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Weiger C, Cohen JE, David Kennedy R, Moran MB. Testing messaging strategies to correct beliefs about nicotine and relative harm perceptions of non-cigarette tobacco products compared to cigarettes: A 2 × 2 factorial experiment of factsheets. Addict Behav 2024; 150:107915. [PMID: 38042048 DOI: 10.1016/j.addbeh.2023.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION The misperception that nicotine is a major cause of cancer is common and may relate to inaccurate relative harm perceptions about tobacco products. To assess if messaging can correct these misperceptions, we tested factsheets that manipulated presences vs absence of (1) a causal alternative (i.e., combustion, not nicotine, causes disease) and/or (2) a reason for the misinformation (i.e., nicotine is the focus of many health messages). METHODS We used an online 2 × 2 factorial experiment of n = 193 adults who smoke and believe nicotine causes cancer to assess the effect of different message strategies on perceptions of tobacco products and switch intention. Pre-post differences and between-condition differences were assessed. RESULTS Strength of agreement with the statement that nicotine is a major cause of cancer decreased and switch intentions increased after message exposure. The proportion of participants with low relative harm perceptions increased for e-cigarettes and smokeless tobacco (p <.0001) and decreased for very low nicotine cigarettes compared to cigarettes. The message with both strategies decreased agreement that nicotine causes cancer more than the message with only the causal alternative. There was no significant effect of condition on relative harm beliefs or switch intentions. CONCLUSIONS Messages with both corrective strategies can reduce the belief that nicotine causes cancer to a greater extent than messaging that only contains a causal alternative. Belief accuracy increased after any message exposure, but these findings should be interpreted cautiously given the study design. Combined strategies should be further investigated in larger samples.
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Affiliation(s)
- Caitlin Weiger
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States.
| | - Joanna E Cohen
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Ryan David Kennedy
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Meghan B Moran
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
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La Capria K, Uriarte C, Elhabashy M, Menkevich M, Maxton O, Awadalla J, Tan ASL, Moran MB, Chen-Sankey J. Exploring the Influence of E-cigarette Ad Features on Perceived Product Appeal and Use Interest Among Young Adults of Varying Tobacco-Use Behaviors. Nicotine Tob Res 2024; 26:361-369. [PMID: 37594249 PMCID: PMC10882433 DOI: 10.1093/ntr/ntad150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Exposure to certain features in commercial e-cigarette ads may influence e-cigarette use perceptions. This study explored the reactions toward common features in e-cigarette ads among young adults of various tobacco-use behaviors. AIMS AND METHODS We used data from in-depth interviews with U.S. young adults (ages 18-29) who do not use tobacco (n = 26) and who currently smoke cigarettes (n = 26). Participants viewed 30 print e-cigarette ads that included multiple features (eg, fruit flavors, price promotions, smoker-targeted messages) before discussing their perceived influence of memorable ad features. We used reflective thematic analysis to analyze interview data. RESULTS Participants from both groups generally noticed fruit and multiple flavors displayed in the ads, which were seen as appealing and were reported to generate product-use interest because of bright colors, sensory appeal, and a variety of flavor options. Participants who smoke perceived price promotions and positive experience testimonials to be appealing, and some reported this generated use interest. Participants from both groups perceived smoker-targeted messages to be unconvincing, and reported this dampened ad and product appeal and use interest. Participants who do not use tobacco perceived nicotine warnings to be unappealing, resulting in reduced perceived appeal of other attractive features (eg, fruit flavors) appearing in the same ads. CONCLUSIONS Marketing features appearing in e-cigarette ads may be perceived by young adults of various tobacco-use behaviors in both similar and different ways. Communication and policy strategies that account for these differential perceptions towards various marketing features are needed to reduce the negative impact of e-cigarette marketing. IMPLICATIONS This study revealed evidence related to young adults' reactions to and perceived influence of commonly used marketing features (eg, fruit flavors, nicotine warnings, price promotions, smoker-targeted messages) in commercial e-cigarette ads. The results highlight the similar and differential perceived appeal and use interest of e-cigarette products promoted with various marketing features among young adults of different tobacco-use behaviors. The results have implications for informing the design of communication strategies and policies related to e-cigarette marketing aimed at promoting complete product switching among young adults who smoke while simultaneously deterring e-cigarette use interest among those who do not use tobacco.
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Affiliation(s)
- Kathryn La Capria
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Caitlin Uriarte
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Madison Menkevich
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Olivia Maxton
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Josephine Awadalla
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Meghan B Moran
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
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Chen-Sankey J, La Cparia K, Glasser A, Padon AA, Moran MB, Wagoner KG, Jackson KM, Berg CJ. Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021. medRxiv 2024:2024.02.03.24302079. [PMID: 38352380 PMCID: PMC10863020 DOI: 10.1101/2024.02.03.24302079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Importance Vaping has become an increasingly common method for consuming nicotine and cannabis, a trend potentially influenced by e-cigarette marketing. However, little is known about the influence of e-cigarette marketing on cannabis vaping behaviors. Objective To examine the associations between e-cigarette marketing exposure and nicotine and cannabis vaping behaviors among adults. Design Setting and Participants This cross-sectional study included a U.S. nationally representative sample of adults (≥18 years) from the Wave 6 survey of the Population Assessment of Tobacco and Health (PATH) Study, conducted from March to November 2021. Exposure Past 30-day e-cigarette marketing exposure (overall and by ten marketing channels). Main Outcomes and Measures Past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age. Results The study included 30,516 respondents (48.0% male and 63.9% non-Hispanic White). Overall, 52.0% of respondents reported past 30-day e-cigarette marketing exposure, and 89.8%, 5.6%, 3.2%, and 1.4% reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. Multinominal logistic regression results show exposure to e-cigarette marketing was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95% CI, 1.01-1.57). Stratification analysis found these associations among those aged 18-24 and 25-34 years but not older adults (≥35 years). Those exposed to e-cigarette marketing also had increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95% CI, 1.04-1.58). Stratification analysis found this association only among those aged 18-24 years. E-cigarette marketing exposure via several channels (retail stores, billboards, events, newspapers/magazines) was associated with increased odds of reporting sole-cannabis vaping. Conclusions and Relevance E-cigarette marketing exposure was only associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-35 years and were found for multiple marketing channels. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in such marketing restrictions for cannabis may contribute to continued influence of e-cigarette marketing on cannabis vaping.
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Affiliation(s)
- Julia Chen-Sankey
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
- Rutgers School of Public Health, Piscataway, NJ
| | - Kathryn La Cparia
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
| | - Allison Glasser
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
| | | | - Meghan B. Moran
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Kristina M. Jackson
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
- Rutgers Addiction Research Center, Piscataway, NJ
| | - Carla J. Berg
- George Washington University, Milken Institute School of Public Health, Washington, DC
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Dowd AN, Thrul J, Czaplicki L, Kennedy RD, Moran MB, Spindle TR. A Cross-Sectional Survey on Oral Nicotine Pouches: Characterizing Use-Motives, Topography, Dependence Levels, and Adverse Events. Nicotine Tob Res 2024; 26:245-249. [PMID: 37712111 PMCID: PMC10803111 DOI: 10.1093/ntr/ntad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Oral nicotine pouches (ONPs) contain a crystalized nicotine powder instead of tobacco leaves. ONPs come in a variety of flavors and are often marketed as "tobacco-free," but research on ONP use-motivations and related experiences is limited. AIMS AND METHODS This cross-sectional web-based survey collected self-report data on ONP use-characteristics (eg, frequency), brands and flavors used, use-motivations, dependence (Fagerström Test for Nicotine Dependence-Smokeless Tobacco [FTND-ST]), and ONP-related adverse events (AEs) experienced. RESULTS The sample included 118 adults who reported current (past 30-day) ONP use. On average (SD), participants reported ONP use on 13 (6) days during the past month. Most participants (% of the sample) also reported the use of tobacco cigarettes (74%) and/or electronic cigarettes (53%) during the past month. Zyn (27%) and Lucy (19%) were the most currently used ONP brands with mint (23%) and tobacco (16%) as the most currently used flavors. The availability of preferred flavors was the most frequently reported (31%) ONP use-motivation. The sample demonstrated significant dependence levels (FTND-ST = 7, SD = 2). Reported AEs included mouth lesions (48%), upset stomach (39%), sore mouth (37%), sore throat (21%), and nausea (9%). Results should be interpreted in the context of study limitations, including using a relatively small and homogeneous online convenience sample. Acknowledging the limitations, this sample was deemed appropriate to include considering the novelty of the findings, the dearth of related research, and the necessity of examining foundational ONP use-characteristics (eg, topography, AEs); however, future research should consider recruiting larger and more generalizable samples. CONCLUSIONS The availability of preferred flavors was a key ONP use-motivation in this sample. Mint and tobacco were the most currently used flavors, with Zyn and Lucy being the most currently used ONP brands. Participants reported dependence and a substantial number of ONP-related AEs. Nationally representative surveys should investigate ONP use along with outcomes included in the current study (eg, AEs) to inform ONP surveillance and policy development efforts. IMPLICATIONS This study is among the first to assess reasons for initiating/maintaining ONP use as well as other relevant use-experiences (eg, AEs, dependence). These results highlight the role of flavors and nicotine dependence in ONP use, which are important considerations for informing ONP regulations.
