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Kalousova L, Xie Y, Levy D, Meza R, Thrasher JF, Elliott MR, Titus AR, Fleischer NL. Cigarette Prices and Disparities in Smoking Cessation in the United States. Nicotine Tob Res 2024; 26:1089-1096. [PMID: 38127643 PMCID: PMC11260891 DOI: 10.1093/ntr/ntad254] [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: 01/29/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Achieving cessation in people with established smoking patterns remains a challenge. Increasing cigarette prices has been one of the most successful strategies for lowering smoking rates. The extent to which it has remained effective in encouraging cessation among adults in recent years and how the effectiveness has varied by sociodemographic characteristics is unclear. AIMS AND METHODS Using repeated cross-sectional data collected by the Tobacco Use Supplement of the Current Population Survey, we investigate the relationship between cigarette prices and cessation from 2003 to 2019 in adults at least 25 years old. We examine the associations between price and cessation in the population overall and by sex, race and ethnicity, and socioeconomic status. RESULTS We found mixed support for associations between greater local prices and cessation. Unadjusted models showed that greater local prices were associated with greater odds of cessation, but the associations did not persist after controlling for sociodemographic characteristics. The associations did not significantly differ by respondent characteristics. Sensitivity analysis using alternative specifications and retail state price as the main predictor showed similar results. Sensitivity analysis with controls for e-cigarette use in the 2014-2019 period showed that greater local price was associated with cessation among adults with less than a high school degree. When stratified by year of data collection, results show that greater local prices were associated with cessation after 2009. CONCLUSIONS Overall, the study adds to the conflicting evidence on the effectiveness of increasing prices on smoking cessation among adults with established smoking patterns. IMPLICATIONS Higher cigarette prices have been one of the most successful tools for lowering smoking prevalence. It remains unclear how effective they have been in recent years in encouraging adults with established smoking patterns to quit. The study's results show that greater local prices were associated with higher odds of cessation, but the association did not persist after sociodemographic adjustment. In a sensitivity analysis, greater local price was associated with cessation among people with less than a high school degree in models controlling for e-cigarette use. We also found evidence that greater local price was associated with cessation after 2009. More comprehensive smoke-free coverage was also associated with greater odds of cessation. The study's results highlight that encouraging cessation among adults with an established smoking pattern remains a challenging policy problem even when cigarette prices rise.
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Affiliation(s)
- Lucie Kalousova
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
- Department of Sociology, Vanderbilt University, Nashville, TN, USA
| | - Yanmei Xie
- Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - David Levy
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael R Elliott
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Andrea R Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Nancy L Fleischer
- Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Vuolo M, Orsini MM, Staff J, Maggs JL, Kelly BC. Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people. Addiction 2024; 119:1037-1047. [PMID: 38413382 DOI: 10.1111/add.16450] [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: 08/09/2023] [Accepted: 01/06/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND AIMS E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status. DESIGN Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated. SETTING United States. PARTICIPANTS Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations). MEASUREMENT We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22. FINDINGS Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates. CONCLUSIONS In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Maria M Orsini
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Jeremy Staff
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer L Maggs
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Collins BN, Lepore SJ, Egleston BL. Eliminating children's tobacco smoke exposure: a pathway to bioverified abstinence among low-income maternal smokers in the Babies Living Safe and Smokefree (BLiSS) trial. J Behav Med 2023; 46:1042-1048. [PMID: 37285107 PMCID: PMC10591859 DOI: 10.1007/s10865-023-00423-9] [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: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Identifying behavioral pathways to smoking cessation in high-risk populations, such as low-income maternal smokers, could reduce tobacco disparities. The previous "BLiSS" multilevel intervention trial demonstrated efficacy of the BLiSS intervention in facilitating low-income maternal smokers' bioverified abstinence. This present study examined four putative pathways measured at 3-month end of treatment (Time 2) that could account for the observed intervention effect on smoking abstinence through 12 months (Time 2 - Time 3). METHODS Nutritionists in community clinics delivering safety net nutrition promotion programs across Philadelphia, Pennsylvania, USA, were trained by trial principal investigators to deliver a brief tobacco intervention informed by the American Academy of Pediatrics best practice guidelines ("Ask, Advise, Refer [AAR]"). After referral, 396 eligible participants were randomized to either a multimodal behavioral intervention (AAR + MBI) or a parallel attention control (AAR + control). Random effects regression analysis tested mediation. RESULTS Elimination of children's tobacco smoke exposure (TSE) at Time 2 was the only significant mediator of longitudinal smoking abstinence through Time 3. AAR + MBI mothers were more likely to eliminate their children's TSE by Time 2 (OR = 2.11, 95%CI 1.30, 3.42), which was significantly associated with Time 3 abstinence (OR = 6.72, CI 2.28, 19.80). Modeling showed a significant total effect of AAR + MBI on abstinence (OR = 6.21, CI 1.86, 20.71), a direct effect of AAR + MBI on abstinence (OR = 4.80, CI 1.45, 15.94) and an indirect effect through TSE elimination (OR = 1.29, CI 1.06, 1.57). CONCLUSIONS Integrating smoking cessation interventions with counseling prior to the quit attempt that is designed to facilitate adoption of smokefree home policies and efforts to eliminate children's TSE could enhance the likelihood of long-term abstinence in populations of smokers with elevated challenges quitting smoking.
