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Gilbert LK, Matthews S, Dube SR, Annor FB. Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries. Child Abuse Negl 2024; 150:106542. [PMID: 37996356 PMCID: PMC10961201 DOI: 10.1016/j.chiabu.2023.106542] [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] [Received: 06/22/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) include forms of abuse, neglect, and household stressors that are potentially early life traumatic experiences. A summed integer count of ACEs is often used to examine cumulative childhood adversity (CCA) but has limitations. OBJECTIVES The current study tests two additional methods for measuring CCA using large samples of youth in low- and middle-income countries. PARTICIPANTS AND SETTING Pooled data were analyzed from a multi-country, nationally representative sample of youth aged 18-24 years (N = 11,498) who completed the Violence Against Children and Youth Surveys (VACS) in Lesotho, Cote d'Ivoire, Kenya, Namibia, and Mozambique. METHODS ACE exposures included: physical, sexual, and emotional violence; witnessing interparental violence; witnessing community violence; orphanhood. CCA was operationalized using an ACE score, ACE impact (standardized regression coefficients from outcome severity), and ACE exposure context (household; intimate partner; peer; community). Associations between CCA with mental distress (MD) were examined by sex using p ≤ 0.05 as the significance level. RESULTS Exposure to ≥3 ACEs was associated with MD (p < 0.05) for both sexes. Among females, all contexts contributed to MD except peer ACEs (p < 0.05). Among males, household and community ACEs contributed to MD. High-impact ACEs were associated with MD both sexes. ACE context was the best-fitting model for these data. CONCLUSIONS The challenges operationalizing CCA warrant continued research to ensure adversity type, severity, and context lead to validly assessing ACEs impact on child wellbeing.
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Affiliation(s)
- Leah K Gilbert
- Eunice Kennedy Shriver Pediatric Trauma and Critical Illness Branch, National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
| | - Sarah Matthews
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shanta R Dube
- Levine College of Health Sciences, Department of Public Health, Wingate University, Wingate, NC, United States
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Gilbert LK, Annor FB, Brown C, Dube SR. Introduction to the child abuse and neglect special issue "epidemiology, risk factors, and impacts of adverse childhood experiences in low- and middle-income countries.". Child Abuse Negl 2024; 150:106748. [PMID: 38508913 DOI: 10.1016/j.chiabu.2024.106748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Leah K Gilbert
- Eunice Kennedy Shriver Pediatric Trauma and Critical Illness Branch, National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States of America.
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Colvette Brown
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Shanta R Dube
- Levine College of Health Sciences, Department of Public Health, Wingate University, Wingate, NC, United States of America
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Annor FB, Amene EW, Zhu L, Stamatakis C, Picchetti V, Matthews S, Miedema SS, Brown C, Thorsen VC, Manuel P, Gilbert LK, Kambona C, Coomer R, Trika J, Kamuingona R, Dube SR, Massetti GM. Parental absence as an adverse childhood experience among young adults in sub-Saharan Africa. Child Abuse Negl 2024; 150:106556. [PMID: 37993366 PMCID: PMC10961199 DOI: 10.1016/j.chiabu.2023.106556] [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] [Received: 04/20/2023] [Revised: 09/18/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Parental absence in childhood has been associated with multiple negative consequences, such as depression and anxiety in young adulthood. OBJECTIVE To assess whether parental absence for six months or more in childhood is associated with poor mental health and substance use in young adulthood and whether parental absence accounts for additional variance beyond those explained by other adverse childhood experiences (ACEs) among youth in sub-Saharan Africa. PARTICIPANTS AND SETTINGS We used combined Violence Against Children and Youth Survey (VACS) data from Cote d'Ivoire (2018), Lesotho (2018), Kenya (2019), Namibia (2019), and Mozambique (2019). Analyses were restricted to 18-24-year-olds (nf = 7699; nm = 2482). METHODS We used logistic regression to examine sex-stratified relationships between parental absence in childhood (defined as biological mother or father being away for six months or more before age 18) and mental health problems and substance use and whether parental absence explained additional variance beyond those explained by other ACEs. RESULTS In sub-Saharan Africa, parental absence in childhood was common (30.5 % in females and 25.1 % in males), significantly associated with poor mental health and substance use among females and males and accounted for additional variance beyond those explained by conventional ACEs. For example, after controlling for study covariates and other ACEs, females who experienced any parental absence had 1.52 (95 % CI = 1.02-2.26) higher odds of experiencing moderate/serious psychological distress compared with those who did not. CONCLUSION The observed association between parental absence and poor mental health suggests that this experience has significant adverse consequences and merits consideration as an ACE.
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Affiliation(s)
- Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States; United States Public Health Service Commissioned Corps, United States.
| | - Ermias W Amene
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Liping Zhu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Caroline Stamatakis
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Rwanda
| | - Viani Picchetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Matthews
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephanie S Miedema
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Colvette Brown
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Viva C Thorsen
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pedro Manuel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | - Leah K Gilbert
- United States Public Health Service Commissioned Corps, United States; Office of the Chief Operating Officer, Office of Safety, Security and Asset Management, Occupational Health Clinic, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Caroline Kambona
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kenya
| | - Rachel Coomer
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Namibia
| | | | | | - Shanta R Dube
- Levine College of Public Health Program, Wingate University, Wingate, NC, United States
| | - Greta M Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Fortson K, Rajbhandari-Thapa J, Ingels J, Thapa K, Dube SR. Adverse childhood experiences, risk of opioid misuse and its pathway among students at a public university. J Am Coll Health 2023; 71:2859-2868. [PMID: 34788586 DOI: 10.1080/07448481.2021.2002336] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We examine role of ACEs and pathways to risk of opioid misuse among young adults. Participants and Methods: A cross-sectional survey of validated measures of ACEs, risk of opioid misuse, and health conditions with a sample of 1,402 students from a large public university followed by multivariate logistic regression and pathway analysis. Results: Majority (61%) of participants reported at least one ACE. A dose-response relationship between numbers of ACEs with risk for opioid misuse was present. Compared to participants with no ACEs, participants with ≥4 ACEs and 0-3 ACEs were 2.93 (95% CI: 1.95, 4.39; p < 0.001) and 1.96 (95% CI: 1.46, 2.65; p < 0.001) times more likely to be at risk for opioid misuse, respectively. Having at least one existing or past health condition significantly mediated the association. Conclusions: Our findings suggest need to include assessment of ACEs as a screening criterion for opioid prescription and administration among college-aged individuals.
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Affiliation(s)
- Kennicia Fortson
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Justin Ingels
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Kiran Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Shanta R Dube
- Department of Population Health Sciences, School of Public Health, Georgia State University, Athens, Georgia, USA
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Dube SR, Li ET, Fiorini G, Lin C, Singh N, Khamisa K, McGowan J, Fonagy P. Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence. Child Abuse Negl 2023; 144:106394. [PMID: 37586139 DOI: 10.1016/j.chiabu.2023.106394] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention. OBJECTIVE We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA. PARTICIPANTS AND SETTING A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified. RESULTS Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan. CONCLUSIONS Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.
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Affiliation(s)
- Shanta R Dube
- Director, Department of Public Health, Master of Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America.
| | - Elizabeth T Li
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Guilherme Fiorini
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Caleb Lin
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nikita Singh
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Kumayl Khamisa
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Panlilio CC, Dube SR, Corr C. A framework for promoting learning and development in the context of adversity: An introduction to the special issue. Child Abuse Negl 2023; 142:106176. [PMID: 37059648 DOI: 10.1016/j.chiabu.2023.106176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Carlomagno C Panlilio
- Department of Educational Psychology, Counseling, and Special Education, Child Maltreatment Solutions Network, Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA.
| | - Shanta R Dube
- Department of Public Health, Levine College of Health Sciences, Wingate University, Wingate, NC, USA
| | - Catherine Corr
- Department of Special Education, University of Illinois, Urbana-Champaign, IL, USA
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Dube SR, Rishi S, Corr C, Panlilio CC. Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care. Child Abuse Negl 2022:105777. [PMID: 35810034 DOI: 10.1016/j.chiabu.2022.105777] [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] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response. OBJECTIVES To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K-12) staff. PARTICIPANTS AND SETTING A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %). METHODS Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC. RESULTS Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice. CONCLUSIONS TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.
