Socioeconomic status across the life course and smoking cessation among older adult smokers in the U.S

INTRODUCTION

Socioeconomic status (SES) at different stages of the life course impacts late-life health. However, whether SES across the life course impacts smoking cessation in late-life is not known.

PURPOSE

Assess how life course SES impacts smoking cessation among older smokers.

METHODS

We identified 5,124 smokers, 50 years and older, from the 1998 to 2018 waves of the Health and Retirement Study. The outcome was self-reported smoking cessation. The main exposure was life course SES, defined as: low child and low adult SES (persistent low); low child, high adult SES (upward mobility); high child, low adult SES (downward mobility); and high child, high adult SES (persistent high). A multilevel mixed-effect logistic model was used to examine how life course SES predicts smoking cessation at age 65 and over time, adjusted for covariates.

RESULTS

Compared to those with persistent high SES, those with persistent low SES, upward and downward SES were more likely to be Hispanic or non-Hispanic Black. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES (OR= 0.69, 95 % CI = [0.51-0.92]), upward SES (OR= 0.49, [0.32-0.75]), and downward SES (OR= 0.55, [0.40-0.76]) were less likely to quit. However, as age increased, only those with downward or persistent low SES were significantly less likely to quit compared to those with persistent high SES.

DISCUSSION

Social mobility of SES from childhood to adulthood significantly impacts smoking cessation. Both stages of the life course should be considered to understand smoking behaviors.

Electronic Cigarettes for Smoking Cessation: The Gap Between Behavior in Smokers and Medical Education

INTRODUCTION

E-cigarettes have engendered a great deal of controversy within the public health and medical communities.  Methods: Two cross-sectional surveys were administered. First, patients at an annual lung cancer screening appointment who self-identified as former smokers were asked about strategies for achieving and maintaining smoking cessation with open-ended questions. Second, medical students at a single university reported their opinion and knowledge of combustible cigarettes and e-cigarettes.

RESULTS

Among the n=102 in the patient survey indicating that they used e-cigarettes or over-the-counter (OTC) nicotine replacement products for smoking cessation, 34.3% (35/102) vaped e-cigarettes, making it the second most common next to patches (47.1% {48/102}). By comparison, n=48 reported using medication. Medical student participants (n=168) were mixed regarding whether a patient should switch from traditional to electronic cigarettes (56.0% yes; 44.0% no) and reported receiving education about traditional cigarettes (92.3%) at a much higher rate than for e-cigarettes (46.4%), p<.001.

CONCLUSION

Many former heavy smokers undergoing a lung cancer screen used e-cigarettes to achieve smoking cessation. However, nearly half of medical students surveyed do not think patients should switch from traditional to e-cigarettes.

Socioeconomic status across the life course and smoking trajectories of older adult smokers in the U.S

The objective of this study is to assess how SES over the life course impacts smoking cessation among older adult smokers in the U.S. 6,058 current smokers 50 years and older were identified from the 1998-2018 Waves of the Health and Retirement Study (HRS). The outcome of interest was smoking cessation. The main independent predictor was lifetime SES, categorized as low child and low adult SES (persistent low); low child, high adult SES; high child, low adult SES; and high child, high adult SES (persistent high). Multilevel mixed-effect logistic model was used to examine how lifetime SES predicts smoking cessation at age 65 and over time, adjusted by health and smoking covariates. The majority of older smokers had persistent high lifetime SES (60.3%), followed by high child/low adult SES (18.7%), persistent low SES (15.5%) and low child/high adult SES (5.6%). Compared to those with persistent high SES, those with persistent low SES were more likely to be Hispanic (25.9% vs. 3.0%, p&lt;0.001) or non-Hispanic Black (22.7% vs. 8.7%, p&lt;0.001), respectively. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES, low child/high adult SES, and low adult/high child SES were less likely to quit (OR: 0.42, 95%CI:0[.31-0.56]; OR:0.37, [0.24-0.55]; OR:0.53, [0.40-0.70], respectively). Similar results were observed over time for those with persistent low SES and low adult/high child SES. However, there was no significant difference for those with low child/high adult SES.