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Affiliation(s)
- Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA.
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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Moore Ude RG, Herring RP, Ismail M, Oda K, Bahjri K, Reis WP, Gaio J, Dos Santos H. Why Can't I Stop Smoking: Predictors of Tobacco Use and Quit Rates in the Freedom From Tobacco Program. Cureus 2023; 15:e41649. [PMID: 37565122 PMCID: PMC10411653 DOI: 10.7759/cureus.41649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction As the leading cause of preventable chronic diseases in adults 18 years and older, tobacco usage in the U.S. results in over 20 million premature deaths annually. Current smokers might need extra support on the path to successfully quitting. Aim To evaluate the influence of predictors of smoking-on-smoking cessation in the Freedom From Tobacco Program (FFT) offered by Southern California Permanente Medical Group (SCPMG). Methods This was a quasi-experimental study to evaluate rates of smoking cessation among participants in the FFT program. There were 471 participants in the study. Factors of the Social Ecological Model (SEM) and demographics were examined to determine if they could predict tobacco cessation. The SEM suggests that an individual's behavior is integrated into a network of intrapersonal characteristics, interpersonal processes, institutional factors, community features, and public policy. In particular, the study mainly addressed the institutional factor. It was promoted within a Health Management Organization and the interpersonal process because it was a group intervention. Findings After multiple regression analyses with all predictors from the SEM and demographics, the only significant predictor was the number of previous attempts to quit. Smokers who tried to stop four or more times in the past were 2.6 times (p<0.03) more likely to quit than those who tried fewer times. As we are aware, this was the first time this result was found for programs implemented by Health Management Organizations. The general quit rate at 12 months for the FFT program was 43.1%. Conclusion As the only predictor of quitting in this study was the number of previous attempts to quit smoking, the recommendation is to develop longer-term smoking cessation programs or a longer follow-up to facilitate smokers who relapse to go back and try to quit again. Another recommendation is to identify the main reasons for relapse and try to address these factors in further interventions.
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Affiliation(s)
- Regina G Moore Ude
- Health and Human Ecology, California State University, San Bernardino, USA
| | - R Patti Herring
- School of Public Heath, Loma Linda University Medical Center, Loma Linda, USA
| | | | - Keiji Oda
- School of Public Health, Loma Linda University Medical Center, Loma Linda, USA
| | - Khaled Bahjri
- Clinical Research, New World Medical, Rancho Cucamonga, USA
| | - Wenes P Reis
- Public Health, Loma Linda University Medical Center, Loma Linda, USA
| | - Josileide Gaio
- Public Health, Loma Linda University Medical Center, Loma Linda, USA
| | - Hildemar Dos Santos
- Preventive Care, Loma Linda University School of Public Health, Loma Linda, USA
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Tam J, Levy DT, Feuer EJ, Jeon J, Holford TR, Meza R. Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective. Am J Prev Med 2023; 64:S1-S10. [PMID: 36781373 PMCID: PMC10033336 DOI: 10.1016/j.amepre.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
U.S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group previously generated smoking histories for the whole U.S. population using an age, period, and birth cohort (APC) methodological framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U.S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, educational attainment, family income, and for each of the 50 U.S. states and Washington, DC. All-cause mortality relative risks associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, demonstrating the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U.S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Eric J Feuer
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Ashford KB, Blair LM, McCubbin AK, Wiggins AT, Rayens MK, Hahn EJ. Municipal smoke-free laws and preterm birth. Am J Obstet Gynecol 2022; 227:767.e1-767.e10. [PMID: 35932874 DOI: 10.1016/j.ajog.2022.07.058] [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: 03/04/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.