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Affiliation(s)
- Shanta R Dube
- Department of Public Health, Director, Master of Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America.
| | | | - Catherine Corr
- Department of Special Education, University of Illinois, Urbana-Champaign, United States of America
| | - Carlomagno C Panlilio
- Educational Psychology Program, Department of Educational Psychology, Counseling, and Special Education, Child Maltreatment Solutions Network; Social Science Research Institute, The Pennsylvania State University, United States of America
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Singh N, Dube SR, Varshney U, Bourgeois AG. A comprehensive mobile health intervention to prevent and manage the complexities of opioid use. Int J Med Inform 2022; 164:104792. [PMID: 35642997 DOI: 10.1016/j.ijmedinf.2022.104792] [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: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Opioid Use crisis continues to be an epidemic with multiple known influencing and interacting factors. With the need for suitable opioid use interventions, we present a conceptual design of an m-health intervention that addresses the various known interacting factors of opioid use and corresponding evidence-based practices. The visualization of the opioid use complexities is presented as the "Opioid Cube". METHODS Following Stage 0 to Stage IA of the NIH Stage Model, we used guidelines and extant health intervention literature on opioid apps to inform the Opioid Intervention (O-INT) design. We present our design using system architecture, algorithms, and user interfaces to integrate multiple functions including decision support. We evaluate the proposed O-INT using analytical modeling. RESULTS The conceptual design of O-INT supports the concept of collaborative care, by providing connections between the patient, healthcare professionals, and their family members. The evaluation of O-INT shows a preference for specific functions, such as overdose detection and potential for high system reliability with minimal side effects. The Opioid Cube provides a visualization of various opioid use states and their influencing and interacting factors. CONCLUSIONS O-INT is a promising design with a holistic approach to manage opioid use and prevent and treat misuse. With several needed functionalities, O-INT design serves as a decision support system for patients, healthcare professionals, researchers, and policy makers. Together, O-INT and the Opioid Cube may serve as a foundation for development and adoption of highly effective m-health interventions for opioid use.
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Affiliation(s)
- Neetu Singh
- Department of Management Information Systems, University of Illinois at Springfield, Springfield, IL 62703, USA.
| | - Shanta R Dube
- Department of Public Health, Levine College of Health Sciences, Wingate University, Wingate, NC 28174, USA.
| | - Upkar Varshney
- Department of Computer Information Systems, Georgia State University, Atlanta, GA 30302, USA.
| | - Anu G Bourgeois
- Department of Computer Science, Georgia State University, Atlanta, GA 30302, USA.
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Almohaimeed B, Dube SR, Luo R. Investigating oral health among individuals with depression: NHANES 2015–2016. Saudi Dent J 2022; 34:249-258. [PMID: 35935724 PMCID: PMC9348997 DOI: 10.1016/j.sdentj.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Depression is highly prevalent across populations, yet studies on its contribution to oral health are lacking. Therefore, our goal is to examine the association of depression and oral health problems (preventative care, access to dental care, and oral condition in relation to quality of life) controlling for sociodemographic and chronic disease indicators (CDI). Methods 5,992 respondents’ data 18+ years old were analyzed from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). The independent variable of interest was depression symptoms status. Oral health outcomes were the dependent variables. We used the Patient Health Questionnaire-9 (PHQ-9) for depression and the Oral Health Questionnaire (OHQ) to measure oral health outcomes. Covariates included sociodemographics (age, education, sex, race/ethnicity, and income) and CDI included current smoking, diabetes, and body mass index. All data were weighted using 2 years sample weight. Results The mean age of respondents was 47.22 years (45.97–48.46) and 46% were males. Participants with depression present 6.93%, and females 63.85% were higher than males 36.15%. Participants with depression have significantly low income 43.10% than others p value < 0.0001. After adjusting for sociodemographics and CDI, participants who have depression were more prone to report fair/poor oral condition [aOR = 1.91 (1.29–2.84)], oral pain [aOR = 2.66 (1.91–3.71)], and difficulty accessing needed dental care [aOR = 2.52 (1.96–3.24)] than others. Having depression was associated with poor oral health perceptions [aOR = 2.10 (1.41–3.13)], and having difficulty at job/school because of their oral health [aOR = 2.85 (1.90–4.26)]. Conclusion Based on the empirical evidence provided by our study, there is an association between depression and oral health outcomes and oral health-related quality of life.
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10
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Varshney U, Singh N, Bourgeois AG, Dube SR. Review, Assess, Classify, and Evaluate (RACE): a framework for studying m-health apps and its application for opioid apps. J Am Med Inform Assoc 2021; 29:520-535. [PMID: 34939117 DOI: 10.1093/jamia/ocab277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/22/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The proliferation of m-health interventions has led to a growing research area of app analysis. We derived RACE (Review, Assess, Classify, and Evaluate) framework through the integration of existing methodologies for the purpose of analyzing m-health apps, and applied it to study opioid apps. MATERIALS AND METHODS The 3-step RACE framework integrates established methods and evidence-based criteria used in a successive manner to identify and analyze m-health apps: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, inter-rater reliability analysis, and Nickerson-Varshney-Muntermann taxonomy. RESULTS Using RACE, 153 opioid apps were identified, assessed, and classified leading to dimensions of Target Audience, Key Function, Operation, Security & Privacy, and Impact, with Cohen's kappa < 1.0 suggesting subjectivity in app narrative assessments. The most common functions were education (24%), prescription (16%), reminder-monitoring-support (13%), and treatment & recovery (37%). A majority are passive apps (56%). The target audience are patients (49%), healthcare professionals (39%), and others (12%). Security & Privacy is evident in 84% apps. DISCUSSION Applying the 3-step RACE framework revealed patterns and gaps in opioid apps leading to systematization of knowledge. Lessons learned can be applied to the study of m-health apps for other health conditions. CONCLUSION With over 350 000 existing and emerging m-health apps, RACE shows promise as a robust and replicable framework for analyzing m-health apps for specific health conditions. Future research can utilize the RACE framework toward understanding the dimensions and characteristics of existing m-health apps to inform best practices for collaborative, connected and continued care.
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Affiliation(s)
- Upkar Varshney
- Department of Computer Information Systems, Georgia State University, Atlanta, Georgia, USA
| | - Neetu Singh
- Department of Management Information Systems, University of Illinois at Springfield, Springfield, Illinois, USA
| | - Anu G Bourgeois
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Shanta R Dube
- Department of Public Health, Levine College of Health Sciences, Wingate University, Wingate, North Carolina, USA
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Suglia SF, Appleton AA, Bleil ME, Campo RA, Dube SR, Fagundes CP, Heard-Garris NJ, Johnson SB, Slopen N, Stoney CM, Watamura SE. Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research. Prev Med 2021; 153:106736. [PMID: 34293381 PMCID: PMC8595689 DOI: 10.1016/j.ypmed.2021.106736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 01/04/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.
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Affiliation(s)
- Shakira F Suglia
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY, United States of America
| | - Maria E Bleil
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States of America
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Shanta R Dube
- Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States of America
| | - Nia J Heard-Garris
- Division of Advanced General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Sara B Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Catherine M Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Sarah E Watamura
- Department of Psychology, University of Denver, Denver, CO, United States of America
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Tan J, Dube SR. A Pilot Study on the Awareness and Knowledge of Adverse Childhood Experiences Science and Trauma-informed Care among Medical School Students. Perm J 2021; 25. [DOI: 10.7812/tpp/20.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jere Tan
- Medical College of Georgia, Augusta, GA
| | - Shanta R Dube
- Levine College of Health Sciences, Wingate University, Wingate, NC
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13
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Feinberg I, O’Connor MH, Owen-Smith A, Dube SR. Public health crisis in the refugee community: little change in social determinants of health preserve health disparities. Health Educ Res 2021; 36:170-177. [PMID: 33599272 PMCID: PMC7928937 DOI: 10.1093/her/cyab004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/15/2021] [Indexed: 05/07/2023]
Abstract
Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.