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Affiliation(s)
- Ashley N Dowd
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Ryan D Kennedy
- Department of Health, Behavior and Society, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Tory R Spindle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Czaplicki L, Patel D, Jewler K, Moran MB. Use of Brand Engagement Appeals in US Cigarette and E-Cigarettes Ads (2019-2020). Subst Use Misuse 2024; 59:832-839. [PMID: 38247155 DOI: 10.1080/10826084.2024.2305791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: The tobacco industry has historically used brand engagement - communication tactics companies use to increase customer attachment to a brand and brand loyalty - to recruit and retain consumers. Limited information is available to assess the brand engagement tactics used to promote the two most popular tobacco products in the US - cigarettes and electronic cigarettes (e-cigarettes) - across different advertising platforms (e.g., direct-to-consumer (DTC), social media). Material and methods: We acquired 520 cigarette and 5,502 e-cigarette ads that ran in the US January 2019 to December 2020 from market research firms (Kantar, Numerator), Rutger's University ad surveillance website (trinketsandtrash.org), and branded social media accounts. Ads were double-coded for eight types of brand engagement tactics: Price Promotion, Sweepstakes, Mobile App, Email/Mail List, Free Gift, Social Media engagement request, Sponsored Events, and Auto-Ship subscription program. We report presence of brand engagement tactics by product type and advertising platform. Results: Overall, 62.9% of cigarette ads and 49.9% of e-cigarette ads contained at least one brand engagement tactic. For cigarette ads, the most common tactics were Sweepstakes and Mobile App requests, which were most commonly featured in DTC ads. For e-cigarettes, the most common tactic was Price Promotion which was featured in most DTC and online e-cigarette ads. Conclusions: Brand engagement was common in this sample of cigarette and e-cigarette ads. Our findings highlight key differences in the type of brand engagement tactic used to promote each product on different advertising platforms. Results can inform continued advertising surveillance studies and regulatory efforts.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kay Jewler
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Czaplicki L, Duren M, Kelley D, Moran MB, Welding K, Kennedy RD. Flavored electronic nicotine delivery systems ads (2019-2020) on traditional U.S. Media by audience demographics. Prev Med Rep 2023; 35:102346. [PMID: 37576840 PMCID: PMC10413146 DOI: 10.1016/j.pmedr.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/18/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023] Open
Abstract
The tobacco industry has historically targeted flavored products to specific U.S. consumer segments, including young people, women, and systemically marginalized groups based on race, ethnicity, or sexual/gender identity. Existing research on target marketing is focused on cigarettes and smokeless tobacco. In contrast, studies of target marketing of electronic nicotine delivery systems (ENDS)-a growing segment of the U.S. tobacco product market - are much more limited. We analyzed data on 496 ENDS ads and audience demographics to explore the extent to which flavored ENDS ads on cable television (n = 25 ads), terrestrial radio (n = 412 ads), and in print consumer magazines (n = 59 ads) are targeted to different demographic groups based on age, sex, and race/ethnicity. We observed flavor-related content in one-quarter to one-third of ENDS ad occurrences during 2019-2020. Across all media outlets examined, audience age was an important factor in explaining the likelihood of ENDS ads containing flavor-related content. For example, within a television channel, there were 3.82 [95% confidence interval (CI): 1.39-10.49] times greater odds that an ENDS ad contained flavor-related content versus not for every 1% increase in the proportion of U.S. youth ages 6-17 watching a television show. In addition, there were 2.13 [95 %CI: 1.30-3.51] and 1.61 [95 %CI:1.60-1.63] times greater odds that an ENDS ad contained flavor-related content versus not in cable television and radio stations, respectively, for every 1% increase in the proportion of male audience members. Race/ethnicity was an important explanatory factor for the presence of flavor-related content on radio but not television ENDS ads. Our findings suggest differences in target marketing of flavored ENDS by media outlet and audience demographics.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michelle Duren
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dannielle Kelley
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Welding
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Moran MB, Czaplicki L, Tadesse L, Handy J, Welding K, Kelley D, Kennedy RD. Presence of flavoured electronic nicotine delivery system (ENDS) products in US ENDS advertisements, 2015-2020: a content analysis. BMJ Open 2023; 13:e070212. [PMID: 37385739 PMCID: PMC10314572 DOI: 10.1136/bmjopen-2022-070212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES Electronic nicotine delivery systems (ENDS) products come in a variety of flavours (eg, fruit, dessert, menthol). Tobacco advertising has historically used flavours as an advertising tactic, but little is known about flavour type and prevalence in ENDS advertisements. We assess the presence of flavoured ENDS in ads over time, by media outlet (eg, magazines, online) and brand. METHODS We acquired ENDS ads (N=4546) that first ran between 2015-2017 (n=1685; study 1) and 2018-2020 (n=2861; study 2) in outlets including opt-in emails, direct-to-consumer mail (study 1 only), video (TV and online), radio (study 2 only), static online/mobile (ie, ads without video or moving graphics), social media, outdoor (eg, billboards; study 2 only) and consumer magazines. We coded for presence of flavoured ENDS products and flavour type (eg, fruit, tobacco, menthol) and merged this information with metadata on ad year, outlet and manufacturer/retailer brand. RESULTS Overall, nearly half (45.5%; n=2067) of ads in our sample featured a flavoured product. Tobacco (59.1%; n=1221), menthol (42.9%; n=887) and fruit (38.6%; n=797) were the most advertised flavours. Over time, the proportion of ads containing tobacco-flavoured and menthol-flavoured ENDS generally decreased before menthol rebounded in 2020. The proportion of ads containing fruit, mint and dessert flavours generally increased over time, with a substantive drop in 2020. We found notable differences in flavoured ENDS advertising by outlet and brand. CONCLUSIONS The overall presence of flavoured ENDS in our sample of ads remained relatively consistent, with tobacco flavour decreasing over time and some non-tobacco flavours increasing over time until 2020 when the presence decreased.
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Affiliation(s)
- M B Moran
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Czaplicki
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lidya Tadesse
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica Handy
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dannielle Kelley
- Center for Tobacco Products, US Food and Drug Administration, Beltsville, Maryland, USA
| | - Ryan David Kennedy
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Luken A, Desjardins MR, Moran MB, Mendelson T, Zipunnikov V, Kirchner TR, Naughton F, Latkin C, Thrul J. Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study. JMIR Mhealth Uhealth 2023; 11:e43990. [PMID: 37327031 PMCID: PMC10337446 DOI: 10.2196/43990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/23/2023] [Accepted: 04/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Interest in quitting smoking is common among young adults who smoke, but it can prove challenging. Although evidence-based smoking cessation interventions exist and are effective, a lack of access to these interventions specifically designed for young adults remains a major barrier for this population to successfully quit smoking. Therefore, researchers have begun to develop modern, smartphone-based interventions to deliver smoking cessation messages at the appropriate place and time for an individual. A promising approach is the delivery of interventions using geofences-spatial buffers around high-risk locations for smoking that trigger intervention messages when an individual's phone enters the perimeter. Despite growth in personalized and ubiquitous smoking cessation interventions, few studies have incorporated spatial methods to optimize intervention delivery using place and time information. OBJECTIVE This study demonstrates an exploratory method of generating person-specific geofences around high-risk areas for smoking by presenting 4 case studies using a combination of self-reported smartphone-based surveys and passively tracked location data. The study also examines which geofence construction method could inform a subsequent study design that will automate the process of deploying coping messages when young adults enter geofence boundaries. METHODS Data came from an ecological momentary assessment study with young adult smokers conducted from 2016 to 2017 in the San Francisco Bay area. Participants reported smoking and nonsmoking events through a smartphone app for 30 days, and GPS data was recorded by the app. We sampled 4 cases along ecological momentary assessment compliance quartiles and constructed person-specific geofences around locations with self-reported smoking events for each 3-hour time interval using zones with normalized mean kernel density estimates exceeding 0.7. We assessed the percentage of smoking events captured within geofences constructed for 3 types of zones (census blocks, 500 ft2 fishnet grids, and 1000 ft2 fishnet grids). Descriptive comparisons were made across the 4 cases to better understand the strengths and limitations of each geofence construction method. RESULTS The number of reported past 30-day smoking events ranged from 12 to 177 for the 4 cases. Each 3-hour geofence for 3 of the 4 cases captured over 50% of smoking events. The 1000 ft2 fishnet grid captured the highest percentage of smoking events compared to census blocks across the 4 cases. Across 3-hour periods except for 3:00 AM-5:59 AM for 1 case, geofences contained an average of 36.4%-100% of smoking events. Findings showed that fishnet grid geofences may capture more smoking events compared to census blocks. CONCLUSIONS Our findings suggest that this geofence construction method can identify high-risk smoking situations by time and place and has potential for generating individually tailored geofences for smoking cessation intervention delivery. In a subsequent smartphone-based smoking cessation intervention study, we plan to use fishnet grid geofences to inform the delivery of intervention messages.
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Affiliation(s)
- Amanda Luken
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael R Desjardins
- Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomas R Kirchner
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
- Center for Urban Science and Progress, New York University Tandon School of Engineering, New York, NY, United States
| | - Felix Naughton
- Behavioural and Implementation Science Research Group, University of East Anglia, Norwich, United Kingdom
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Alonso F, Rath J, Ramírez AS, Cantrell J, Jordan A, Suarez S, Moran MB. Perceptions of and Experiences With Cigarette and E-Cigarette Use Among a Diverse Population of US Latino Adolescents and Young Adults. Am J Health Promot 2023; 37:646-653. [PMID: 36608694 PMCID: PMC10663052 DOI: 10.1177/08901171221151125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine potential unique factors influencing cigarette and e-cigarette use in US Latino youth. APPROACH We conducted a qualitative study assessing cigarette and e-cigarette perceptions and experiences, including experiences with/perceptions of the products, cultural influences and influences of friends and family. SETTING Four online discussion boards, conducted in October 2020. PARTICIPANTS 92 Latino youth aged 15-21 years living in the US. METHOD Data from the discussion groups were coded and analyzed by three trained coders using a thematic analysis approach. RESULTS Stress relief emerged as the dominant theme connected with both cigarettes and e-cigarettes. Apart from stress, perceptions of and experiences with the products differed. E-cigarettes were commonly viewed as trendy and cool and participants often reported using them due to curiosity and popularity. Participants commonly compared e-cigarettes to cigarettes, noting benefits of e-cigarettes. Participants also noted more negative short and long-term health effects of cigarette use, and discussed generational differences between the two products. CONCLUSION Findings from this study help address a dearth of research examining tobacco use among diverse groups of Latino youth. Findings indicate that despite differences in country of heritage, Latino youth are united by similar opinions about cigarettes and e-cigarettes. Additionally, they share cultural values and experiences which could be leveraged for tobacco control communications that cut across populations of Latino youth.
