Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022

This study examines support for the Department of Housing and Urban Development's (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018-March 2020 (post-rule), and September 2020-December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.

Abstract P6-05-60: People with metastatic breast cancer face barriers to finding information and support

People with metastatic breast cancer face barriers to finding information and support Background FORCE, a national nonprofit organization developed a health communication tool to help patients assess research relevance, key findings, and the quality of media reporting on cancer to support informed and shared health decision-making. People with metastatic breast cancer (mBC) are a priority population. Methods The organization conducted a survey about awareness of and access to breast cancer information and supportive services for people living with metastatic breast cancer. The organization promoted the survey through e-mail and social media, and a network of partner organizations that serve the metastatic breast cancer community. The survey invited respondents to volunteer to participate in focus groups and a follow-up survey in order to support efforts to serve this priority population. Results and Conclusions While interest in clinical trials was high, many users reported that thy do not know how to find an appropriate clinical trial. A majority of the 335 respondents were interested in information about clinical trials, treatment side effects, research findings, long-term health issues, diet/exercise, fatigue, and emotional health. Three quarters of the respondents indicated that they had never participated in a clinical trial, 67% indicated they would be interested in participating in the future, and about 40% indicated they did not know how to find a clinical trial recruiting people with metastatic breast cancer. Approximately one-third of participants were unable to obtain referrals to services they sought. Other barriers to services included lack of insurance coverage, lack of availability, and the COVID-19 public health emergency. Focus group responses indicate that women with mBC find the health communication tool to be useful, and appropriate in language, images, and tone. Results indicate that women with mBC are interested in finding information about clinical trials and other topics related to treatment side effects and quality of life. FORCE and partners are incorporating these results into tailored online resources to meet the needs of the mBC community.

Citation Format: Robin H. Pugh-Yi, Piri Welcsh, Kelly Owens, Diane Rose, Erica Kuhn, Craig T. Dearfield, Susan Friedman. People with metastatic breast cancer face barriers to finding information and support [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-60.

Are excluding e-cigarettes a loophole in the smokefree public housing rule?

The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.

Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing

OBJECTIVES

Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold.

SETTING

15 District of Columbia Housing Authority properties between March 2019 and March 2021.

PARTICIPANTS

221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black).

PRIMARY AND SECONDARY OUTCOMES

Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban.

RESULTS

Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product.

CONCLUSIONS

Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.

Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule

The present study examines public housing residents' smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development's mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18-80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60-80 were more likely to consider quitting because of the rule, compared to residents ages 18-59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.

E-cigarette initiation predicts subsequent academic performance among youth: Results from the PATH Study

Research shows cigarette smoking is associated with lower academic performance among youth. This study examines how initiating e-cigarette use is associated with subsequent academic performance. Data from Waves 2-4 youth and parent surveys of the Population Assessment of Tobacco and Health (PATH) Study were analyzed. Youth (12-15 years old) who reported never using any tobacco products at Wave 2 were included in the analysis (n = 4960). Initiation of e-cigarettes and cigarettes was assessed at Wave 3. Weighted multivariable linear regression models were tested to assess the association between e-cigarette and cigarette initiation at Wave 3 and academic performance at Wave 4, controlling for covariates at Wave 2. At Wave 3, 4.3% and 1.9% of youth initiated e-cigarette and cigarette use, respectively. Youth who initiated e-cigarette use at Wave 3 had lower academic performance at Wave 4, compared to those who did not initiate e-cigarette use (adjusted regression coefficient [ARC] -0.22, 95% confidence interval [CI] -0.43, -0.02). Initiating cigarettes was also associated with lower academic performance (ARC -0.51, 95% CI -0.84, -0.18). Results indicate that e-cigarette use initiation is associated with lower subsequent academic performance, independent from the association between cigarette use initiation and lower academic performance among U.S. youth. Future research needs to examine whether preventing youth e-cigarette and cigarette use can lead to improvement in academic performance.

Abstract P6-14-08: Effects of online resource to support laypersons' understanding of media reports on breast cancer research

Rationale: Breast cancer is the second leading cause of death among women ages 20 to 39. Approximately 7% of women with breast cancer are diagnosed before age 40. Women age 45 or younger with breast cancer or who are at high risk for breast cancer have distinct health risks and different needs from their older counterparts. Breast cancer risk, etiology, treatment, outcomes, and related survivorship and quality of life concerns often vary between younger and older women. Diagnosis at a young age is associated with higher risk of recurrence, second malignancy, mortality, morbidity, and quality of life issues.