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Affiliation(s)
- I Feinberg
- Department of Learning Sciences, Adult Literacy Research Center, Georgia State University, Atlanta, GA 30303, USA
| | - M H O’Connor
- Center for Community Engagement at Clarkston, Prevention Research Center, Georgia State University, Atlanta, GA 30303, USA
| | - A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - S R Dube
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA
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Suglia SF, Campo RA, Brown AGM, Stoney C, Boyce CA, Appleton AA, Bleil ME, Boynton-Jarrett R, Dube SR, Dunn EC, Ellis BJ, Fagundes CP, Heard-Garris NJ, Jaffee SR, Johnson SB, Mujahid MS, Slopen N, Su S, Watamura SE. Social Determinants of Cardiovascular Health: Early Life Adversity as a Contributor to Disparities in Cardiovascular Diseases. J Pediatr 2020; 219:267-273. [PMID: 32111376 PMCID: PMC7883398 DOI: 10.1016/j.jpeds.2019.12.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022]
Affiliation(s)
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Alison G M Brown
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Catherine Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Cheryl A Boyce
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY
| | - Maria E Bleil
- Department of Family and Child Nursing, University of Washington, Seattle, WA
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Shanta R Dube
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Boston, MA
| | - Bruce J Ellis
- Departments of Psychology and Anthropology, University of Utah, Salt Lake City, UT
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Psychiatry, Baylor College of Medicine, Waco, TX
| | - Nia J Heard-Garris
- Division of Academic General Pediatrics, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | - Sara B Johnson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mahasin S Mujahid
- Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley CA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
| | - Shaoyong Su
- Department of Population Health Sciences, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
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Dube SR, Liu J, Fan AZ, Meltzer MI, Thompson WW. Assessment of age-related differences in smoking status and health-related quality of life (HRQoL): Findings from the 2016 Behavioral Risk Factor Surveillance System. J Community Psychol 2019; 47:93-103. [PMID: 30506930 PMCID: PMC7568861 DOI: 10.1002/jcop.22101] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 06/09/2023]
Abstract
Despite significant declines in the use of cigarettes, a significant proportion of adults smoke. This study explores the association between smoking and health-related quality of life (HRQoL) by age. The 2016 Behavioral Risk Factor Surveillance System survey was administered to adults in 50 states and District of Columbia (n = 437,195). Physically unhealthy days (PUDs) and mentally unhealthy days (MUDs)) were regressed on age strata (18-24, 25-34, 35-44, 45-54, 55-64, ≥ 65 years) and smoking status (never, former, someday, and everyday) using negative binomial regression models with adjustment for sociodemographic covariates. For each age group, everyday smoking highly predicted PUDs and MUDs. Predicted PUDs increased with age; predicted MUDs decreased with age. Among adults aged 45-54 and 55-64 years, 3-day difference in PUDs was observed between never smokers and everyday smokers. Among young adults (18-24 years), a 4.3-day difference in MUDs was observed between everyday and never smokers. The discrepancies were nonlinear with age. The observed relationship between smoking and HRQoL provides novel information about the need to consider age when designing community-based interventions. Additional research can provide needed depth to understanding the relationship between smoking and HRQoL in specific age groups.
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Affiliation(s)
| | - Jin Liu
- University of South Carolina
| | - Amy Z. Fan
- National Institute on Alcohol Abuse and Alcoholism, National Institute of Health
| | - Martin I. Meltzer
- Nation Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - William W. Thompson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention
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Dube SR. Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective. Child Abuse Negl 2018; 85:180-184. [PMID: 29555095 DOI: 10.1016/j.chiabu.2018.03.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 05/21/2023]
Abstract
Currently, in the U.S. and worldwide, childhood trauma is a public health crisis. Childhood adversities, such as abuse, neglect, and related household stressors, are common, interrelated and contribute to multiple adverse social, behavioral and health outcomes throughout the lifespan. The present article provides further discussion regarding adverse childhood experiences (ACEs) screening in healthcare utilizing the etic and emic perspectives. Screening in the healthcare system leans toward the etic view: objective observations of symptoms, which may then lead to intervention delivery. Whereas the emic view provides the subjective perspective as experienced by participants of a system, culture, or common group. Finkelhor's argument about cautions regarding widespread screening is relevant in the current allopathic healthcare system, which utilizes an etic perspective and where evidence-based ACEs interventions within a biomedical-centric model are lacking. Therefore, in healthcare settings, universal ACEs screening may serve the clinicians with a surveillance tool to inform and guide medical practice and policy as they relate to delivering trauma-informed care. The Public Health Code of Ethics and Basis for Action reminds us about the values approach for collecting and using data ethically to protect population health. Practitioners and researchers across the globe are beginning to take community-engaged action, with an emic view of all community members involved.
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Affiliation(s)
- Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, 140 Decatur Street, Urban Life Building, Suite 465, Atlanta, GA 30303, United States.
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Afifi TO, Brown S, Dube SR, Emery C, Fraser J, Jud A, Lindberg D, Theron L, Wekerle C. Putting Children First: When trauma research and governmental policy collides. Child Abuse Negl 2018; 83:A1-A2. [PMID: 30122237 DOI: 10.1016/j.chiabu.2018.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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18
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Dube SR, McGiboney GW. Education and learning in the context of childhood abuse, neglect and related stressor: The nexus of health and education. Child Abuse Negl 2018; 75:1-5. [PMID: 29079034 DOI: 10.1016/j.chiabu.2017.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Shanta R Dube
- Division of Epidemiology and Biostatistics School of Public Health, Georgia State University, 140 Decatur Street, Urban Life Building, Suite 465, Atlanta, GA, 30303, United States.
| | - Garry W McGiboney
- Georgia Department of Education, Twin Towers East, Suite 2053, 205 Jesse Hill Jr. Drive, Atlanta, GA, 30334, United States.
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Dube SR, Rishi S. Utilizing the salutogenic paradigm to investigate well-being among adult survivors of childhood sexual abuse and other adversities. Child Abuse Negl 2017; 66:130-141. [PMID: 28249732 DOI: 10.1016/j.chiabu.2017.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 06/06/2023]
Abstract
The long-term negative consequences of adverse childhood experiences are well documented. However, less is known about salutogenesis (well-being) among adult survivors of childhood adversity. The 2010 Behavioral Risk Factor Surveillance System data were analyzed to assess the contribution of four health promoting factors (physical activity, smoking abstinence, educational level, social-emotional support) with positive health-related quality of life (HRQoL), among adults who retrospectively reported childhood abuse or exposure to other childhood toxic stressors (n=12,032) and separately for adults who reported childhood sexual abuse (CSA). Outcomes examined included positive self-rated health (good/very good/excellent); mentally unhealthy days (MUDS) and physically unhealthy days (PUDS) in the past 30 days. After controlling for demographic characteristics and existing health conditions, physical activity (p<.05), smoking abstinence (p<.05), education of high school or greater (p<.05), and social-emotional support (p<.05) were associated with positive HRQoL outcomes among adult survivors of childhood adversity and adult survivors of CSA. Each unit increase of the health promoting factor score (0-4) resulted in adjusted odds ratio of 2.1 (95% CI: 1.3-2.4) for self-rated health and 1.6 (95%CI: 1.1-2.6) for <14 PUDs among male CSA survivors; among female survivors the adjusted odds ratios were 2.4 (95% CI: 1.8-3.2) for self-rated health, 2.3 (95% CI: 1.7-3.1) for <14 MUDs, and 2.2 (95% CI: 1.6-3.0) for <14 PUDs. The study validates that a large proportion of adults survive childhood adversities and underscores the importance of the salutogenic paradigm to identify strategies that may contribute to well-being.
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Affiliation(s)
- Shanta R Dube
- Associate Professor, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University; Affiliated Faculty, Center for the Study on Stress, Trauma, and Resilience, Department of Counseling & Psychological Services, Georgia State University.
| | - Shobhana Rishi
- Education Program Consultant, California Department of Education, Sacramento, CA, USA; Research Associate, Omkar Mission Research Institute, Pune, India
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Abstract
INTRODUCTION Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products has proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) Model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. METHODS In June-August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Statistical analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. RESULTS Among 54 products, 70.4% were e-cigarettes and 29.6% were e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. CONCLUSIONS The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products.
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Affiliation(s)
- Shanta R. Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, 1 Park Place, Suite 711, Atlanta, GA 30303, United States
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21
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Anda RF, Fleisher VI, Felitti VJ, Edwards VJ, Whitfield CL, Dube SR, Williamson DF. Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance. Perm J 2015; 8:30-8. [PMID: 26704603 DOI: 10.7812/tpp/03-089] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined the relation between eight types of adverse childhood experience (ACE) and three indicators of impaired worker performance (serious job problems, financial problems, and absenteeism). METHODS We analyzed data collected for the Adverse Childhood Experiences Study from 9633 currently employed adult members of the Kaiser Foundation Health Plan in San Diego. RESULTS Strong graded relations were found between the ACE Score (total number of ACE categories experienced) and each measure of impaired worker performance (p < .001). We found strong evidence that the relation between ACE Score and worker performance was mediated by interpersonal relationship problems, emotional distress, somatic symptoms, and substance abuse. CONCLUSIONS The long-term effects of adverse childhood experiences on the workforce impose major human and economic costs that are preventable. These costs merit attention from the business community in conjunction with specialists in occupational medicine and public health.