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Affiliation(s)
- Fernanda Alonso
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Rath
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - A. Susana Ramírez
- Department of Public Health, University of California, Merced, CA, USA
| | - Jennifer Cantrell
- Department of Social and Behavioral Science, New York University School of Global Public Health, New York, NY, USA
| | - Ashton Jordan
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sebastian Suarez
- Leonard N. Stern School of Business, New York University, New York, NY, USA
| | - Meghan B. Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Marynak K, Welding K, Kelley D, Trigger S, Moran MB, Kennedy RD. Electronic nicotine delivery system advertising in business-to-business publications, United States, 2015-2020. Drug Alcohol Rev 2023; 42:262-267. [PMID: 36269112 DOI: 10.1111/dar.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/09/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tobacco retailers are a key target audience for tobacco product advertising, yet little is known about the messages and channels used to market electronic nicotine delivery systems (ENDS) to retailers. METHODS We assessed expenditures for business-to-business print advertising for ENDS in the United States, by year and by advertiser, from 2015 to 2020; and the content of advertisements placed in 2020. RESULTS The total number of ENDS brands placing business-to-business advertisements declined from 45 in 2015 to 6 in 2020; spending declined from $2.6 million in 2015 (for 283 occurrences) to $492,789 in 2020 (69 occurrences). Across years, the top-spending advertisers were Logic ($1.9 million), blu ($1.0 million), JUUL ($625,050), NJOY ($373,126) and Vuse ($322,075). Common messages of advertisements placed in 2020 included that products are not intended for minors; brand market share; health warnings; profitability or revenue potential for retailers; and flavours. DISCUSSION This study suggests that ENDS companies anticipate that ENDS retailers are interested in stocking products that maximise profits, appeal to consumers and comply with regulatory requirements. Declines in the number of advertisers mirror the overall consolidation of the ENDS industry that occurred during the study period. CONCLUSIONS Business-to-business print advertising represents an important channel in which ENDS brands communicate a variety of messages about their products directly to potential retailers.
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Affiliation(s)
- Kristy Marynak
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Kevin Welding
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Dannielle Kelley
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, USA
| | - Sarah Trigger
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, USA
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Ryan D Kennedy
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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11
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Nian Q, Grilo G, Cohen JE, Smith KC, Reynales-Shigematsu LM, Flores Escartin MG, Moran MB. Disparities in self-reported exposure to tobacco marketing among youth and young adults from low-socioeconomic status neighbourhoods in Mexico City. Glob Public Health 2023; 18:2049346. [PMID: 35301935 DOI: 10.1080/17441692.2022.2049346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/11/2022] [Indexed: 11/04/2022]
Abstract
Exposure to tobacco marketing is positively associated with smoking initiation and behaviours. There is limited literature examining disparities among reported exposure in low- and middle-income countries. This study sought to fill this gap with a survey among 1427 adolescents and 889 adult smokers in Mexico City in 2020. Data were analysed using chi-square and hierarchical regression models. Two-thirds of adolescents noticed cigarette pack displays in stores. Participants from low- and mid-socioeconomic status (SES) neighbourhoods were more exposed to tobacco marketing than their counterparts through several channels. After addressing the shared variance among participants from the same household nested in neighbourhood SES level and controlling for gender, adolescent non-smokers and adult smokers who noticed pack displays were more likely to be susceptible to smoking (OR = 1.8, 95% CI 1.4-2.4) and to smoke more (OR = 1.7, 95% CI 1.21-2.47); adult smokers who noticed tobacco marketing at more places were less likely to be certain about smoking risks (OR = 0.9, 95% CI 0.8-0.9). The results suggest that the tobacco industry targets youth and individuals from low-SES neighbourhoods through several channels. Greater exposure to tobacco marketing was associated with increased susceptibility to smoking and decreased risk perception. These findings support a comprehensive ban on tobacco marketing in Mexico.
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Affiliation(s)
- Qinghua Nian
- Department of Health, Behaviour & Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Graziele Grilo
- Department of Health, Behaviour & Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joanna E Cohen
- Department of Health, Behaviour & Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine C Smith
- Department of Health, Behaviour & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Maria Guadalupe Flores Escartin
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Meghan B Moran
- Department of Health, Behaviour & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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12
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Stanton CA, Pasch KE, Pericot-Valverde I, Cruz-Cano R, Moran MB, Abadi MH, Mays D, Mercincavage M, Tang Z, Chen-Sankey J. Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change. Prev Med 2022; 164:107266. [PMID: 36152822 PMCID: PMC9691545 DOI: 10.1016/j.ypmed.2022.107266] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
E-cigarette marketing tactics to reach and appeal to youth are rapidly changing. This study examined to what extent youth e-cigarette marketing exposure was associated with e-cigarette use behavior change one year later, during a time when youth e-cigarette use was starting to surge in the U.S. Using nationally representative longitudinal public-use data from the Population Assessment of Tobacco and Health (PATH) Study, we examined associations between recalled e-cigarette marketing exposure (2016-2018) at Wave (W) 4 and e-cigarette use harm perception and behavior change (ever, current, and regular use) one year later (W4.5; 2017-2018) among W4 never tobacco users (n = 9405). Recall of exposure to e-cigarette marketing through different channels was also examined in multivariable models controlling for socio-demographic factors and established e-cigarette use risk factors. Results show that the most frequently recalled channels of e-cigarette marketing exposure were retail stores (50.3%), television (22.2%), and websites/social media (20.2%). Over one year, 21.2%, 7.8%, 3.4%, and 1.2% of respondents reported reduced harm perceptions, and ever, current, and regular use of e-cigarettes, respectively, at follow-up. Recalled exposure to e-cigarette marketing was associated with reduced e-cigarette harm perception (AOR = 1.20; 95% CI = 1.05-1.37) and ever (AOR = 1.26; 95% CI = 1.01-1.56) and current use (AOR = 1.40; 95% CI = 1.02-1.92) at follow-up. E-cigarette marketing exposure through websites/social media was associated with reduced harm perceptions and all stages of e-cigarette use change, including regular use. Identifying marketing techniques and channels that change youth e-cigarette harm perceptions and influence e-cigarette use progression is essential to inform e-cigarette regulatory policies and prevention campaigns.
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Affiliation(s)
- Cassandra A Stanton
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Keryn E Pasch
- Department of Kinesiology and Health Education at the University of Texas, Austin, TX, United States of America
| | - Irene Pericot-Valverde
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics Indiana University School of Public Health-Bloomington, University of Maryland, College Park, MD, United States of America
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa H Abadi
- Pacific Institute for Research & Evaluation, Louisville, KY, United States of America
| | - Darren Mays
- Department of Internal Medicine, College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Zhiqun Tang
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States of America; School of Public Health, Rutgers University, Piscataway, NJ, United States of America.
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13
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Beavis AL, Meek K, Moran MB, Fleszar L, Adler S, Rositch AF. Exploring HPV vaccine hesitant parents' perspectives on decision-making and motivators for vaccination. Vaccine X 2022; 12:100231. [PMID: 36337836 PMCID: PMC9630772 DOI: 10.1016/j.jvacx.2022.100231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/29/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Limited knowledge and dissatisfaction with provider interactions are sources of hesitancy. Vaccine hesitant parents want information on both the benefits and risks of vaccination. Effective interventions require understanding the nuanced reasons for vaccine hesitancy. Potential strategies include tools to facilitate in-depth discussions with pediatricians.
Introduction The human papillomavirus (HPV) vaccine is highly effective at preventing HPV-associated cancers in both males and females, yet vaccination rates remain sub-optimal in part due to vaccine hesitancy. This study sought to assess which strategies vaccine-hesitant parents perceive as most likely to motivate them to vaccinate their children against HPV. Methods In 2021, we recruited parents with children ages 10–17 years old who were not vaccinated against HPV and who felt unsure or hesitant about their decision to vaccinate their child. Participants were recruited through an online patient portal within a single institution. A screening survey assessed for vaccine hesitancy. Semi-structured interviews focused on HPV vaccine decision-making, motivators, and potential strategies to improve vaccination rates in hesitant parents. Audio recordings were transcribed and analyzed via a combination of deductive and inductive codes. Results and Discussion A total of twenty-two vaccine-hesitant parents were interviewed. The major themes identified were a lack of confidence in vaccine decision-making, a desire for more information, and dissatisfaction with provider encounters. Parents reported that their hesitancy was driven by concerns about safety and necessity, often based on negative anecdotal reports. Although pediatricians were the most often cited source of vaccine information, many parents were dissatisfied with the encounters they had regarding the vaccine. Parents expressed a desire for detailed information on both the benefits and risks of the vaccine, and resources that allowed them to actively participate in vaccine discussions with providers. Suggested modes of delivery for this information included in-depth pediatrician discussions, written materials provided by pediatricians, and facilitation tools, such as a list of questions to help parents prepare for pediatrician visits. Thus, strategies that empower parents to feel informed and confident in their decision to vaccinate their children could be useful in motivating vaccine-hesitant parents to vaccinate their children against HPV.