Young women with or at high risk for breast cancer need clearly presented information based on sound evidence to help them make informed decisions about their specific health needs. To help women better understand media coverage about new research, Facing Our Risk of Cancer Empowered (FORCE) developed XRAYS (eXamining Relevance of Articles to Young Survivors). XRAYS is an online resource that provides brief articles summarizing recent research relevant to young women with or at risk for breast cancer. XRAYS articles rate the quality and relevance of scientific research and the quality of media reporting on that research.

Objectives: The objectives of the current project were to:

1) conduct an initial test of XRAYS's effectiveness in improving users' knowledge about information covered in media reports

2) assess the degree to which XRAYS facilitates awareness of recent research findings

3) Obtain feedback regarding XRAYS' utility and appeal

4) Use results to inform XRAYS development

Methods and Results: An independent evaluator randomly assigned 21 participants to a treatment (read media article plus XRAYS review) or control (read media article only) condition. Each respondent completed multiple choice pre- and post-intervention tests about information contained in one of three media reports (Two respondents took their written surveys with them. Statistical analyses were conducted on data from the remaining respondents). Results demonstrate that both groups improved between pre- and post-test. The treatment group increased knowledge significantly more than the control group.

Table 1.Results of within group comparisonsGroupNPre-test Mean, Percentage Correct Responses (s.d.)Post-test Mean, Percentage Correct Responses (s.d.)t-score (d.f.)PComparison Group857.5 (12.82)72.5 (23.75)-2.05 (7)n.s.XRAYS1152.73 (20.54)87.27 (16.18)-7.29 (10)<.001

Table 2.Results of between group comparisonGroupNMean Change Score (s.d.)t-score (d.f.)PComparison Group815.00 (20.70)-2.34 (18)<.05XRAYS1134.55 (15.72)  

Participants also contributed to one of three focus groups. Focus group results indicate that XRAYS is a valuable resource for identifying relevant recent research findings and for explaining limitations in research methods, relevance, and reporting quality. Results also indicate that it is critical for XRAYS to be brief, use non-technical language, and address the most recent trends in media coverage. FORCE is using focus group feedback to guide decisions about XRAYS content, format, and dissemination. FORCE will collect additional data to confirm test findings and to assess effects of XRAYS on understanding of evidence quality.

Citation Format: Pugh Yi RH, Rezende L, Dearfield CT, Welcsh PL, Friedman SJ. Effects of online resource to support laypersons' understanding of media reports on breast cancer research [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-14-08.

XRAYS (eXamining Relevance of Articles to Young Survivors) Program Survey of Information Needs and Media Use by Young Breast Cancer Survivors and Young Women at High-Risk for Breast Cancer

Women age 45 years or younger with breast cancer, or who are at high-risk for breast cancer due to previously having the disease or to genetic risk, have distinct health risks and needs from their older counterparts. Young women frequently seek health information through the Internet and mainstream media, but often find it does not address their particular concerns, that it is difficult to evaluate or interpret, or even misleading. To help women better understand media coverage about new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community's needs, FORCE launched a web-based survey to assess where young women seek information about breast cancer, and to learn their unmet information needs. A total of 1,178 eligible women responded to the survey. In general, the breast cancer survivors and high-risk women between ages 18-45 years who responded to this survey, are using multiple media sources to seek information about breast cancer risk, prevention, screening, and treatment. They place trust in several media sources and use them to inform their medical decisions. Only about one-third of respondents to this survey report discussing media sources with their health care providers. Current survey results indicate that, by providing credible information on the quality of evidence and reporting in media reports on cancer, XRAYS is addressing a key need for health information. Results suggest that it will be useful for XRAYS to offer reviews of articles on a broad range of topics that can inform decisions at each stage of risk assessment and treatment.

Influence of social and neighborhood contexts on smoking cessation among urban minorities

A range of individual, social, and neighborhood factors influence the smoking-related health inequities of urban minorities. Yet little is known about how these factors interact to influence smoking behaviors, including cessation. Hierarchical linear modeling was used to estimate the variance in cessation service utilization among a sample of primarily African American adults accounted for by individual, social, and neighborhood factors. Findings showed individual and social factors were important predictors of cessation service utilization. Social contexts have significant effects on smoking cessation service use, and social influences were more significant predictors of cessation service use than neighborhood factors.

Contextual Factors that Influence Alcohol Use Behaviors

This study tests a multilevel model of factors that affect adolescents' decisions to use alcohol. Hierarchical linear modeling was used to estimate the variance in alcohol use accounted for by the influences of individual, social, and neighborhood factors. Social factors are significant predictors of alcohol use across several models tested, while selected neighborhood factors were generally not. Results indicate that social and community contexts have important effects on adolescent alcohol use, and that social influences were more significant predictors of alcohol use than neighborhood factors for this sample.