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22
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Mowery PD, Dube SR, Thorne SL, Garrett BE, Homa DM, Nez Henderson P. Disparities in Smoking-Related Mortality Among American Indians/Alaska Natives. Am J Prev Med 2015; 49:738-744. [PMID: 26163166 DOI: 10.1016/j.amepre.2015.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/23/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Smoking-related disparities continue to be a public health problem among American Indian/Alaska Native (AI/AN) population groups and data documenting the health burden of smoking in this population are sparse. The purpose of this study was to assess mortality attributable to cigarette smoking among AI/AN adults relative to non-Hispanic white adults (whites) by calculating and comparing smoking-attributable fractions and mortality. METHODS Smoking-attributable fractions and mortality among AI/ANs (n=1.63 million AI/ANs) and whites were calculated for people living in 637 Indian Health Service Contract Health Service Delivery Area counties in the U.S., from mortality data collected during 2001-2009. Differences in smoking-attributable mortality between AI/ANs and whites for five major causes of smoking-related deaths were examined. All data analyses were carried out in 2013-2014. RESULTS Overall, from 2001 to 2009, age-adjusted death rates, smoking-attributable fractions, and smoking-attributable mortality for all-cause mortality were higher among AI/ANs than among whites for adult men and women aged ≥35 years. Smoking caused 21% of ischemic heart disease, 15% of other heart disease, and 17% of stroke deaths in AI/AN men, compared with 15%, 10%, and 9%, respectively, for white men. Among AI/AN women, smoking caused 18% of ischemic heart disease deaths, 13% of other heart diseases deaths, and 20% of stroke deaths, compared with 9%, 7%, and 10%, respectively, among white women. CONCLUSIONS These findings underscore the need for comprehensive tobacco control and prevention efforts that can effectively reach and impact the AI/AN population to prevent and reduce smoking.
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Affiliation(s)
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
| | | | | | - David M Homa
- Office on Smoking and Health, CDC, Atlanta, Georgia
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Fulmer EB, Neilands TB, Dube SR, Kuiper NM, Arrazola RA, Glantz SA. Protobacco Media Exposure and Youth Susceptibility to Smoking Cigarettes, Cigarette Experimentation, and Current Tobacco Use among US Youth. PLoS One 2015; 10:e0134734. [PMID: 26308217 PMCID: PMC4550466 DOI: 10.1371/journal.pone.0134734] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Youth are exposed to many types of protobacco influences, including smoking in movies, which has been shown to cause initiation. This study investigates associations between different channels of protobacco media and susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US middle and high school students. Methods By using data from the 2012 National Youth Tobacco Survey, structural equation modeling was performed in 2013. The analyses examined exposure to tobacco use in different channels of protobacco media on smoking susceptibility, experimentation, and current tobacco use, accounting for perceived peer tobacco use. Results In 2012, 27.9% of respondents were never-smokers who reported being susceptible to trying cigarette smoking. Cigarette experimentation increased from 6.3% in 6th grade to 37.1% in 12th grade. Likewise, current tobacco use increased from 5.2% in 6th grade to 33.2% in 12th grade. Structural equation modeling supported a model in which current tobacco use is associated with exposure to static advertising through perception of peer use, and by exposure to tobacco use depicted on TV and in movies, both directly and through perception of peer use. Exposure to static advertising appears to directly increase smoking susceptibility but indirectly (through increased perceptions of peer use) to increase cigarette experimentation. Models that explicitly incorporate peer use as a mediator can better discern the direct and indirect effects of exposure to static advertising on youth tobacco use initiation. Conclusions These findings underscore the importance of reducing youth exposure to smoking in TV, movies, and static advertising.
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Affiliation(s)
- Erika B. Fulmer
- Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS F-79, Atlanta, Georgia, 30341, United States of America
- * E-mail:
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California San Francisco, 50 Beale Street, Suite 1300, San Francisco, California, 94105, United States of America
| | - Shanta R. Dube
- Epidemiology and Biostatistics, School of Public Health, Georgia State University, 140 Decatur Street, Suite 848, Atlanta, Georgia, 30303, United States of America
| | - Nicole M. Kuiper
- Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS F-79, Atlanta, Georgia, 30341, United States of America
| | - Rene A. Arrazola
- Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS F-79, Atlanta, Georgia, 30341, United States of America
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, 530 Parnassus Avenue, San Francisco, California, 94143–1390, United States of America
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Abstract
INTRODUCTION Physicians and health care providers play an important role in educating their patients about the health risks of tobacco use and in providing effective cessation interventions. Little is known about these practices in hospital outpatient settings. The objective of the study was to assess the prevalence, correlates, and trends of tobacco use screening and cessation assistance offered to US adults during their hospital outpatient clinic visits. METHODS Data for aggregated hospital outpatient visits among patients aged 18 years or older (N = 148,727) from the 2005-2010 National Hospital Ambulatory Medical Care Survey were analyzed. Tobacco use screening was defined as documentation of screening for either current tobacco use (cigarettes, cigars, snuff, or chewing tobacco) or no current use on the patient record form. Tobacco cessation assistance was defined as documentation of either tobacco counseling or cessation medications. RESULTS Tobacco use screening was reported for 63.0% (estimated 271 million visits) of hospital outpatient visits, and cessation assistance was reported for 24.5% (estimated 17.1 million visits) of visits among current tobacco users. From 2005 through 2010, tobacco use screening (P for trend = .06) and cessation assistance (P for trend = .17) did not change significantly. CONCLUSION From 2005 through 2010, more than one-third of hospital outpatient visits had no screening for tobacco use, and among current tobacco users, only 1 in 4 received any cessation assistance. Health care providers should consistently identify and document their patients' tobacco use status and provide them with appropriate tobacco cessation assistance. Opportunities also exist to expand the coverage for tobacco cessation.
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Affiliation(s)
- Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mail Stop F79, Atlanta, GA 30341.
| | - Shanta R Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Orpinas P, Lacy B, Nahapetyan L, Dube SR, Song X. Cigarette Smoking Trajectories From Sixth to Twelfth Grade: Associated Substance Use and High School Dropout. Nicotine Tob Res 2015; 18:156-62. [PMID: 25744961 DOI: 10.1093/ntr/ntv040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this longitudinal study was to identify distinct trajectories of cigarette smoking from sixth to twelfth grade and to characterize these trajectories by use of other drugs and high school dropout. METHODS The diverse sample for this analysis consisted of a cohort of 611 students from Northeast Georgia who participated in the Healthy Teens Longitudinal Study (2003-2009). Students completed seven yearly assessments from sixth through twelfth grade. We used semi-parametric, group-based modeling to identify groups of students whose smoking behavior followed a similar progression over time. RESULTS Current smoking (past 30 day) increased from 6.9% among sixth graders to 28.8% among twelfth graders. Four developmental trajectories of cigarette smoking were identified: Abstainers/Sporadic Users (71.5% of the sample), Late Starters (11.3%), Experimenters (9.0%), and Continuous Users (8.2%). The Abstainer/Sporadic User trajectory was composed of two distinct groups: those who never reported any tobacco use (True Abstainers) and those who reported sporadic, low-level use (Sporadic Users). The True Abstainers reported significantly less use of alcohol and other drugs and lower dropout rates than students in all other trajectories, and Sporadic Users had worse outcomes than True Abstainers. Experimenters and Continuous Users reported the highest drug use. Over one-third of Late Starters (35.8%) and almost half of Continuous Users (44.4%) dropped out of high school. CONCLUSIONS Cigarette smoking was associated with behavioral and academic problems. Results support early and continuous interventions to reduce use of tobacco and other drugs and prevent high school dropout.
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Affiliation(s)
- Pamela Orpinas
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA;
| | - Beth Lacy
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| | - Lusine Nahapetyan
- Kinesiology and Health Studies, Southeastern Louisiana University, Hammond, LA
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
| | - Xiao Song
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA
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Mdodo R, Frazier EL, Dube SR, Mattson CL, Sutton MY, Brooks JT, Skarbinski J. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med 2015; 162:335-44. [PMID: 25732274 DOI: 10.7326/m14-0954] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The negative health effects of cigarette smoking and HIV infection are synergistic. OBJECTIVE To compare the prevalence of current cigarette smoking and smoking cessation between adults with HIV receiving medical care and adults in the general population. DESIGN Nationally representative cross-sectional surveys. SETTING United States. PATIENTS 4217 adults with HIV who participated in the Medical Monitoring Project and 27 731 U.S. adults who participated in the National Health Interview Survey in 2009. MEASUREMENTS The main exposure was cigarette smoking. The outcome measures were weighted prevalence of cigarette smoking and quit ratio (ratio of former smokers to the sum of former and current smokers). RESULTS Of the estimated 419 945 adults with HIV receiving medical care, 42.4% (95% CI, 39.7% to 45.1%) were current cigarette smokers, 20.3% (CI, 18.6% to 22.1%) were former smokers, and 37.3% (CI, 34.9% to 39.6%) had never smoked. Compared with the U.S. adult population, in which an estimated 20.6% of adults smoked cigarettes in 2009, adults with HIV were nearly twice as likely to smoke (adjusted prevalence difference, 17.0 percentage points [CI, 14.0 to 20.1 percentage points]) but were less likely to quit smoking (quit ratio, 32.4% vs. 51.7%). Among adults with HIV, factors independently associated with greater smoking prevalence were older age, non-Hispanic white or non-Hispanic black race, lower educational level, poverty, homelessness, incarceration, substance use, binge alcohol use, depression, and not achieving a suppressed HIV viral load. LIMITATION Cross-sectional design with some generalizability limitations. CONCLUSION Adults with HIV were more likely to smoke and less likely to quit smoking than the general adult population. Tobacco screening and cessation strategies are important considerations as part of routine HIV care.