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Affiliation(s)
- Anna L. Beavis
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kristin Meek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura Fleszar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sarah Adler
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Corresponding author at: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E6150, Baltimore, MD 21205, United States.
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14
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Sholler DJ, Moran MB, Dolan SB, Borodovsky JT, Alonso F, Vandrey R, Spindle TR. Use patterns, beliefs, experiences, and behavioral economic demand of indica and sativa cannabis: A cross-sectional survey of cannabis users. Exp Clin Psychopharmacol 2022; 30:575-583. [PMID: 33856822 PMCID: PMC8517044 DOI: 10.1037/pha0000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cannabis products available for retail purchase are often marketed based on purported plant species (e.g., "indica" or "sativa"). The cannabis industry frequently claims that indica versus sativa cannabis elicits unique effects and/or is useful for different therapeutic indications. Few studies have evaluated use patterns, beliefs, subjective experiences, and situations in which individuals use indica versus sativa. A convenience sample of cannabis users (n = 179) was surveyed via Amazon Mechanical Turk (mTurk). Participants were asked about their prior use of, subjective experiences with, and opinions on indica versus sativa cannabis and completed hypothetical purchasing tasks for both cannabis subtypes. Participants reported a greater preference to use indica in the evening and sativa in the morning and afternoon. Participants were more likely to perceive feeling "sleepy/tired" or "relaxed" after using indica and "alert," "energized," and "motivated" after using sativa. Respondents were more likely to endorse wanting to use indica if they were going to sleep soon but more likely to use sativa at a party. Hypothetical purchasing patterns (i.e., grams of cannabis purchased as a function of escalating price) did not differ between indica and sativa, suggesting that demand was similar. Taken together, cannabis users retrospectively report feeling different effects from indica and sativa; however, demand generally did not differ between cannabis subtypes, suggesting situational factors could influence whether someone uses indica or sativa. Placebo-controlled, blinded studies are needed to characterize the pharmacodynamics and chemical composition of indica and sativa cannabis and to determine whether user expectancies contribute to differences in perceived indica/sativa effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Dennis J. Sholler
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health
| | - Sean B. Dolan
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine
| | | | - Fernanda Alonso
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine
| | - Tory R. Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine
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15
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Marynak KL, Robichaud MO, Puryear T, Kennedy RD, Moran MB. #Nicotineaddiction on TikTok: A quantitative content analysis of top-viewed posts. Tob Induc Dis 2022; 20:69. [PMID: 35979474 PMCID: PMC9353672 DOI: 10.18332/tid/151868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION TikTok, the video-sharing app popular among youth, is a source of user-generated content about nicotine addiction with the potential to endorse or deter nicotine use among young viewers. We systematically analyzed content and themes of TikTok posts tagged #nicotineaddiction. METHODS We conducted a quantitative content analysis of the visual and textual content of the 149 top-viewed English-language TikTok posts tagged #nicotineaddiction as of 1 March 2021. Posts were double-coded using a shared codebook, noting content creator characteristics, nicotine products featured, references to quitting, and overall themes of #nicotineaddiction expressed. We assessed the prevalence of post characteristics and themes overall and by apparent age of content creators (aged ≥21 years versus <21 years). RESULTS The 149 posts analyzed received a mean and median of 62433 and 15800 likes, respectively. E-cigarettes were referenced or featured in 75% of posts; 58% featured a specific nicotine product brand, most commonly Puff Bar (23% of total) and JUUL (19%). Overall, 22% of posts mentioned quitting nicotine. The top themes of #nicotineaddiction expressed were physical or psychological consequences (e.g. withdrawal symptoms, 46%), physical or psychological benefits (e.g. tasting good, feeling ‘buzzed’, 28%), and social benefits (e.g. bonding with fellow users, 28%). Compared to those aged ≥21 years, posts by content creators likely <21 years (26%) less commonly mentioned quitting (p<0.01), had fewer followers (p<0.01), were more commonly from Canada (p<0.01) and less commonly from the US (p<0.01), and more commonly featured JUUL (p<0.05). CONCLUSIONS While reaching a large and engaged audience, TikTok content creators suggest a range of benefits and consequences of nicotine addiction. Future research is warranted to examine this content’s potential to influence young people’s intentions to use or quit nicotine products.
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Affiliation(s)
- Kristy L. Marynak
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Meagan O. Robichaud
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Tyler Puryear
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Ryan D. Kennedy
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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16
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Rivera YM, Moran MB, Thrul J, Joshu C, Smith KC. When Engagement Leads to Action: Understanding the Impact of Cancer (Mis)information among Latino/a Facebook Users. Health Commun 2022; 37:1229-1241. [PMID: 34256676 PMCID: PMC8755854 DOI: 10.1080/10410236.2021.1950442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Latinos/as - the largest minority group in the U.S. - are avid Facebook users, making this an opportune tool to educate on the uptake of cancer prevention and screening behaviors. However, there is a dearth in scholarship exploring how Latinos/as engage with and act upon health content encountered on social media, which may be influenced by cultural values. This qualitatively-driven, mixed-methods study explores how Latinos/as engage with and act upon cancer prevention and screening information (CPSI) on Facebook. During one-on-one, in-depth interviews, participants (n = 20) logged onto their Facebook account alongside the researcher and discussed cancer-related posts they engaged with during the past 12 months. Interview questions included the reasons for engagement, and whether engagement triggered further action. Interviews were analyzed thematically. In parallel, a content analysis of the CPSI posts identified during the interviews was conducted. The majority of CPSI posts participants engaged with contained food-related content and visual imagery. Engagement was most common when individuals had personal relationships to the poster, when posts included videos/images, and when posts contained content promoting the curative properties of popular Latin American foods. Engagement often led to information-seeking and sharing, discussing content with others, and/or changing health behaviors. Findings highlight the importance of adequately contextualizing how cultural values influence the ways in which Latinos/as engage with and act upon CPSI on Facebook, which may lead individuals to bypass evidence-based procedures. Multi-pronged efforts are necessary to adequately leverage social media to empower Latinos/as to partake in behaviors that effectively reduce cancer health disparities.
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Affiliation(s)
- Yonaira M Rivera
- Department of Communication, School of Communication & Information, Rutgers University
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins School of Public Health
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins School of Public Health
| | - Corinne Joshu
- Department of Epidemiology, Johns Hopkins School of Public Health
| | - Katherine C Smith
- Department of Health, Behavior & Society, Johns Hopkins School of Public Health
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Rivera YM, Moran MB, Thrul J, Joshu C, Smith KC. Contextualizing Engagement With Health Information on Facebook: Using the Social Media Content and Context Elicitation Method. J Med Internet Res 2022; 24:e25243. [PMID: 35254266 PMCID: PMC8933799 DOI: 10.2196/25243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 08/07/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Most of what is known regarding health information engagement on social media stems from quantitative methodologies. Public health literature often quantifies engagement by measuring likes, comments, and/or shares of posts within health organizations’ Facebook pages. However, this content may not represent the health information (and misinformation) generally available to and consumed by platform users. Furthermore, some individuals may prefer to engage with information without leaving quantifiable digital traces. Mixed methods approaches may provide a way of surpassing the constraints of assessing engagement with health information by using only currently available social media metrics.
Objective
This study aims to discuss the limitations of current approaches in assessing health information engagement on Facebook and presents the social media content and context elicitation method, a qualitatively driven, mixed methods approach to understanding engagement with health information and how engagement may lead to subsequent actions.
Methods
Data collection, management, and analysis using the social media content and context elicitation method are presented. This method was developed for a broader study exploring how and why US Latinos and Latinas engage with cancer prevention and screening information on Facebook. The study included 20 participants aged between 40 and 75 years without cancer who participated in semistructured, in-depth interviews to discuss their Facebook use and engagement with cancer information on the platform. Participants accessed their Facebook account alongside the researcher, typed cancer in the search bar, and discussed cancer-related posts they engaged with during the previous 12 months. Engagement was defined as liking, commenting, and/or sharing a post; clicking on a post link; reading an article in a post; and/or watching a video within a post. Content engagement prompted questions regarding the reasons for engagement and whether engagement triggered further action. Data were managed using MAXQDA (VERBI GmbH) and analyzed using thematic and content analyses.
Results
Data emerging from the social media content and context elicitation method demonstrated that participants mainly engaged with cancer prevention and screening information by viewing and/or reading content (48/66, 73%) without liking, commenting, or sharing it. This method provided rich content regarding how US Latinos and Latinas engage with and act upon cancer prevention and screening information on Facebook. We present 2 emblematic cases from the main study to exemplify the additional information and context elicited from this methodology, which is currently lacking from quantitative approaches.
Conclusions
The social media content and context elicitation method allows a better representation and deeper contextualization of how people engage with and act upon health information and misinformation encountered on social media. This method may be applied to future studies regarding how to best communicate health information on social media, including how these affect assessments of message credibility and accuracy, which can influence health outcomes.