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Affiliation(s)
- Kristin B Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY.
| | - Lisa M Blair
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | - Andrea K McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | | | | | - Ellen J Hahn
- University of Kentucky College of Nursing, Lexington, KY
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Semple S, Dobson R, O'Donnell R, Zainal Abidin E, Tigova O, Okello G, Fernández E. Smoke-free spaces: a decade of progress, a need for more? Tob Control 2022; 31:250-256. [PMID: 35241597 DOI: 10.1136/tobaccocontrol-2021-056556] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022]
Abstract
Adoption of smoke-free measures has been one of the central elements of tobacco control activity over the past 30 years. The past decade has seen an increasing number of countries and proportion of the global population covered by smoke-free policies to some extent. Despite reductions in global smoking prevalence, population growth means that the number of non-smokers exposed to the harms caused by secondhand smoke remains high. Smoke-free policy measures have been shown to be useful in protecting non-smokers from secondhand smoke, and can additionally increase cessation and reduce smoking initiation. Policies tend to be aimed primarily at enclosed public or workplace settings with very few countries attempting to control exposure in private or semiprivate spaces such as homes and cars, and, as a result, children may be benefiting less from smoke-free measures than adults. Compliance with legislation also varies by country and there is a need for education and empowerment together with guidance and changing social norms to help deliver the full benefits that smoke-free spaces can bring. Restrictions and policies on use of electronic cigarettes (e-cigarettes) in smoke-free settings require more research to determine the benefits and implications of bystanders' exposure to secondhand e-cigarette aerosol, dual use and smoking cessation.
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Affiliation(s)
- Sean Semple
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Ruaraidh Dobson
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O'Donnell
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Emilia Zainal Abidin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gabriel Okello
- African Centre for Clean Air, Kampala, Uganda.,Cambridge Institute for Sustainability Leadership, University of Cambridge, Cambridge, UK.,AirQo, College of Computing and Information Sciences, Makerere University, Kampala, Uganda
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Titus AR, Xie Y, Thrasher JF, Levy DT, Elliott MR, Patrick ME, Fleischer NL. A longitudinal analysis of smoke-free laws and smoking initiation disparities among young adults in the United States. Addiction 2022; 117:730-738. [PMID: 34342916 PMCID: PMC8810897 DOI: 10.1111/add.15658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Tobacco control policies may differentially impact smoking initiation among socio-demographic groups. We measured longitudinal associations between exposure to smoke-free laws in grade 12 (modal age 18 years) and patterns of smoking initiation in the United States. DESIGN Prospective longitudinal analysis. SETTING AND PARTICIPANTS We used data on US young adults sampled at modal age 18 years from the Monitoring the Future Survey. Baseline data were collected between 2000 and 2017, with the last year of follow-up in 2018. The sample number varied by outcome and time-point, ranging from 7314 to 17 702. MEASUREMENTS Smoke-free law coverage in work-places and hospitality venues (restaurants/bars) was measured as the percentage of the county population covered by each type of law. We examined associations with any past 30-day smoking initiation and daily smoking initiation at modal ages 19/20, 21/22 and 23/24, using Poisson regression and calculating average marginal effects. We explored effect modification by sex, race/ethnicity and parental education by testing the significance of interaction terms. FINDINGS Work-place law coverage at modal age 18 was associated with a lower probability of daily smoking initiation at modal ages 21/22 [-2.4 percentage points (p.p.); 95% confidence interval (CI) = -3.9, -0.9] and 23/24 (-2.0 p.p.; 95% CI = -3.9, -0.2). Hospitality law coverage was associated with a lower probability of daily smoking initiation at modal ages 19/20 (-1.6 p.p.; 95% CI = -2.8, -0.4), 21/22 (-2.3 p.p.; 95% CI = -3.7, -0.9) and 23/24 (-1.8 p.p.; 95% CI = -3.6, -0.0). Findings were inconclusive with regard to associations with any past 30-day smoking initiation and with regard to effect modification, after adjusting for multiple testing. CONCLUSIONS Exposure to smoke-free laws at age 18 appears to be prospectively associated with reduced daily smoking initiation 1-6 years later.