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Affiliation(s)
- Rennatus Mdodo
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - Emma L. Frazier
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - Shanta R. Dube
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - Christine L. Mattson
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - Madeline Y. Sutton
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - John T. Brooks
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
| | - Jacek Skarbinski
- From National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and School of Public Health, Georgia State University, Atlanta, Georgia
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King BA, Patel R, Nguyen KH, Dube SR. Trends in awareness and use of electronic cigarettes among US adults, 2010-2013. Nicotine Tob Res 2015; 17:219-27. [PMID: 25239961 PMCID: PMC4512831 DOI: 10.1093/ntr/ntu191] [Citation(s) in RCA: 422] [Impact Index Per Article: 46.9] [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: 05/29/2014] [Accepted: 09/05/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) marketing has increased considerably since the product entered the US market in 2007, thereby warranting additional surveillance to monitor recent trends in population-level awareness and utilization. We assessed the prevalence, characteristics, and trends in e-cigarette awareness and use among nationally representative samples of US adults during 2010-2013. METHODS Data came from the 2010-2013 HealthStyles survey, an annual consumer-based web survey of US adults aged ≥ 18 years. Sample sizes ranged from 2,505 (2010) to 4,170 (2012). Descriptive statistics were used to assess e-cigarette awareness, ever use, and current use (use within the past 30 days) overall and by sex, age, race/ethnicity, education, income, US region, and cigarette smoking status. Trends were assessed using logistic regression. RESULTS During 2010-2013, increases (p < .05) were observed for e-cigarette awareness (40.9%-79.7%), ever use (3.3%-8.5%), and current use (1.0%-2.6%). Awareness increased among all socio demographic subpopulations during 2010-2013 (p < .05); an increase in ever use of e-cigarettes occurred among all sociodemographic groups except those aged 18-24 years, Hispanics, and those living in the Midwest (p < .05). During 2010-2013, ever use increased among current (9.8%-36.5%) and former (2.5%-9.6%) cigarette smokers (p < .05), but it remained unchanged among never smokers (1.3%-1.2%). CONCLUSIONS Awareness and use of e-cigarettes increased considerably among US adults during 2010-2013. In 2013, more than one-third of current cigarette smokers reported having ever used e-cigarettes. Given the uncertain public health impact of e-cigarettes, continued surveillance of emerging use patterns is critical for public health planning.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA;
| | | | - Kimberly H Nguyen
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA
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Garrett BE, Dube SR, Babb S, McAfee T. Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities. Nicotine Tob Res 2014; 17:892-7. [PMID: 25516538 DOI: 10.1093/ntr/ntu266] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). METHODS Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. RESULTS Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. CONCLUSIONS Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities.
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Affiliation(s)
- Bridgette E Garrett
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
| | - Stephen Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tim McAfee
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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Majeed BA, Dube SR, Sterling K, Whitney C, Eriksen MP. Opinions about electronic cigarette use in smoke-free areas among U.S. Adults, 2012. Nicotine Tob Res 2014; 17:675-81. [PMID: 25358659 DOI: 10.1093/ntr/ntu235] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 05/19/2014] [Accepted: 10/22/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In the United States, electronic cigarettes (e-cigarettes) are currently unregulated, extensively marketed, and experiencing a rapid increase in use. The purpose of this study was to examine the opinions of U.S. adults about e-cigarette use in smoke-free public areas. METHODS Data were obtained from the online HealthStyle survey administered to a probability sample of a nationally representative online panel. The study included 4,043U.S. adults, aged 18 years or older who responded to this question, "Do you think e-cigarette should be allowed to be used in public areas where tobacco smoking is prohibited?" Multinomial logistic regression analyses were used to examine opinions on e-cigarette use in smoke-free areas by sex, age, race/ethnicity, household income, education, census region, and cigarette smoking status and e-cigarette awareness and ever use. RESULTS Overall, about 40% of adults were uncertain whether e-cigarettes should be allowed in smoke-free areas, 37% opposed, while 23% favored their use in smoke-free public places. Multinomial logistic regression analyses showed that adults who were aware, ever used e-cigarettes, and current cigarette smokers were more likely to express an "in favor" opinion than adults who expressed an uncertain opinion (don't know). CONCLUSION Over 75% of U.S. adults reported uncertainty or disapproval of the use of e-cigarettes in smoke-free areas. Current cigarette smokers, adults aware or have ever used e-cigarettes were more supportive to exempting e-cigarettes from smoking restrictions. With impending regulation and the changing e-cigarette landscape, continued monitoring and research on public opinions about e-cigarette use in smoke-free places are needed.
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Affiliation(s)
- Ban A Majeed
- School of Public Health, Georgia State University, Atlanta, GA
| | - Shanta R Dube
- School of Public Health, Georgia State University, Atlanta, GA
| | | | - Carrie Whitney
- School of Public Health, Georgia State University, Atlanta, GA
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Abstract
BACKGROUND Cigarette smoking remains a leading cause of morbidity and mortality. Although gender differences in cigarette smoking in the U.S. population have been documented, information on these differences among working adults is limited. PURPOSE To describe the current smoking prevalence by gender among working U.S. adults and examine gender differences in smoking by occupation. METHODS The 2004-2011 National Health Interview Survey data for adults aged ≥18 years that were working in the week prior to the interview (N=132,215) were analyzed in 2013. Current cigarette smokers were those who smoked at least 100 cigarettes in their lifetime and currently smoke every day or some days. RESULTS During 2004-2011, an estimated 22.8% of men workers and 18.3% of women workers were current smokers. Of the current smokers, women workers had higher odds of being an everyday smoker (prevalence OR [POR]=1.17, 95% CI=1.09, 1.26); having poor self-rated emotional health (POR=1.28, 95% CI=1.15, 1.41); and having chronic obstructive pulmonary disease (POR=2.45, 95% CI=2.14, 2.80), heart disease (POR=1.27, 95% CI=1.12, 1.45), and current asthma (POR=2.21, 95% CI=1.96, 2.49) compared with men workers. Women in "supervisors, construction, and extraction" (38.9%) occupations and men in "extraction" (40.5%) occupations had the highest smoking prevalence. CONCLUSION Among working adults, women had lower prevalence of smoking than men, yet women who smoke were more likely than men to have adverse health outcomes, including self-rated poorer physical and emotional health.
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Affiliation(s)
- Girija Syamlal
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia.
| | - Jacek M Mazurek
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Shanta R Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Jamal A, Dube SR, Babb SD, Malarcher AM. Tobacco use screening and cessation assistance during physician office visits among persons aged 11-21 years--National Ambulatory Medical Care Survey, United States, 2004-2010. MMWR Suppl 2014; 63:71-79. [PMID: 25208261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Bunnell RE, Agaku IT, Arrazola RA, Apelberg BJ, Caraballo RS, Corey CG, Coleman BN, Dube SR, King BA. Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013. Nicotine Tob Res 2014; 17:228-35. [PMID: 25143298 DOI: 10.1093/ntr/ntu166] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. METHODS We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. RESULTS Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24-2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. CONCLUSION In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes.
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Affiliation(s)
- Rebecca E Bunnell
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Israel T Agaku
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - René A Arrazola
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Benjamin J Apelberg
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Rockville, MD
| | - Ralph S Caraballo
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catherine G Corey
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Rockville, MD
| | - Blair N Coleman
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Rockville, MD
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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Corey CG, Dube SR, Ambrose BK, King BA, Apelberg BJ, Husten CG. Cigar smoking among U.S. students: reported use after adding brands to survey items. Am J Prev Med 2014; 47:S28-35. [PMID: 25044193 PMCID: PMC4521384 DOI: 10.1016/j.amepre.2014.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among U.S. youth overall, cigars are the most commonly used tobacco product after cigarettes. However, youth who identify their products by brand names, not general terms like "cigar," may underreport use. PURPOSE To examine changes in reported cigar (cigar, cigarillo, or little cigar) smoking among students following inclusion of cigar brand examples on the National Youth Tobacco Survey (NYTS). METHODS Data from the 2011 and 2012 NYTS and National Survey on Drug Use and Health (NSDUH) were analyzed in 2013 to estimate ever and current cigar smoking, overall and by race/ethnicity. The 2012 NYTS included cigar brand examples (Black and Mild, Swisher Sweets, Dutch Masters, White Owl, Phillies Blunt) in the survey instructions and ever use question, but the 2011 NYTS and 2011 and 2012 NSDUH did not. RESULTS NYTS ever cigar smoking was higher in 2012 (27.8%) than 2011 (19.5%) among black students overall. Current cigar smoking was 60%-70% higher among black females and students aged ≥ 17 years, in 2012 than 2011. For black females, current cigar smoking (11.5%) was two times greater than that of white females (4.3%) in 2012, whereas the prevalence among these subgroups was comparable in 2011. Similar changes were not observed among these subgroups in the 2011-2012 NSDUH. CONCLUSIONS This study highlights the high burden of cigar use among U.S. youth and suggests that NYTS ascertainment of cigar smoking may have improved by including brands. Disparities in cigar smoking need to be addressed to prevent and reduce all youth tobacco use.