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Affiliation(s)
- Yonaira M Rivera
- Department of Communication, School of Communication & Information, Rutgers University, New Brunswick, NJ, United States
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brusnwick, NJ, United States
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Corinne Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine C Smith
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Eschliman EL, Uzzi M, White JJ, Mathews A, Henry M, Moran MB, Page K, Latkin CA, Tucker JD, Yang C. Crowdsourced PrEP Promotion Messages for an HIV High-Burden Area: A Framework-Based Content Analysis. AIDS Educ Prev 2022; 34:69-81. [PMID: 35192395 PMCID: PMC10839679 DOI: 10.1521/aeap.2022.34.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an important and highly effective HIV prevention strategy, but its uptake remains low, particularly among marginalized populations at high risk of HIV. Innovative and community-driven promotion strategies, such as open contests, are needed to address disparities. This directed content analysis uses a PrEP-specific adaptation of the Information-Motivation-Behavioral Skills (IMB) model to identify themes related to PrEP use reflected in community-generated submissions (n = 73) from an open contest conducted to elicit crowdsourced health promotion messages on PrEP in Baltimore, Maryland. In addition to identifying eight of the themes from the adapted IMB model, this analysis also identified two novel salient themes in the motivation category: self-worth/self-love and self-care practice. Findings from this analysis can inform PrEP promotion efforts by pointing to salient themes identified from a community-driven approach that are less well represented in existing research.
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Affiliation(s)
- Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mudia Uzzi
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jordan J. White
- Morgan State University, School of Social Work, Baltimore, Maryland
| | | | - Marcus Henry
- Know Your Place Movement & J.O.Y. Baltimore, Baltimore, Maryland
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen Page
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph D. Tucker
- University of North Carolina-Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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19
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Grilo G, Lagasse LP, Cohen JE, Moran MB, Reynales-Shigematsu LM, Smith KC. "It's all About the Colors:" How do Mexico City Youth Perceive Cigarette Pack Design. Int J Public Health 2021; 66:585434. [PMID: 34744557 PMCID: PMC8565279 DOI: 10.3389/ijph.2021.585434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries. Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into “appealing” and “unappealing” groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis. Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves. Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.
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Affiliation(s)
- Graziele Grilo
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lisa P Lagasse
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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20
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Kennedy HR, Moran MB, Thrul J. Household Rules regarding Cannabis Use and Tobacco Smoking in Denver Airbnb Venues. J Psychoactive Drugs 2021; 53:195-200. [PMID: 33399521 DOI: 10.1080/02791072.2020.1856454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cannabis legalization threatens to undermine clean indoor air norms. We investigated the prevalence and nature of tobacco and cannabis use rules in Airbnb venues in Denver, Colorado, where recreational cannabis was legalized in 2014. The study used publicly available Inside Airbnb data for all Denver listings (N = 4,511) collected on 06/29/2019. We analyzed reported tobacco smoking and cannabis use house rules. Tobacco smoking with or without conditions was allowed in 9.7% of venues. Of all venues, 23.7% included details about cannabis use. Of these, 75.9% allowed cannabis use without or with conditions. Of the venues that allowed cannabis use, 30.5% also allowed tobacco smoking. Of the venues that did not allow cannabis use, 0.4% allowed tobacco smoking. Additional multilevel regression models revealed that venues in higher income neighborhoods were less likely to allow cannabis and tobacco use. A substantial number of Airbnb listings in Denver, Colorado permit cannabis use and venues permitting cannabis use may be more likely to also permit tobacco smoking. Findings support the idea that cannabis legalization threatens clean indoor air norms. Airbnb should consider including cannabis use in house rules in jurisdictions that have legalized cannabis to help guests identify spaces with clean air.
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Affiliation(s)
- Hudson R Kennedy
- River Hill High School, Howard County Board of Education, Clarksville, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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21
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Czaplicki L, Rahman B, Simpson R, Rose SW, Liu M, Perks SN, Moran MB, Schillo BA. Going Smokeless: Promotional Features and Reach of US Smokeless Tobacco Direct-Mail Advertising (July 2017–August 2018). Nicotine Tob Res 2020; 23:1349-1357. [DOI: 10.1093/ntr/ntaa255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Although cigarette use in the United States has declined over time, smokeless tobacco (SLT) use has remained steady. Direct-mail advertising and coupon redemption have been linked to increased tobacco use, and efforts to promote SLT through direct-mail advertising may contribute to sustained SLT use. We examined reach of SLT direct-mail advertisements by recipient demographics and promotional features, including coupons.
Methods
Direct-mail data (n = 418) were acquired from Comperemedia (Mintel) and coded for product type (traditional [eg, chewing tobacco], pouched [eg, moist snuff, snus], or both [traditional SLT and any pouched SLT products]); promotions (eg, coupons); flavors; and themes (eg, masculinity). Using Mintel’s volume estimates for number of pieces sent, we calculated the proportion of mail volume sent by recipient demographics (age, income, region) and advertising features across product type.
Results
Between July 2017 and August 2018, tobacco companies sent an estimated 249 million pieces of SLT direct-mail to US households; approximately half (49.6%) featured pouched SLT products. Across product types, over 75% of mail volume was sent to 31- to 60-year-old adults and 30–40% was sent to low-income households. The majority (>70%) of pouched SLT product mail contained coupons and flavor promotions. Outdoor and blue-collar-lifestyle themes were prominent in advertisements for all product types, along with less common adventure- and fun-related appeals.
Conclusions
Coupons, flavors, and a combination of blue-collar and fun/adventure message themes were used to promote traditional and pouched SLT products through direct-mail, particularly to low-income households. Results support limits on direct-mail coupon distribution and continued surveillance of marketing appeals.
Implications
There is a long history of research into tobacco advertising practices, largely focusing on cigarettes. This study highlights specific direct-mail marketing tactics used by the tobacco industry, including coupons to promote SLT products across the United States. Given the limited success in reducing SLT use and the association between direct-mail promotions and tobacco use, these study results provide support for policies to restrict use of coupons in direct-to-consumer tobacco marketing and indicate the need for continued surveillance of direct-mail advertisements as the SLT market continues to evolve.
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Affiliation(s)
- Lauren Czaplicki
- Truth Initiative Schroeder Institute, Washington, DC
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Basmah Rahman
- Truth Initiative Schroeder Institute, Washington, DC
| | | | - Shyanika W Rose
- Center for Health Equity Transformation and Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY
| | - Michael Liu
- Truth Initiative Schroeder Institute, Washington, DC
| | | | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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22
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Weiger CV, Alexander TN, Moran MB. Are national antitobacco campaigns reaching high-risk adolescents? A cross-sectional analysis from PATH Wave 2. Health Educ Res 2020; 35:44-59. [PMID: 31965169 PMCID: PMC6991619 DOI: 10.1093/her/cyz036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- C V Weiger
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - T N Alexander
- Public Health Research and Translational Science, Battelle Memorial Institute, Battelle Public Health Center for Substance Use Research, 6115 Falls Rd #200, Baltimore, MD 21209, USA
| | - M B Moran
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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23
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White JJ, Mathews A, Henry MP, Moran MB, Page KR, Latkin CA, Tucker JD, Yang C. A Crowdsourcing Open Contest to Design Pre-Exposure Prophylaxis Promotion Messages: Protocol for an Exploratory Mixed Methods Study. JMIR Res Protoc 2020; 9:e15590. [PMID: 31899456 PMCID: PMC6969383 DOI: 10.2196/15590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background In the United States, black men who have sex with men (BMSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) can reduce HIV incidence. However, real-world implementation of PrEP outside of clinical trials has identified racial disparities in PrEP awareness, uptake, and adherence. In the context of a long history of medical mistrust and power imbalances between scientists and community members, strategies to increase uptake of PrEP among BMSM should consider ways to ensure messages address the needs and priorities of the community. Crowdsourcing contests shift traditional individual tasks to a large group and may enhance community engagement. Objective This paper describes the research protocol of a contest approach to soliciting PrEP promotion messages among BMSM in Baltimore. Methods Open-contest implementation and evaluation will proceed as follows: (1) organize a community steering group; (2) develop platforms to solicit crowd input; (3) engage the community to contribute ideas through a Web-based forum and in-person events; (4) evaluate contest entries using both community panel judge assessment and crowd voting; (5) utilize mixed methods to evaluate feasibility, acceptability, and community engagement; and (6) disseminate contest results. Results This study was funded by the National Institutes of Health (National Institute of Mental Health: R34MH116725) in May 2018 and was approved by the institutional review board in April 2018. The open contest started in February 2019, and data analyses for the mixed method evaluation are expected to complete in December 2019. Conclusions The contest will potentially bring new ideas in developing more impactful and locally defined PrEP promotion campaigns. We will determine whether an open-contest approach is acceptable among BMSM in Baltimore. If successful, this study can inform future projects using a similar approach on how to identify and implement programs and policies that are more responsive to community needs and that build up community assets. International Registered Report Identifier (IRRID) DERR1-10.2196/15590
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Affiliation(s)
- Jordan J White
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Marcus P Henry
- Know Your Place Movement, JOY Baltimore, Baltimore, MD, United States
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kathleen R Page
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joseph D Tucker
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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24
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Zhao Martin N, Murphy ST, Ball-Rokeach S, Frank LB, Moran MB. Neighborhoods and Perceived Norms: Understanding the Impact of Neighborhoods on Perceived Norms and Cancer Screening. Health Commun 2019; 34:1513-1523. [PMID: 30080981 DOI: 10.1080/10410236.2018.1504655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examines the importance of urban ethnic neighborhoods as the context of everyday life, where normative influences on health are formed, modified, and maintained. Built on communication infrastructure theory, this study investigates the role of women's connections to their neighborhood storytelling network-consisting of residents, local/ethnic media, and community organizations-in shaping their descriptive normative perceptions regarding cervical cancer screening. Specifically, we explore the communication mechanisms that underlie Latinas' exposure and attention to media information about Pap tests, their discussions with health-care professionals about Pap tests, their perceptions about how normative Pap tests are among "women like them", and their compliance with cervical cancer screening guidelines. Our findings suggest that neighborhood storytelling resources hold promise for health communication research to understand not only the uptake of Pap tests but also health disparities in other domains that affect diverse populations and communities.
