Tobacco Use as a Health Disparity: What Can Pediatric Clinicians Do?

E-cigarette disparities: Who are the targets?

The tobacco industry has a long history of promoting health disparities especially through targeted marketing campaigns. The disparities perpetuated by e-cigarettes are just becoming apparent. This article will focus on disparities in e-cigarette usage within the following categories of youth: racial or ethnic groups, sexual and gender minoritized individuals, adolescents with asthma, teens with disabilities, and those coping with mental health stresses. Millions of youth are still using e-cigarettes, and e-cigarette use is disproportionately impacting White youth, youth who identify at lesbian, gay and transgender, and youth with disabilities. In addition, this article highlights the timeline of key tobacco regulations and recommended actions to curb the e-cigarette epidemic.

An Analysis of the Links between Smoking and BMI in Adolescents: A Moving Average Approach to Establishing the Statistical Relationship between Quantitative and Dichotomous Variables

The aim of this study was to determine the effect of smoking on BMI in male adolescents and explore the relationship between smoking status and diet. Methods: A cross-sectional epidemiological study into the health and diet of adolescents was carried out based on a representative sample of 375 vocational school male students aged 16–17 in the city of Chelyabinsk (Russian Federation). The students and their parents filled out verified questionnaires on their socioeconomic status, diet, and smoking status. Students’ height and body weight were measured. A comparative analysis of diets was performed between groups of smokers and non-smokers (149 and 226 individuals, respectively), and the relationship between smoking, body mass index, and actual diet was estimated. The methods used included descriptive statistics, Student’s t-test, Mann–Whitney U test, comparison of proportions, and moving average. Results: Non-smoking adolescent boys tended to have excess body mass compared with smokers (19.0% and 12.1%, respectively). Smokers (adolescent boys) consumed less meat, cereals, beans, and cheeses and more sweet beverages, added sugar, coffee, and alcohol. The bulk of the smokers’ diet was composed of carbohydrates (p = 0.026) and, to a lesser extent, proteins (p = 0.006). Conclusions: Significant differences were discovered in the diet between smokers and non-smokers (among adolescent boys), and smoking was associated with several indicators of unhealthy diet patterns. This is an important conclusion for developing a future program that could additionally protect at-risk groups of adolescents.

Nicotine Dependence among Adolescents Single and Dual Cigarette Users

The prevalence of concurrent use of combustible and electronic cigarettes (dual-use) is on the rise among Malaysian adolescents. This study compares nicotine dependence among exclusive cigarette users, e-cigarette users, and dual adolescent users. A total of 227 adolescent smokers completed a self-administrated questionnaire with items based on Hooked on Nicotine Checklist (HONC) incorporated. Endorsement of at least one HONC item indicates nicotine dependence. Exhaled carbon monoxide readings and salivary cotinine data were also collected. Over half (52.9%) of the participants were exclusive e-cigarette users (EC). The prevalence of exclusive conventional cigarette smokers (CC) and dual users was 11.9% and 35.2%, respectively. Adolescents who have mothers with secondary school education were more likely to become addicted to nicotine (Adjusted Odd Ratio (aOR) = 2.72; 95% CI = 1.17–6.32). Adolescents’ “mother’s education” level predicted nicotine dependence. This highlighted the need to target families within the identified demography with a more supportive anti-tobacco program.

Does Participation in Sports Influence the Prevalence of and Initiation into Multiple Substance Misuse in Adolescence? A Two-Year Prospective Analysis