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Affiliation(s)
- Catherine G Corey
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland.
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Benjamin J Apelberg
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
| | - Corinne G Husten
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
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King BA, Homa DM, Dube SR, Babb SD. Exposure to secondhand smoke and attitudes toward smoke-free workplaces among employed U.S. adults: findings from the National Adult Tobacco Survey. Nicotine Tob Res 2014; 16:1307-18. [PMID: 24812025 DOI: 10.1093/ntr/ntu069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study assessed the prevalence and correlates of secondhand smoke (SHS) exposure and attitudes toward smoke-free workplaces among employed U.S. adults. METHODS Data came from the 2009-2010 National Adult Tobacco Survey, a landline and cellular telephone survey of adults aged ≥18 years in the United States and the District of Columbia. National and state estimates of past 7-day workplace SHS exposure and attitudes toward indoor and outdoor smoke-free workplaces were assessed among employed adults. National estimates were calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, U.S. region, and smoking status. RESULTS Among employed adults who did not smoke cigarettes, 20.4% reported past 7-day SHS exposure at their workplace (state range: 12.4% [Maine] to 30.8% [Nevada]). Nationally, prevalence of exposure was higher among males, those aged 18-44 years, non-Hispanic Blacks, Hispanics, and non-Hispanic American Indians/Alaska natives compared to non-Hispanic Whites, those with less education and income, those in the western United States, and those with no smoke-free workplace policy. Among all employed adults, 83.8% and 23.2% believed smoking should never be allowed in indoor and outdoor areas of workplaces, respectively. CONCLUSIONS One-fifth of employed U.S. adult nonsmokers are exposed to SHS in the workplace, and disparities in exposure exist across states and subpopulations. Most employed adults believe indoor areas of workplaces should be smoke free, and nearly one-quarter believe outdoor areas should be smoke free. Efforts to protect employees from SHS exposure and to educate the public about the dangers of SHS and benefits of smoke-free workplaces could be beneficial.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shanta R Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen D Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Nguyen KH, King BA, Dube SR. Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states. Tob Control 2014; 24:376-81. [PMID: 24794714 DOI: 10.1136/tobaccocontrol-2013-051526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/02/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Many states have implemented laws prohibiting tobacco smoking in indoor public places. However, private settings remain a major source of secondhand smoke (SHS) exposure for many people. We assessed the association between current asthma and SHS exposure in vehicles among adult never-smokers in Indiana, Kentucky, Louisiana and Mississippi. METHODS Data came from the 2011 Behavioral Risk Factor Surveillance System, a state-based telephone survey of US adults aged ≥18 years. Analyses were restricted to states (n=4) that administered an optional SHS module. Prevalence of self-reported asthma and past 7-day SHS exposure in vehicles was calculated by demographics, voluntary smoke-free vehicle rules and SHS exposure in homes, public places and workplaces. Logistic regression was used to assess the adjusted association between asthma and SHS exposure in vehicles. RESULTS Among 17 863 never-smoking adults, 7.4% reported having current asthma, whereas 12.3% reported past 7-day SHS exposure in vehicles. Among adults with asthma, SHS exposure in vehicles was lower among those with voluntary smoke-free rules compared with those without voluntary smoke-free rules (9.5% vs 56.7%, p<0.0001). Following adjustment, adults exposed to SHS in a vehicle had a higher odds of having current asthma compared with unexposed adults (OR=2.01, 95% CI 1.18 to 3.40). CONCLUSIONS Never-smoking adults recently exposed to SHS in a vehicle had higher odds of having current asthma compared with unexposed adults. Efforts are warranted to warn about the dangers of SHS and to encourage voluntary smoke-free rules in vehicles, especially among adults with asthma.
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Affiliation(s)
- Kimberly H Nguyen
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shanta R Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Georgia, USA
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Agaku IT, King BA, Dube SR. Current cigarette smoking among adults - United States, 2005-2012. MMWR Morb Mortal Wkly Rep 2014; 63:29-34. [PMID: 24430098 PMCID: PMC4584648] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite significant declines during the past 30 years, cigarette smoking among adults in the United States remains widespread, and year-to-year decreases in prevalence have been observed only intermittently in recent years. To assess progress made toward the Healthy People 2020 objective of reducing the proportion of U.S. adults who smoke cigarettes to ≤12% (objective TU-1.1),* this report provides the most recent national estimates of smoking prevalence among adults aged ≥18 years, based on data from the 2012 National Health Interview Survey (NHIS). The findings indicate that the proportion of U.S. adults who smoke cigarettes fell to 18.1% in 2012. Moreover, during 2005-2012, the percentage of ever smokers who quit increased significantly, from 50.7% to 55.0%, and the proportion of daily smokers who smoked ≥30 cigarettes per day (CPD) declined significantly, from 12.6% to 7.0%. Proven population-level interventions, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and barrier-free access to help quitting, are critical to decreasing cigarette smoking and reducing the health and economic burden of tobacco-related diseases in the United States.
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Affiliation(s)
- Israel T. Agaku
- EIS officer, CDC
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Brian A. King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Shanta R. Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Arrazola RA, Kuiper NM, Dube SR. Patterns of current use of tobacco products among U.S. high school students for 2000-2012--findings from the National Youth Tobacco Survey. J Adolesc Health 2014; 54:54-60.e9. [PMID: 24074604 PMCID: PMC4534716 DOI: 10.1016/j.jadohealth.2013.08.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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: 05/31/2013] [Revised: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to assess patterns and trends of tobacco use among high school students to better understand which products are used individually or concurrently. METHODS Data from the National Youth Tobacco Survey from 2000 through 2012 were used to assess patterns and trends of current tobacco use (cigarettes, cigars, smokeless tobacco, and other tobacco products) among U.S. high school students. We assessed use of products individually and concurrently. RESULTS During 2000-2012, overall linear declines were observed in current use of any tobacco product from 33.6% to 20.4% (p < .05), current use of only 1 tobacco product, from 18.8% to 10.5% (p < .05), and current poly tobacco use, from 14.7% to 9.9% (p < .05), among high school students. Overall current use of only cigarettes had both a linear decline, from 14.0% to 4.7%, as well as a quadratic trend. CONCLUSIONS During 2000-2012, the most significant overall decline observed was for students who reported smoking only cigarettes. The results suggest that more data on the use of multiple tobacco products, not just cigarettes, is needed to guide tobacco prevention and control policies and programs.
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Affiliation(s)
- René A Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Nicole M Kuiper
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanta R Dube
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Agaku IT, King BA, Dube SR. Trends in exposure to pro-tobacco advertisements over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students, 2000-2012. Prev Med 2014; 58:45-52. [PMID: 24183778 DOI: 10.1016/j.ypmed.2013.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/08/2013] [Accepted: 10/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most tobacco use begins during youth. Thus, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising among United States students in grades 6-12 during 2000-2012. METHODS Data from the 2000-2012 National Youth Tobacco Survey were analyzed to assess self-reported exposure to pro-tobacco advertisements through three media: over the Internet, in newspapers/magazines, and at retail stores. Trends during 2000-2012 were assessed in a binary logistic regression model (P<0.05). RESULTS Among all middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% to 43.0% during 2000-2012 (P<0.001 for linear trend). During the same period, declines were observed in the overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines (65.0% to 36.9%) and at retail stores (87.8% to 76.2%) (P<0.001 for all linear trends). CONCLUSION Exposure to pro-tobacco advertisements over the Internet increased significantly during 2000-2012 among United States middle and high school students, while a decline in exposure to advertisements in newspapers or magazines, and at retail stores occurred during the same period. However, over two-thirds of students still reported retail store exposure to pro-tobacco advertisements in 2012. Enhanced and sustained efforts would be beneficial to reduce even more exposure to all forms of pro-tobacco advertisements among youths.