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Affiliation(s)
- Nan Zhao Martin
- Department of Public Health, California State University Los Angeles
| | - Sheila T Murphy
- Annenberg School for Communication and Journalism, University of Southern California
| | - Sandra Ball-Rokeach
- Annenberg School for Communication and Journalism, University of Southern California
| | | | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health
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25
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Brown JL, Smith KC, Zhu M, Moran MB, Hoe C, Cohen JE. Menthol and flavor capsule cigarettes in the Philippines: A comparison of pack design. Tob Induc Dis 2019; 17:76. [PMID: 31768168 PMCID: PMC6843184 DOI: 10.18332/tid/112718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco use is a major public health problem in the Philippines. Menthol flavored and flavor capsule cigarettes are independently associated with increased smoking initiation and appeal to youth and young adults. Packaging is an important tobacco marketing tool. We describe cigarette packs sold in the Philippines market and describe products’ flavor and capsule inclusion. METHODS Tobacco packs were systematically collected in the Philippines in 2016 and categorized as non-flavored non-capsule, menthol non-capsule, menthol capsule, and non-menthol capsule. Structural elements (e.g. pack type, shape) and graphic components (e.g. imagery, descriptors, color) of the packs were compared. RESULTS Menthol capsule packs were significantly more likely to be hard packs than menthol non-capsule. Menthol packs were more likely to be colored green than non-flavored packs. Non-menthol capsule packs were more likely to display the term ‘fresh’ than non-capsule packs. Capsule packs were more likely to display technological appeals than non-capsule packs. CONCLUSIONS Menthol and flavor capsule cigarettes are packaged differently (most notably, in terms of color and technological appeals) than non-menthol and non-capsule packs. Packaging and labeling policy should take this into consideration.
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Affiliation(s)
- Jennifer L Brown
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Meng Zhu
- Johns Hopkins Carey Business School, Baltimore, United States
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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26
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Latkin CA, Kennedy RD, Davey-Rothwell MA, Tseng TY, Czaplicki L, Baddela A, Edwards C, Chander G, Moran MB, Knowlton AR. The Relationship Between Neighborhood Disorder and Barriers to Cessation in a Sample of Impoverished Inner-City Smokers in Baltimore, Maryland, United States. Nicotine Tob Res 2019; 20:1451-1456. [PMID: 29126121 DOI: 10.1093/ntr/ntx252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022]
Abstract
Introduction Economic disparities in rates of smoking have been well documented in many countries. These disparities exist on an individual and geographic or neighborhood level. This cross-sectional study examined the relationship between neighborhood physical and social disorder and barriers to smoking cessation among an impoverished urban sample. Methods A sample of current smokers were recruited through street outreach, posted advertisements, and word of mouth from impoverished neighborhoods in Baltimore, Maryland, USA for a study of psychosocial factors and smoking behaviors. Neighborhood disorder was assessed with a 10-item scale from the Block Environmental Inventory and barriers to cessation with a 9-item scale. Results In the multiple logistic regression model, perceived stress (aOR = 1.60, 95% CI = 1.32 to 1.95), neighborhood disorder (aOR= 1.34, 95% CI = 1.11 to 1.63), and level of nicotine dependence (aOR = 1.97), 95% CI = 1.62 to 2.40) were all strongly associated with barriers to cessation. Conclusion The results of this study suggest that neighborhood disorder may lead to barriers to cessation among low-income populations. The findings also indicate that tobacco control interventions should examine and address social and physical aspects of impoverished neighborhoods. Implications In many countries, tobacco control programs and policies have been less effective among low-income populations as compared to more affluent populations. Little is known about how neighborhood factors influence smoking cessation. This study examined the relationship between neighborhood disorder and barriers to cessation among a low-income population. We recruited a convenience sample of hard-to-reach cigarette smokers from low-income neighborhoods. Even after controlling for level of nicotine dependence and stress, neighborhood disorder was found to be associated with barriers to cessation. The findings suggest the important role of neighborhood disorder as a barrier to smoking cessation.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan D Kennedy
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa A Davey-Rothwell
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tuo-Yen Tseng
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren Czaplicki
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anirudh Baddela
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catie Edwards
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geetanjali Chander
- Division of Infectious diseases, Johns Hopkins School of Medicine, Baltimore, MD
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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27
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Tan ASL, Soneji SS, Choi K, Moran MB. Prevalence of using pod-based vaping devices by brand among youth and young adults. Tob Control 2019; 29:461-463. [PMID: 31175225 DOI: 10.1136/tobaccocontrol-2019-055064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Andy S L Tan
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Samir S Soneji
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth University, Lebanon, New Hampshire, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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28
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Lagasse LP, Minosa MKR, Moran MB, Cohen JE. " Decide Now, Buy Marlboro": Examining the influence and appeal of Marlboro's new brand architecture among Filipino adolescents. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0117/ijamh-2018-0117.xml. [PMID: 30281513 DOI: 10.1515/ijamh-2018-0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 11/15/2022]
Abstract
In recent years, Philip Morris International (PMI) launched a global rebranding strategy to expand the reach of Marlboro. Using a mixed-methods design, this study evaluated the appeal and influence of Marlboro advertising among Filipino youth. Six hundred and twenty-three adolescents aged 13-17 years old in Metro Manila participated in a survey, including three advertising conditions: two for Marlboro and one for Mighty, a local cigarette brand. One-way repeated measures analysis of variance (ANOVA) and paired t-tests evaluated differences between the three conditions on participants' attitudes toward advertisements [measured as identification, likeability, and perceived effectiveness (PE)]. Compared to Mighty, never-smokers rated Marlboro advertisements as more identifiable and likeable. Comparing by smoking status (never vs. ever), multivariable logistic regression assessed the influence of these attitudes on intention to smoke. Increased likeability was associated with greater intention to smoke among never-smokers, and greater PE increased odds of intention to smoke for both never- and ever-smokers. Additionally, six focus group discussions (FGD) explored responses to campaign messaging. Themes were compared within and across groups. Marlboro was also appealing to FGD participants, who described the ads as attractive to youth and promoting "adventure" and "freedom", whereas the Mighty brand was seen as being for adults and current smokers. Our findings illustrate that Marlboro advertisements are distinctly appealing to youth. Marlboro rhetoric - where consumers are urged to "decide" to "Be Marlboro" - was particularly powerful. These findings support the need for addressing gaps in policies regulating the marketing and promotion of tobacco in the Philippines.
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Affiliation(s)
- Lisa P Lagasse
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marela Kay R Minosa
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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29
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Choi K, Chen JC, Tan AS, Soneji S, Moran MB. Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults. Tob Control 2018; 28:tobaccocontrol-2018-054363. [PMID: 29921623 PMCID: PMC6301118 DOI: 10.1136/tobaccocontrol-2018-054363] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND We assessed whether receipt of coupons-via direct mail or e-mail-was prospectively related to trajectories of smoking behaviours. METHODS Data were from a cohort of US adults (n=26 447) who participated in wave 1 (2013-2014) and wave 2 (2014-2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours. FINDINGS At wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88). CONCLUSIONS Tobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.
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Affiliation(s)
- Kelvin Choi
- National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland, U.S.A
| | - Julia Cen Chen
- National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland, U.S.A
| | - Andy S.L. Tan
- Dana-Farber Cancer Institute Division of Population Sciences, Boston, Massachusetts, U.S.A
- Harvard T.H. Chan School of Public Health Department of Social and Behavioral Sciences, Boston, Massachusetts, U.S.A
| | - Samir Soneji
- Geisel School of Medicine at Dartmouth The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, U.S.A
| | - Meghan B. Moran
- Johns Hopkins University Bloomberg School of Public Health Department of Health, Behavior and Society, Baltimore, Maryland, U.S.A
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30
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Chen NNT, Moran MB, Frank LB, Ball-Rokeach SJ, Murphy ST. Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication. J Health Commun 2018; 23:661-669. [PMID: 30058946 PMCID: PMC6326179 DOI: 10.1080/10810730.2018.1500661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study explored how structural and cultural forces work together with psychological and communication factors in influencing Pap test compliance among Latinas in Los Angeles County, a group who face health disparities related to cervical cancer screening, incidence and mortality. By adopting a multilevel approach to obtain a grounded understanding of this issue, this work revealed that structural barriers, fatalism, religious service attendance, perceived susceptibility, perceived costs, and cues to action from health care providers are all associated with Pap test compliance. Financial barriers also influence compliance, with underinsurance having a stronger negative impact compared to no insurance at all. These findings provide insights into how communication efforts can be strategically designed to address both individual- and system-level barriers to promote health-seeking behaviors among Latinas, and potentially among other population groups experiencing health disparities due to similar reasons.