Concurrent smoking and harmful drinking (CSHD) in adolescence is an important public health and social problem, while participation in sports is considered as being protective against CSHD. This study aimed to prospectively evaluate the influence of various facets of sports participation on the prevalence of and initiation into CSHD of adolescents. Participants were adolescents from southern Croatia (n = 711, 43.6% females, 16 years of age at study baseline), who were tested at baseline and at follow-up (two years later). Variables included gender, age, sports factors (participation in individual and team sports, sport experience, competitive success, intensity of involvement in sports), and CSHD. The CSHD prevalence did not increase significantly over the course of the study (from 5.6% to 7.5%, p > 0.05). Binomial logistic regression with age and gender as covariates suggested that team sports participation correlated to CSHD prevalence at baseline, and follow-up, with higher risk for CSHD among those adolescents who quit team sports (OR = 9.18 and 2.68, 95%CI = 2.04–22.26 and 1.05–6.83 for baseline and follow-up, respectively), and those never involved in team sports (OR = 9.00 and 3.70, 95%CI = 2.07–39.16 and 1.57–8.72 for baseline and follow-up, respectively). A higher risk of CSHD at baseline was seen among those adolescents who were involved in sports for longer (OR = 1.66, 95%CI = 1.16–2.38). The results are discussed in the context of the fact that the study included adolescents at the age of rigid sports selection (the transition from youth to professional-level sports). Since the majority of participants began CSHD at an earlier age, further studies in subjects of a younger age range are warranted.

Provision of free nicotine replacement therapy to parental smokers in the pediatric emergency setting

INTRODUCTION

Although the administration of free Nicotine Replacement Therapy (NRT) is effective in helping smokers quit, the feasibility, acceptability and safety of this practice have not been examined in the emergency setting of the pediatric emergency department (PED) or urgent care (UC). We examined the characteristics of parental smokers who were interested and eligible for free NRT during their child's emergency visit and the uptake, usage, and associated side effects of NRT use.

METHODS

We analyzed data from 377 parental smokers who were randomized to receive cessation counseling and free NRT as part of an emergency visit-based randomized controlled trial. Parents interested in NRT were screened for medical contraindications; eligible parents were given a 6-week supply of NRT patches or lozenges during their child's emergency visit and offered another supply 6 weeks later. We conducted Wilcoxon rank-sum tests and chi-squared tests to address our main study objective.

RESULTS

The majority of parents were female (87.5%), non-Hispanic Black (52.5%), and mean (SD) age was 33.1 (8.2) years. A total of 252 (66.8%) parents were interested in receiving NRT. Compared to uninterested parents, interested parents were more likely to: be older [33.6 (8.2) vs 31.9 (8.2), years]; be non-Hispanic Black (54.0% vs 49.6%); have older children [5.5 (5.0) vs 4.2 (4.6)]; have a higher readiness to quit [7.0 (2.4) vs 5.2 (2.6)]; and have a child being evaluated in UC compared to the PED (72.4% vs 56.5%). A total of 53 (21%) interested parents had >1 NRT contraindications. At 6 weeks, 94 (79.0%) parents reported some ≥NRT usage and 50 (53.2%) requested an additional 6-week supply. There were no serious adverse events and 5 (5.3%) reported minor side effects.

CONCLUSIONS

Parental smokers in the emergency setting are interested in receiving free NRT, the majority use it, and use is not associated with adverse side effects. The emergency visit may be an optimal time to offer NRT to parental smokers.

Are national antitobacco campaigns reaching high-risk adolescents? A cross-sectional analysis from PATH Wave 2

Smoking education and prevention campaigns have had marked success in reducing rates of tobacco use among adolescents, however, disparities in use continue to exist. It is critical to assess if adolescents at risk for tobacco use are being exposed to antitobacco campaigns. We used data from Wave 2 of the Population Assessment of Tobacco and Health Study to assess the relationship between exposure to three antitobacco campaigns and key characteristics related to higher risk of cigarette use using full-sample weights and Poisson regression models with robust variance. Adjusted models identified that exposure to antitobacco campaigns was more common among racial and sexual minority adolescents and adolescents who: reported exposure to tobacco marketing, spent more time using media and had household income greater than $25 000. While some high-risk youth are more likely to report exposure to campaigns, there are some priority groups that are not being reached by current efforts compared with non-priority groups, including youth living in households with income below the poverty line and adolescents who are susceptible to cigarette smoking. Future campaigns should consider targeting these groups specifically in order to reduce tobacco use disparities.