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Affiliation(s)
- Andrea R. Titus
- Population Health, Grossman School of Medicine, New York
University, New York, NY, USA
| | - Yanmei Xie
- Epidemiology, School of Public Health, University of
Michigan, 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
| | - David T. Levy
- Oncology, Lombardi Comprehensive Cancer Center, Georgetown
University, Washington, DC, USA
| | - Michael R. Elliott
- Biostatistics, School of Public Health, University of
Michigan, Ann Arbor, MI, USA,Survey Research Center, Institute for Social Research,
University of Michigan, Ann Arbor, MI, USA
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann
Arbor, MI, USA
| | - Nancy L. Fleischer
- Epidemiology, School of Public Health, University of
Michigan, Ann Arbor, MI, USA
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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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10
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Liu B, Dompreh I, Hartman AM. Small-Area Estimation of Smoke-Free Workplace Policies and Home Rules in US Counties. Nicotine Tob Res 2021; 23:1300-1307. [PMID: 33532860 DOI: 10.1093/ntr/ntab015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/30/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The workplace and home are sources of exposure to secondhand smoke, a serious health hazard for nonsmoking adults and children. Smoke-free workplace policies and home rules protect nonsmoking individuals from secondhand smoke and help individuals who smoke to quit smoking. However, estimated population coverages of smoke-free workplace policies and home rules are not typically available at small geographic levels such as counties. Model-based small-area estimation techniques are needed to produce such estimates. METHODS Self-reported smoke-free workplace policies and home rules data came from the 2014-2015 Tobacco Use Supplement to the Current Population Survey. County-level design-based estimates of the two measures were computed and linked to county-level relevant covariates obtained from external sources. Hierarchical Bayesian models were then built and implemented through Markov Chain Monte Carlo methods. RESULTS Model-based estimates of smoke-free workplace policies and home rules were produced for 3134 (of 3143) US counties. In 2014-2015, nearly 80% of US adult workers were covered by smoke-free workplace policies, and more than 85% of US adults were covered by smoke-free home rules. We found large variations within and between states in the coverage of smoke-free workplace policies and home rules. CONCLUSIONS The small-area modeling approach efficiently reduced the variability that was attributable to small sample size in the direct estimates for counties with data and predicted estimates for counties without data by borrowing strength from covariates and other counties with similar profiles. The county-level modeled estimates can serve as a useful resource for tobacco control research and intervention. IMPLICATIONS Detailed county- and state-level estimates of smoke-free workplace policies and home rules can help identify coverage disparities and differential impact of smoke-free legislation and related social norms. Moreover, this estimation framework can be useful for modeling different tobacco control variables and applied elsewhere, for example, to other behavioral, policy, or health related topics.
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Affiliation(s)
- Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Isaac Dompreh
- Center for Statistical Research and Methodology, US Census Bureau, Washington, DC, USA
| | - Anne M Hartman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Bien-Gund CH, Choi GH, Mashas A, Shaw PA, Miller M, Gross R, Brady KA. Persistent Disparities in Smoking Rates Among PLWH Compared to the General Population in Philadelphia, 2009-2014. AIDS Behav 2021; 25:148-153. [PMID: 32591983 DOI: 10.1007/s10461-020-02952-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite reductions in smoking rates in the general population, little is known about recent smoking trends among people living with HIV (PLWH). We compared the risk for smoking and temporal trends in smoking among PLWH and the general population in the Philadelphia metropolitan area between 2009 and 2014. We used weighted logistic regression to assess the relation between HIV and smoking, and examined temporal smoking trends. The adjusted odds ratio (OR) for smoking comparing PLWH to the general population was 1.80 (95% CI 1.55-2.09) after adjusting for socio-economic, demographic, and mental health diagnosis variables. Smoking prevalence decreased in both the PLWH and general populations during the study period, and we did not observe a significant difference in rates of decline between groups (P = 0.54). Despite overall progress in smoking cessation, a disparity persisted in smoking rates between PLWH and the general population, with and without adjustment for socio-economic, demographic, and mental health variables. Further research is needed to understand the mechanisms linking HIV and tobacco use in order to inform public health efforts to reduce smoking among PLWH.
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Affiliation(s)
- Cedric H Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Grace H Choi
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Antonios Mashas
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Melissa Miller
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
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