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Affiliation(s)
| | - Meghan B. Moran
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA;
| | - Lauren B. Frank
- Department of Communication, Portland State University, Portland, OR, USA;
| | - Sandra J. Ball-Rokeach
- Annenberg School for Communication, University of Southern California, Los Angeles, CA, USA;
| | - Sheila T. Murphy
- Annenberg School for Communication, University of Southern California, Los Angeles, CA, USA;
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Pierce JP, Sargent JD, White MM, Borek N, Portnoy DB, Green VR, Kaufman AR, Stanton CA, Bansal-Travers M, Strong DR, Pearson JL, Coleman BN, Leas E, Noble ML, Trinidad DR, Moran MB, Carusi C, Hyland A, Messer K. Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products. Pediatrics 2017; 139:e20163353. [PMID: 28562266 PMCID: PMC5470502 DOI: 10.1542/peds.2016-3353] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Non-cigarette tobacco marketing is less regulated and may promote cigarette smoking among adolescents. We quantified receptivity to advertising for multiple tobacco products and hypothesized associations with susceptibility to cigarette smoking. METHODS Wave 1 of the nationally representative PATH (Population Assessment of Tobacco and Health) study interviewed 10 751 adolescents who had never used tobacco. A stratified random selection of 5 advertisements for each of cigarettes, e-cigarettes, smokeless products, and cigars were shown from 959 recent tobacco advertisements. Aided recall was classified as low receptivity, and image-liking or favorite ad as higher receptivity. The main dependent variable was susceptibility to cigarette smoking. RESULTS Among US youth, 41% of 12 to 13 year olds and half of older adolescents were receptive to at least 1 tobacco advertisement. Across each age group, receptivity to advertising was highest for e-cigarettes (28%-33%) followed by cigarettes (22%-25%), smokeless tobacco (15%-21%), and cigars (8%-13%). E-cigarette ads shown on television had the highest recall. Among cigarette-susceptible adolescents, receptivity to e-cigarette advertising (39.7%; 95% confidence interval [CI]: 37.9%-41.6%) was higher than for cigarette advertising (31.7%; 95% CI: 29.9%-33.6%). Receptivity to advertising for each tobacco product was associated with increased susceptibility to cigarette smoking, with no significant difference across products (similar odds for both cigarette and e-cigarette advertising; adjusted odds ratio = 1.22; 95% CI: 1.09-1.37). CONCLUSIONS A large proportion of US adolescent never tobacco users are receptive to tobacco advertising, with television advertising for e-cigarettes having the highest recall. Receptivity to advertising for each non-cigarette tobacco product was associated with susceptibility to smoke cigarettes.
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Affiliation(s)
- John P Pierce
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - James D Sargent
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - David B Portnoy
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Victoria R Green
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Cassandra A Stanton
- Westat, Rockville, Maryland
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | | | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Jennifer L Pearson
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Blair N Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Eric Leas
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Karen Messer
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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Moran MB, Walker MW, Alexander TN, Jordan JW, Wagner DE. Why Peer Crowds Matter: Incorporating Youth Subcultures and Values in Health Education Campaigns. Am J Public Health 2017; 107:389-395. [PMID: 28103067 DOI: 10.2105/ajph.2016.303595] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Grounded on research showing that peer crowds vary in risk behavior, several recent health behavior interventions, including the US Food and Drug Administration's Fresh Empire campaign, have targeted high-risk peer crowds. We establish the scientific foundations for using this approach. We introduce peer crowd targeting as a strategy for culturally targeting health behavior interventions to youths. We use social identity and social norms theory to explicate the theoretical underpinnings of this approach. We describe Fresh Empire to demonstrate how peer crowd targeting functions in a campaign and critically evaluate the benefits and limitations of this approach. By replacing unhealthy behavioral norms with desirable, healthy lifestyles, peer crowd-targeted interventions can create a lasting impact that resonates in the target audience's culture.
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Affiliation(s)
- Meghan B Moran
- Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew W. Walker and Tesfa N. Alexander are with the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Jeffrey W. Jordan and Dana E. Wagner are with Rescue, San Diego, CA
| | - Matthew W Walker
- Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew W. Walker and Tesfa N. Alexander are with the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Jeffrey W. Jordan and Dana E. Wagner are with Rescue, San Diego, CA
| | - Tesfa N Alexander
- Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew W. Walker and Tesfa N. Alexander are with the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Jeffrey W. Jordan and Dana E. Wagner are with Rescue, San Diego, CA
| | - Jeffrey W Jordan
- Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew W. Walker and Tesfa N. Alexander are with the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Jeffrey W. Jordan and Dana E. Wagner are with Rescue, San Diego, CA
| | - Dana E Wagner
- Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew W. Walker and Tesfa N. Alexander are with the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Jeffrey W. Jordan and Dana E. Wagner are with Rescue, San Diego, CA
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Mays D, Moran MB, Levy DT, Niaura RS. The Impact of Health Warning Labels for Swedish Snus Advertisements on Young Adults' Snus Perceptions and Behavioral Intentions. Nicotine Tob Res 2016; 18:1371-5. [PMID: 26116085 PMCID: PMC5942605 DOI: 10.1093/ntr/ntv140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study examined the impact of warning labels conveying the potential harms and addictiveness of Swedish snus and the potential-reduced harms of Swedish snus among young adult nonsmokers and smokers. METHODS A convenience sample of young adults aged 18-30 residing in the United States (n = 517, 56% male, 33% smokers) participated in an online experiment. Participants completed baseline measures and were randomized to 1 of 5 experimental conditions where they viewed a Swedish snus ad with warning labels that varied by condition: (1) Control-no warning; (2) Addiction-warning conveying the addictiveness of snus; (3) Harm-warning communicating the potential harms of snus; (4) Harm Reduction-warning conveying the potential-reduced harms of snus compared with cigarettes; (5) Harm Reduction Switch-warning communicating the potential-reduced harms of snus when switching completely from cigarettes to snus. Outcomes measured included perceived harms and addictiveness of snus, thoughts about not using snus, and intentions to use snus. RESULTS Participants in the Harm Reduction and Harm Reduction Switch conditions perceived snus to be less harmful than cigarettes compared with the Control, Addiction, and Harm conditions. Nonsmokers in the Harm Reduction condition reported fewer thoughts about not using snus than nonsmokers in the Harm condition. CONCLUSIONS Warnings conveying the potential-reduced harms of Swedish snus compared with cigarettes generate perceptions that snus is less harmful than cigarettes and produce fewer thoughts about not using snus among nonsmokers. Such perceptions have been associated with snus use in prior studies.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC;
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Raymond S Niaura
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
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Murphy ST, Frank LB, Chatterjee JS, Moran MB, Zhao N, Amezola de Herrera P, Baezconde-Garbanati LA. Comparing the Relative Efficacy of Narrative vs Nonnarrative Health Messages in Reducing Health Disparities Using a Randomized Trial. Am J Public Health 2015; 105:2117-23. [PMID: 25905845 DOI: 10.2105/ajph.2014.302332] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the relative efficacy of a fictional narrative film to a more traditional nonnarrative film in conveying the same health information. METHODS We used a random digit dial procedure to survey the cervical cancer-related knowledge, attitudes, and behavior of non-Hispanic White, Mexican American, and African American women, aged 25 to 45 years, living in Los Angeles, California, from 2011 to 2012. Participants (n = 704) were randomly assigned to view either a narrative or nonnarrative film containing the same information about how cervical cancer could be prevented or detected, and they were re-contacted 2 weeks and 6 months later. RESULTS At 2 weeks, both films produced a significant increase in cervical cancer-related knowledge and attitudes, but these effects were significantly higher for the narrative film. At 6 months, viewers of both films retained greater than baseline knowledge and more positive attitudes toward Papanicolaou (Pap) tests, but women who saw the narrative were significantly more likely to have had or scheduled a Pap test. The narrative was particularly effective for Mexican American women, eliminating cervical cancer screening disparities found at baseline. CONCLUSIONS Narratives might prove to be a useful tool for reducing health disparities.
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Affiliation(s)
- Sheila T Murphy
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Lauren B Frank
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Joyee S Chatterjee
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Meghan B Moran
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Nan Zhao
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Paula Amezola de Herrera
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Lourdes A Baezconde-Garbanati
- Sheila T. Murphy, Joyee S. Chatterjee, Nan Zhao, and Paula Amezola de Herrera are with the Annenberg School for Communication and Journalism, University of Southern California, Los Angeles. Lauren B. Frank is with the Department of Communication, Portland State University, Portland, OR. Meghan B. Moran is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Lourdes A. Baezconde-Garbanati is with the Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California
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Abstract
Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.
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Affiliation(s)
- Lauren B Frank
- a Department of Communication , Portland State University
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Baezconde-Garbanati LA, Chatterjee JS, Frank LB, Murphy ST, Moran MB, Werth LN, Zhao N, Amezola de Herrera P, Mayer D, Kagan J, O'Brien D. Tamale Lesson: A case study of a narrative health communication intervention. ACTA ACUST UNITED AC 2014. [DOI: 10.1179/1753807614y.0000000055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
BACKGROUND AND AIMS The most popular recreational pastime in the U.S. is television viewing. Some researchers have claimed that television may be addictive. We provide a review of the definition, etiology, prevention and treatment of the apparent phenomenon of television addiction. METHODS Selective review. RESULTS We provide a description of television (TV) addiction, including its negative consequences, assessment and potential etiology, considering neurobiological, cognitive and social/cultural factors. Next, we provide information on its prevention and treatment. DISCUSSION AND CONCLUSIONS We suggest that television addiction may function similarly to substance abuse disorders but a great deal more research is needed.
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Affiliation(s)
- Steve Sussman
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, CA, USA,Corresponding Author: Steve Sussman, PhD, FAAHB, FAPA, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Soto Street Building, 2001 North Soto Street, Room 302A, Los Angeles, CA 90033, USA; Phone: +1-323-442-8220; Cell phone: +1-626-376-0389; Fax: +1-626-442-8201;
| | - Meghan B. Moran
- School of Communication, San Diego State University, San Diego, CA, USA
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Kim YC, Moran MB, Wilkin HA, Ball-Rokeach SJ. Integrated connection to neighborhood storytelling network, education, and chronic disease knowledge among African Americans and Latinos in Los Angeles. J Health Commun 2011; 16:393-415. [PMID: 21302173 DOI: 10.1080/10810730.2010.546483] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Combining key ideas from the knowledge-gap hypothesis and communication infrastructure theory, the present study aimed to explain the relations among individuals' education, access to community-based communication resources, and knowledge of chronic diseases (diabetes, hypertension, breast cancer, and prostate cancer) among African Americans and Latinos in Los Angeles. Rather than explore the effect of isolated communication resources, this study explored the effect of an integrated connection to community-based storytellers on chronic disease knowledge. The authors hypothesized that individuals' access to a community-based communication infrastructure for obtaining and sharing information functions as an intervening step in the process where social inequality factors such as education lead to chronic disease knowledge gaps in a local community context. With random samples of African Americans and Latinos in Los Angeles, the authors found that access to community-based communication resources plays a mediating role in the case of breast cancer and diabetes knowledge, but not in hypertension and prostate cancer knowledge. The authors discussed these findings on the basis of communication infrastructure theory and knowledge-gap hypothesis.