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Affiliation(s)
- Israel T Agaku
- Office on Smoking and Heath, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Brian A King
- Office on Smoking and Heath, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Shanta R Dube
- Office on Smoking and Heath, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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King BA, Tynan MA, Dube SR, Arrazola R. Flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students. J Adolesc Health 2014; 54:40-6. [PMID: 24161587 PMCID: PMC4572463 DOI: 10.1016/j.jadohealth.2013.07.033] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE Flavors can mask the harshness and taste of tobacco, making flavored tobacco products appealing to youth. We assessed the prevalence and correlates of flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students in 2011. METHODS Data were obtained from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of U.S. students in grades 6-12. National estimates of current flavored-little-cigar use, flavored-cigarette use, and combined use of either product were calculated overall and among current smokers by respondent characteristics, including sex, race/ethnicity, school level, and grade. Additionally, intention to quit tobacco and smoking frequency were assessed by flavored product use. RESULTS The overall prevalence of current use was 4.2% for flavored cigarettes, 3.3% for flavored little cigars, and 6.3% for either product. Among current cigar smokers, 35.9% reported using flavored little cigars, and among current cigarette smokers, 35.4% reported using flavored cigarettes. Among current cigar or cigarette smokers, 42.4% reported using flavored little cigars or flavored cigarettes. Flavored product use among current smokers was higher among non-Hispanic whites than among blacks and Hispanics, higher among high school students than middle school students, and increased with grade. Among cigar smokers, prevalence of no intention to quit tobacco was higher among flavored-little-cigar users (59.7%) than nonusers (49.3%). CONCLUSIONS More than two fifths of U.S. middle and high school smokers report using flavored little cigars or flavored cigarettes, and disparities in the use of these products exist across subpopulations. Efforts are needed to reduce flavored tobacco product use among youth.
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Affiliation(s)
- Brian A. King
- Address correspondence to: Brian A. King, Ph.D., M.P.H., Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341. (B.A. King)
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Garrett BE, Dube SR, Winder C, Caraballo RS. Cigarette smoking - United States, 2006-2008 and 2009-2010. MMWR Suppl 2013; 62:81-84. [PMID: 24264495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Cigarette smoking is the leading cause of preventable disease and death in the United States, resulting in approximately 443,000 deaths and $193 billion in direct health-care expenditures and productivity losses each year. Declines in smoking prevalence would significantly impact the health-care and economic costs of smoking. Efforts to accelerate the decline in cigarette smoking include reducing cigarette smoking disparities among specific population groups. Findings from the previous report on cigarette use in the first CDC Health Disparities and Inequalities Report (CHDIR) indicated that progress has been achieved in reducing disparities in cigarette smoking among certain racial/ethnic groups. However, little progress has been made in reducing disparities in cigarette smoking among persons of low socioeconomic status (SES) and low educational attainment.
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Arrazola RA, Dube SR, King BA. Tobacco product use among middle and high school students--United States, 2011 and 2012. MMWR Morb Mortal Wkly Rep 2013; 62:893-7. [PMID: 24226625 PMCID: PMC4585347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nearly 90% of adult smokers in the United States began smoking by age 18 years. To assess current tobacco product use among youths, CDC analyzed data from the 2012 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which found that, in 2012, the prevalence of current tobacco product use among middle and high school students was 6.7% and 23.3%, respectively. After cigarettes, cigars were the second most commonly used tobacco product, with prevalence of use at 2.8% and 12.6%, respectively. From 2011 to 2012, electronic cigarette use increased significantly among middle school (0.6% to 1.1%) and high school (1.5% to 2.8%) students, and hookah use increased among high school students (4.1% to 5.4%). During the same period, significant decreases occurred in bidi and kretek use among middle and high school students, and in dissolvable tobacco use among high school students. A substantial proportion of youth tobacco use occurs with products other than cigarettes, so monitoring and prevention of youth tobacco use needs to incorporate other products, including new and emerging products. Implementing evidence-based interventions can prevent and reduce tobacco use among youths as part of comprehensive tobacco control programs. In addition, implementation of the 2009 Family Smoking Prevention and Tobacco Control Act, which granted the Food and Drug Administration (FDA) the authority to regulate the manufacture, distribution, and marketing of tobacco products, also is critical to addressing this health risk behavior.
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King BA, Dube SR, Babb SD, McAfee TA. Patient-reported recall of smoking cessation interventions from a health professional. Prev Med 2013; 57:715-7. [PMID: 23872172 PMCID: PMC4572889 DOI: 10.1016/j.ypmed.2013.07.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence and characteristics of current cigarette smokers who report receiving health care provider interventions ('5A's': ask, advise, assess, assist, arrange) for smoking cessation. METHODS Data came from the 2009-2010 National Adult Tobacco Survey, a telephone survey of United States adults aged ≥ 18 years. Among current cigarette smokers who reported visiting a health professional in the past year (n=16,542), estimates were calculated overall and by sex, age, race/ethnicity, education, income, health insurance coverage, and sexual orientation. RESULTS Among smokers who visited a health professional (75.2%), 87.9% were asked if they used tobacco, 65.8% were advised to quit, and 42.6% were asked if they wanted to quit. Among those wanting to quit, 78.2% were offered assistance and 17.5% had follow-up arranged. Receipt of the 'ask' component was lower among males and uninsured individuals. Receipt of the 'advise' and 'assess' components was lower among those aged 18-24 and uninsured individuals. Receipt of the 'assist' component was lower among non-Hispanic blacks. No differences were observed for the 'arrange' component. CONCLUSIONS Many current smokers report receiving health care provider interventions for smoking cessation. Continued efforts to educate, encourage, and support all health professionals to provide effective, comprehensive tobacco cessation interventions to their patients may be beneficial.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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King BA, Dube SR, Babb SD. Perceptions about the harm of secondhand smoke exposure among U.S. middle and high school students: findings from the 2012 National Youth Tobacco Survey. Tob Induc Dis 2013; 11:16. [PMID: 23867000 PMCID: PMC3717105 DOI: 10.1186/1617-9625-11-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 06/14/2013] [Accepted: 07/15/2013] [Indexed: 11/16/2022] Open
Abstract
Background Increased knowledge of the harmful effects of SHS is an evidence-based key indicator for eliminating nonsmokers’ exposure to SHS. This study assessed the prevalence and predictors of perceptions about the harm of secondhand smoke (SHS) exposure among U.S. middle and high school students. Findings Data were obtained from the 2012 National Youth Tobacco Survey, a nationally representative school-based survey of U.S. students in grades 6–12. Respondents who reported that they thought breathing smoke from other people’s cigarettes or other tobacco products causes “some” or “a lot” of harm were considered to have the perception that SHS is harmful. Multivariate logistic regression was used to identify predictors of the perception that SHS is harmful. Predictors included sex, race/ethnicity, school grade level, current tobacco use, and whether the respondent currently lived with a tobacco user. Overall, 75.4% of students perceived SHS exposure as harmful. The adjusted odds of perceiving SHS exposure as harmful were higher among non-Hispanic Asians than among non-Hispanic whites, and among students in 10th-12th grades than among students in 8th grade. Adjusted odds were lower among boys than among girls, among non-Hispanic blacks than among non-Hispanic whites, among students living with a tobacco user than among those not, and among those who use combustible tobacco only or both combustible and non-combustible tobacco than among those who use no tobacco. Conclusions Most middle and high school students perceive SHS exposure as harmful, but efforts are needed to increase the prevalence of this perception in certain subpopulations, particularly tobacco users.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-79, Atlanta, GA 30341, USA.
