokers aged 14 and older. Measures included the Internalized Stigma of Smoking Inventory (ISSI), Heaviness of Smoking Index, quit intentions, past-year quit attempts, and current use of electronic cigarettes (e-cigarettes). RESULTS Self-stigma was significantly associated with higher intent to quit in the next 6 months (odds ratio [OR] = 2.47, P < .01) and in the next 30 days (OR = 4.21, P < .01), relative to no intention to quit, as well as having made 1 or 2 quit attempts in the past year (OR = 1.60, P < .01) or 3 or more quit attempts (OR = 1.74, P < .01) and associated with daily e-cigarette use (OR = 1.73, P < .05). Felt-stigma was positively associated with intent to quit in the next 30 days (OR = 1.54, P < .01), having made 3 or more quit attempts in the past year (OR = 1.35, P < .01), and both daily (OR = 2.05, P < .05) and some-day (OR = 1.30, P < .05) e-cigarette use. Discrimination was associated only with increased odds of daily e-cigarette use (OR = 1.83, P < .05). CONCLUSIONS Smokers who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts, report a stronger intention quit smoking in the future, and report use of e-cigarettes, suggesting that feelings of self-and felt-stigmatization are related to greater motivation to stop smoking.
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Affiliation(s)
- Richard J O'Connor
- a Department of Health Behavior , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Vaughan W Rees
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Cheryl Rivard
- a Department of Health Behavior , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Dorothy K Hatsukami
- c Department of Psychiatry , University of Minnesota , Minneapolis , Minnesota , USA
| | - K Michael Cummings
- d Department of Psychiatry and Behavioral Science , Medical University of South Carolina , Charleston , South Carolina , USA
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Antin TM, Annechino R, Hunt G, Lipperman-Kreda S, Young M. The Gendered Experience of Smoking Stigma: Implications for Tobacco Control. CRITICAL PUBLIC HEALTH 2016; 27:443-454. [PMID: 29962663 PMCID: PMC6025843 DOI: 10.1080/09581596.2016.1249825] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tobacco denormalization is a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of widespread beliefs about the effectiveness of tobacco denormalization approaches, concerns about their emphasis on stigmatization have emerged. Social science research on smoking stigma raises questions about the potential iatrogenic consequences of tobacco denormalization approaches. Few studies have considered how smoking stigma may be internalized differently by different people, particularly those who experience stigmatization because of other socially-ascribed makers of inequity (e.g. race, ethnicity, gender, sexuality). The intersection of multiple stigmas may work to intensify the "social isolation and marginalization" that some people already experience (Greaves & Hemsing 2009; pg S127). This paper presents results from a pattern-level analysis of focus group and interview data from a study investigating smoking-related stigma and perceptions of tobacco denormalization approaches among 15 low income Black women who smoke in the San Francisco Bay Area. Our analysis revealed a cycle where Black women's experiences with structural oppression resulted in stress and the use of cigarettes to cope with that stress. Though the connection between smoking and stress is well documented in previous research, our analysis further revealed the additional contribution of the stigmatization of smoking and how it intensifies inequity for Black women who smoke. Implications of these findings for tobacco control and prevention are discussed.
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Affiliation(s)
- Tamar M.J. Antin
- Center for Critical Public Health, Prevention Research Center, 180 Grand, Suite 1200, Oakland, CA 94612
- Center for Critical Public Health, Institute for Scientific Analysis, Suite 211, 1150 Ballena Blvd, Alameda, CA 94501
| | - Rachelle Annechino
- Center for Critical Public Health, Prevention Research Center, 180 Grand, Suite 1200, Oakland, CA 94612
| | - Geoffrey Hunt
- Center for Critical Public Health, Institute for Scientific Analysis, Suite 211, 1150 Ballena Blvd, Alameda, CA 94501
| | | | - Malisa Young
- Center for Critical Public Health, Prevention Research Center, 180 Grand, Suite 1200, Oakland, CA 94612
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Voigt K. Voigt Responds. Am J Public Health 2016; 106:569-70. [DOI: 10.2105/ajph.2015.303029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kristin Voigt
- Kristin Voigt is with The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK, and the Institute for Health and Social Policy and the Department of Philosophy, McGill University, Montreal, Quebec, Canada
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