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Affiliation(s)
- Yong-Chan Kim
- College of Communication, Yonsei University, Seoul, Republic of Korea.
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Pokhrel P, Brown BB, Moran MB, Sussman S. Comments on adolescent peer crowd affiliation: a response to Cross and Fletcher (2009). J Youth Adolesc 2010; 39:213-6. [PMID: 19774454 DOI: 10.1007/s10964-009-9454-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sussman S, Moran MB, Sun P, Pokhrel P, Gunning M, Rohrbach LA, Kniazev V, Masagutov R. Peer group self-identification in samples of Russian and U.S. adolescents. J Drug Educ 2010; 40:203-215. [PMID: 21133332 DOI: 10.2190/de.40.2.g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Most peer group self-identification research has been conducted in the United States. This article examined the generalizability of self-identified group name research among teens in Ufa, a city in the Russian Federation. A cross-sectional, anonymous collection of data on group self-identification, drug use, addiction concern, sensation seeking, and self-rated school performance was collected from 365 10th grade youth in Ufa and 965 10th grade youth in the United States. The results supported the existence of peer group self-identification by youth in both countries and, in general, replicated the findings that youth who self-identify as a High Risk Youth, are relatively likely to use drugs, show greater concern about becoming an addict, report a greater sensation seeking preference, higher levels of depression, and poorer school performance. Implications of these results are discussed.
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Affiliation(s)
- Steve Sussman
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, CA 91803, USA.
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Moran MB. Clinical research requires IRB review. Arch Intern Med 2001; 161:2151. [PMID: 11570950 DOI: 10.1001/archinte.161.17.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nee SM, Dewees RV, Nee TW, Johnson LF, Moran MB. Slope distribution of a rough surface measured by transmission scattering and polarization. Appl Opt 2000; 39:1561-1569. [PMID: 18345052 DOI: 10.1364/ao.39.001561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transmission scattering from medium to air was used to measure the slope distribution of the rough plane surface of a transparent glass hemisphere. A facet model successfully explained the measured results of refraction, scattering, and polarization: Transmission scattering existed for incident angles greater than the critical angle, all measured curves for the normalized scattered intensity versus the facet slope angle for different detection directions overlapped, and the measured polarization of scattering was approximately constant for >99% of the facets. The slope distribution obtained by transmission scattering agrees with those of the surface profiles in the valid range of the profiler and can represent the slope distribution of the rough surface.
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Affiliation(s)
- S M Nee
- Physics Branch, Research Department, Weapons Division, Naval Air Warfare Center, China Lake, California 93555-6001, USA.
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Liefooghe R, Suetens C, Meulemans H, Moran MB, De Muynck A. A randomised trial of the impact of counselling on treatment adherence of tuberculosis patients in Sialkot, Pakistan. Int J Tuberc Lung Dis 1999; 3:1073-80. [PMID: 10599010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
SETTING Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan. OBJECTIVE To determine whether intensive counselling can improve treatment adherence. DESIGN In a randomised controlled intervention trial of 1,019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default. RESULTS The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay. CONCLUSIONS Intensive counselling has a significant, although limited, impact on treatment adherence.
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Affiliation(s)
- R Liefooghe
- Institute of Tropical Medicine, Antwerp, Belgium.
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Liefooghe R, Michiels N, Habib S, Moran MB, De Muynck A. Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan. Soc Sci Med 1995; 41:1685-92. [PMID: 8746868 DOI: 10.1016/0277-9536(95)00129-u] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.
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Affiliation(s)
- R Liefooghe
- Department of Epidemiology, Institute of Tropical Medicine, Antwerpen, Belgium
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Abstract
OBJECTIVES To determine the frequency of referral of patients age 69 years and older to the pulmonary function laboratory at a tertiary-care hospital for airflow limitation studies; to determine the point prevalence of a significant reversible component in patients with COPD as an age-related function; and to determine the proportion of patients who were prescribed bronchodilators following a pulmonary function test (PFT) demonstrating significant reversibility. DESIGN A retrospective review of pulmonary function tests of patients 69 years and older within calendar year 1990 was performed. Chart review of those showing significant reversibility to bronchodilators during a PFT was performed to determine level of follow-up. SETTING Referral-based pulmonary division in a tertiary-care hospital. PATIENTS Men and women 69 years and older who had interpretable PFTs at Northwestern Memorial Hospital (NMH) during the calendar year 1990 (n = 405). Patients whose PFTs were uninterpretable due to poor effort (n = 10) were excluded from the study. INTERVENTIONS No specific interventions were performed as a part of the study. Referring physicians may have requested a PFT with postbronchodilator (albuterol by nebulizer) testing and may have subsequently prescribed bronchodilators for their patients. MEASUREMENTS We studied the effect of age, gender, smoking history, and degree of airflow obstruction on changes in spirometry values and reversibility status after bronchodilator (if applicable) as determined by a PFT. MAIN RESULTS Of the 405 consecutive elderly patients studied, 193 (47.7%) received bronchodilators and 60 (31.1%) of these patients had significant improvement as judged by the criteria listed in the Methods section. The improvement occurred equally across all age groups (p > 0.05) and the percent responding to bronchodilators increased as the degree of obstruction increased (p < 0.001). Those who had never smoked were twice as likely to respond than were current or former smokers; men were more likely to respond than women. Most patients (84%) who responded were subsequently prescribed bronchodilators. CONCLUSIONS Responses to inhaled bronchodilators occur at all ages. Older patients showed greater reversibility as the degree of obstruction increased, while a smoking history reduced the likelihood of a bronchodilator response. COPD in the elderly may differ from the traditional form of the disease.
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Affiliation(s)
- J T Chang
- Northwestern University Medical School, Chicago, IL, USA
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Abstract
STUDY OBJECTIVE To determine the prevalence of delirium and other alterations in mental status in older adults in the emergency department setting. DESIGN Prospective, cross-sectional study. SETTING Private, nonprofit, academic medical center in a densely populated urban area. PARTICIPANTS One hundred eighty-eight adults 70 years or older who presented to the ED. INTERVENTIONS None. RESULTS Delirium and other alterations in mental status were present in 39.9% of the patients studied; 24% of these patients had delirium. Age and severity of illness were positively correlated with alteration in mental status. Patients with alterations in mental status were more likely to be admitted to an inpatient unit. Among those admitted from home, alterations in mental status in the ED were associated with a higher likelihood of institutionalization at discharge. CONCLUSION Alterations in mental status are prevalent in ED patients. Older adults with alterations in mental status, particularly alterations in consciousness and delirium, are at high risk for admission to an inpatient unit and institutionalization after discharge. Standardized mental status testing identified high-risk older adults in the ED.
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Affiliation(s)
- B J Naughton
- Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA
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Naughton BJ, Moran MB, Feinglass J, Falconer J, Williams ME. Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial. J Am Geriatr Soc 1994; 42:1045-9. [PMID: 7930327 DOI: 10.1111/j.1532-5415.1994.tb06207.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults. DESIGN Randomized controlled trial. Patients were followed in the acute hospital from admission through discharge. Results based on both univariate and multiple regression analyses. SETTING Private, nonprofit, academic medical center in a densely populated urban area. PATIENTS Adults 70 years of age and older admitted from the Emergency Department to the medicine service (non-ICU admission) who did not have an internist on staff at the admitting hospital. Of 141 randomized patients, 111 (78.7%) met eligibility criteria. INTERVENTION Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay. MAIN OUTCOME MEASURES Length of stay, total cost of acute hospital care, cost of laboratory, pharmacy, and rehabilitation services. RESULTS Patients in the intervention group had 2.1 fewer days of hospitalization, but this shorter length of stay was not statistically significant (P = 0.108). There were no differences in mortality or discharge disposition. In risk-adjusted, multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group (-$2,544, P = 0.029); assignment to the intervention group was associated with a lower predicted cost per patient for laboratory (including cardiology graphics) services (P = 0.007) and pharmacy costs (P = 0.047). CONCLUSIONS When controlled for important predictors of expected resource use, care provided by a geriatric management team resulted in a significant reduction in the cost of hospitalization. A reduction in the cost of laboratory, cardiographic, and pharmacy services is consistent with the team's philosophy of defining the services needed based on goals related to functional outcomes.
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Affiliation(s)
- B J Naughton
- Department of Medicine, Northwestern University, Chicago, IL
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Abstract
This is a report of a dietary analysis of meals offered in one large congregate feeding program and clients' consumption patterns as they relate to self-reported dietary restrictions. Most meals exceeded dietary guidelines for kilocalories, cholesterol, and proportion of energy from fat. Of 438 congregate meal clients 60 years of age and older who were surveyed at senior citizen centers and congregate meal sites, 30% reported following a "special diet." The most commonly mentioned dietary modifications were low sodium and/or low fat/low cholesterol. Clients who reported dietary restrictions also reported eating fewer congregate meals per week than did clients who denied dietary restrictions.
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