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Abstract
INTRODUCTION An increasing number of US states and localities have implemented comprehensive policies prohibiting tobacco smoking in all indoor areas of public places and worksites. However, private settings such as homes and vehicles remain a major source of exposure to secondhand smoke (SHS) for many people. This study assessed the prevalence and correlates of voluntary smoke-free rules and SHS exposure in homes and vehicles among US adults. METHODS We obtained data from the 2009-2010 National Adult Tobacco Survey, a landline and cellular-telephone survey of adults aged 18 years or older residing in the 50 US states or the District of Columbia. We calculated national and state estimates of smoke-free rules and past-7-day SHS exposure in homes and vehicles and examined national estimates by sex, age, race/ethnicity, and education. RESULTS The national prevalence of voluntary smoke-free home rules was 81.1% (state range, 67.9%-92.9%), and the prevalence of household smoke-free vehicle rules was 73.6% (state range, 58.6%-85.8%). Among nonsmokers, the prevalence of SHS exposure was 6.0% in homes (state range, 2.4%-13.0%) and 9.2% in vehicles (state range, 4.8%-13.7%). SHS exposure among nonsmokers was greatest among men, younger adults, non-Hispanic blacks, and those with a lower level of education. CONCLUSION Most US adults report having voluntary smoke-free home and vehicle rules; however, millions of people remain exposed to SHS in these environments. Disparities in exposure also exist among certain states and subpopulations. Efforts are needed to warn about the dangers of SHS and to promote voluntary smoke-free home and vehicle rules.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Dube SR, Arrazola RA, Lee J, Engstrom M, Malarcher A. Pro-tobacco influences and susceptibility to smoking cigarettes among middle and high school students--United States, 2011. J Adolesc Health 2013; 52:S45-51. [PMID: 23601611 PMCID: PMC4610118 DOI: 10.1016/j.jadohealth.2012.07.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/03/2012] [Accepted: 07/10/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Smoking is a leading cause of cancer, and most smokers begin during adolescence. We examined the proportion of adolescents exposed to pro-tobacco advertising and assessed the association between this exposure and susceptibility to smoking. METHODS Data from the 2011 National Youth Tobacco Survey were used to calculate the proportion of susceptible middle school (MS) and high school (HS) students exposed to pro-tobacco advertisements through stores, magazines, and the Internet. Following previous work, susceptibility to smoking cigarettes was defined as "never smoked but open to trying cigarettes." RESULTS In 2011, 81.5% of MS students and 86.9% of HS students were exposed to tobacco advertisements in stores; 48.2% of MS students and 54.0% of HS students were exposed to such advertising in magazines. Exposure to tobacco advertisements on the Internet was similar for MS (40.8%) and HS students (40.2%). Of those surveyed, 22.5% of MS students and 24.2% of HS students were susceptible to trying cigarettes. Exposure to magazine advertising declined from 71.8% in 2000 to 46.1% in 2009 among susceptible MS students; however, exposure increased to 55.4% in 2011. Tobacco advertising seen through the Internet among susceptible HS students increased from 25.9% in 2000 to 44.7% in 2011. CONCLUSIONS Adolescents continue to be exposed to pro-tobacco advertisements. Adolescents susceptible to smoking are more likely to report exposure to pro-tobacco advertisements. In addition to continued monitoring, more effective interventions to eliminate youth exposure to pro-tobacco marketing are needed.
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Affiliation(s)
- Shanta R. Dube
- Address correspondence to: Shanta R. Dube, Ph.D., M.P.H., Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, N.E., MS K-50, Atlanta, GA 30341-3717. (S.R. Dube)
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Abstract
INTRODUCTION Electronic cigarettes, or e-cigarettes, were introduced into the U.S. market in recent years. However, little is known about the health impact of the product or the extent of its use. This study assessed the prevalence and correlates of awareness and ever-use of e-cigarettes among U.S. adults during 2010-2011. METHODS Data were obtained from the HealthStyles survey, a national consumer-based survey of U.S. adults aged ≥18 years old. In 2010, data collection for the HealthStyles survey was both mail-based (n = 4,184) and web-based (n = 2,505), and in 2011, web-based (n = 4,050) only. Estimates of awareness and ever-use of e-cigarettes were calculated overall and by sex, age, race/ethnicity, educational attainment, household income, region, and smoking status. RESULTS In 2010, overall awareness of e-cigarettes was 38.5% (mail survey) and 40.9% (web survey); in 2011, awareness was 57.9% (web survey). Ever-use of e-cigarettes among all respondents was 2.1% in the 2010 mail survey, 3.3% in the 2010 web survey, and 6.2% in the 2011 web survey. Ever-use of e-cigarettes was significantly higher among current smokers compared with both former and never-smokers, irrespective of survey method or year. During 2010-2011, ever-use increased among both sexes, those aged 45-54 years, non-Hispanic Whites, those living in the South, and current and former smokers. CONCLUSIONS Awareness and ever-use of e-cigarettes increased among U.S. adults from 2010 to 2011. In 2011, approximately 1 in 5 current smokers reported having ever-used e-cigarettes. Continued surveillance of e-cigarettes is needed for public health planning.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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Abstract
PURPOSE Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. METHODS Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. RESULTS In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. CONCLUSIONS This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE--especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, USA.
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Abstract
INTRODUCTION Under its authority to regulate tobacco products, the U.S. Food and Drug Administration prohibited certain characterizing flavors in cigarettes in September 2009; however, flavored cigars are still permitted to be manufactured, distributed, and sold. This study assessed the prevalence and correlates of flavored cigar smoking among U.S. adults. METHODS Data were obtained from the 2009-2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged ≥ 18 years old residing in the 50 U.S. states and the District of Columbia. National and state estimates of flavored cigar use were calculated overall and among current cigar smokers; national estimates were calculated by sex, age, race/ethnicity, educational attainment, annual household income, U.S. Census Region, and sexual orientation. RESULTS The national prevalence of flavored cigar smoking was 2.8% (95% confidence interval [CI] = 2.6%-3.1%; state range: 0.6%-5.7%) and was greater among those who were male, younger in age, non-Hispanic Other race, less educated, less wealthy, and lesbian, gay, bisexual, or transgendered (LGBT). Nationally, the prevalence of flavored cigar use among cigar smokers was 42.9% (95% CI = 40.1%-45.7%; state range: 11.1%-71.6%) and was greater among those who were female, younger in age, Hispanic, non-Hispanic Other race, less educated, less wealthy, and LGBT. CONCLUSIONS More than two fifths of current cigar smokers report using flavored cigars. Disparities in flavored cigar use also exist across states and subpopulations. Efforts to curb flavored cigar smoking have the potential to reduce the prevalence of overall cigar smoking among U.S. adults, particularly among subpopulations with the greatest burden.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, GA 30341, USA.
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King BA, Dube SR, Tynan MA. Attitudes toward smoke-free workplaces, restaurants, and bars, casinos, and clubs among u.s. Adults: findings from the 2009-2010 national adult tobacco survey. Nicotine Tob Res 2013; 15:1464-70. [PMID: 23296211 DOI: 10.1093/ntr/nts342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 11/14/2022]
Abstract
INTRODUCTION An increasing number of U.S. states and communities have implemented smoke-free policies prohibiting smoking in all indoor workplaces and public areas. Public attitudes toward smoke-free environments are an evidenced-based, key indicator for the successful implementation and enforcement of smoke-free policies. METHODS Data were obtained from the 2009-2010 National Adult Tobacco Survey, a landline and cell phone survey of adults aged ≥18 years old residing in the 50U.S. states and the District of Columbia. The overall proportion of respondents who reported that smoking should "never be allowed" in workplaces, restaurants, and bars/casinos/clubs was calculated, both nationally and by state. National estimates were also calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, and smoking status. RESULTS Nationally, 81.6% of U.S. adults think workplaces should be smoke-free (state range: 68.6% [Kentucky] to 89.1% [California]); 74.9% think restaurants should be smoke-free (state range: 59.5% [Missouri] to 84.6% [California]); 50.0% think bars/casinos/clubs should be smoke-free (state range: 32.3% [Nevada] to 61.3% [Maine]); and 47.5% think workplaces, restaurants, and bars/casinos/clubs should be smoke-free (state range: 30.3% [Nevada] to 58.8% [Maine]). Regardless of venue type, women, older individuals, non-Hispanic Asians, individuals with higher education and income, and nonsmokers were the most likely to think these environments should be smoke-free. CONCLUSIONS A majority of U.S. adults think workplaces and restaurants should be smoke-free, while half think bars, casinos, and clubs should be smoke-free. Continued efforts are needed to educate the public about the dangers of secondhand smoke and the benefits of smoke-free indoor environments.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, 30341, USA.
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King BA, Dube SR, Tynan MA. Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. Am J Public Health 2012; 102:e93-e100. [PMID: 22994278 DOI: 10.2105/ajph.2012.301002] [Citation(s) in RCA: 244] [Impact Index Per Article: 20.3] [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 assessed the prevalence and sociodemographic correlates of tobacco use among US adults. METHODS We used data from the 2009-2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state. RESULTS National prevalence of current use was 25.2% for any tobacco; 19.5% for cigarettes; 6.6% for cigars, cigarillos, or small cigars; 3.4% for chewing tobacco, snuff, or dip; 1.5% for water pipes; 1.4% for snus; and 1.1% for pipes. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic "other" race/ethnicity, less educated, less wealthy, and lesbian, gay, bisexual, or transgender. Prevalence ranged from 14.1% (Utah) to 37.4% (Kentucky). CONCLUSIONS Tobacco use varies by geography and sociodemographic factors, but remains prevalent among US adults. Evidence-based prevention strategies are needed to decrease tobacco use and the health and economic burden of tobacco-related diseases.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-50, Atlanta, GA 30341, USA.
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