Contextual influences on simultaneous alcohol and cannabis use in a predominately white sample of college students

Objective: Simultaneous alcohol and cannabis (i.e., marijuana [SAM]) use is highly prevalent among young adults and college students and associated with a number of negative consequences compared to single substance use. The current study examined socio-contextual factors (e.g., physical, situational, social) associated with SAM use versus cannabis-only versus alcohol-only use. Method: Data were collected from college student SAM users (N = 313, 53% women, M age = 19.79; 74% White; 10% Hispanic/Latinx) who completed two bursts (28 days) of online repeated daily surveys (RDS). RDS were collected five times per day during both bursts (3 months apart). Results: Results suggested that odds of being at home were greater for cannabis-only use compared to SAM and SAM compared to alcohol-only use. Odds of being at a friend's place were greater for SAM compared to alcohol-only and cannabis-only use. Odds of being at a party were greater for SAM compared to alcohol-only use and odds of being at a bar or restaurant were greater for alcohol-only compared to SAM use. Results also suggested that odds of having more people in a location consistently were greater for SAM compared to cannabis-only use, and alcohol-only compared to cannabis-only use. Conclusion: Physical and social contexts (parties, friend's homes, and being around more people) are significantly associated with SAM use occasions. These findings are well-aligned with a social-ecological framework and suggest intervention and prevention efforts should take a comprehensive approach to reduce harms associated with SAM use. Future work is needed to examine these associations in diverse samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric Analysis of a Microenvironment Secondhand Smoke Exposure Questionnaire

Background: We conducted a psychometric analysis of an adapted secondhand smoke (SHS) questionnaire by testing the three-component structure of the original scale that measures SHS exposure in home, work and social environments. Methods: The 15-item questionnaire was administered to 839 daily smokers participating in a multi-site randomized controlled trial. Following parallel analysis, we conducted a confirmatory factor analysis specifying a three-factor structure. Cronbach’s alphas and fit indices were calculated to assess internal consistency. Criterion validity was assessed by comparing the Social environments subscale to the Brief Wisconsin Inventory of Smoking Dependence Motives Social/Environmental Goads subscale. Predicative validity of the questionnaire was assessed using linear regressions and tobacco biomarkers of harm; NNAL, expired carbon monoxide and total cotinine. Results: Five items did not load onto any factor and were dropped, resulting in a 10-item questionnaire. The Cronbach’s alphas were (0.86), (0.77) and (0.67) for the Work, Social, and Home subscales, respectively. The WISDM subscale was moderately correlated with scores on the Social subscale (r = 0.57, p < 0.001). The questionnaire demonstrated predictive validity of smoke exposure above individual’s own reported use as measured by cigarettes smoked per day. Conclusions: Three constructs emerged; results indicate that a shortened 10-item scale could be used in future studies.

The Altered Course of Learning: How Alcohol Outcome Expectancies Are Shaped by First Drinking Experiences

According to expectancy theory, outcome expectancies are first formed vicariously (through observing other people) and then through direct experience. This cohort-sequential longitudinal study explored these expectancy origins in 1,023 youths (52% female, ages 10.5-15.5 years at recruitment, M = 12.47 years, SD = 0.95). Discontinuous multilevel growth models described patterns of change in expectancies before and after the first experience of distinct drinking milestones (i.e., first sip, first full drink, first heavy-drinking situation). Youths' expectations for positive and negative drinking outcomes generally increased and decreased over adolescence, respectively, reflecting general developmental trends. Drinking experiences altered learning trajectories, however, reifying positive expectancies and invalidating negative expectancies at each milestone and altering the course of expectancy change thereafter. For positive outcome expectancies, the influence of direct experience on learning was stronger when drinking milestones were met at an earlier age. Conversely, invalidation of negative expectancies was stronger when the first-drink milestone was met at a later age.

Simultaneous Alcohol and Marijuana Use: A Brief Measure of Motives

OBJECTIVE

Increasing numbers of substance users report simultaneous alcohol and marijuana (SAM) use such that their effects overlap. More research is needed to understand what motivates this behavior, especially to inform interventions that address SAM use. A 26-item measure of SAM motives was designed and tested in previous research. The purpose of the current study was to validate that measure and create a briefer version of it.

METHOD

Using two waves of data from a multi-site sample of college students (n = 1,014), exploratory and confirmatory factor analyses were conducted to develop a brief 11-item SAM Motives Measure (B-SMM). Negative binomial regression analyses were conducted to assess the reliability and validity of both the original and brief measures.

RESULTS

The brief measure contains four subscales (conformity, positive effects, calm/coping, and social) that match the empirically supported motivational model of substance use. Internal consistency of the subscales ranged from .77 to .87. Most subscales significantly predicted frequency and consequences of SAM use both concurrently and prospectively.

CONCLUSIONS

The psychometrically sound measure developed in this study facilitates the examination of SAM motives in clinical settings with time-constrained patient contact and can be valuable for research involving frequent and repeated measures of substance use behaviors.

Simultaneous Alcohol and Marijuana Use: A Brief Measure of Motives

OBJECTIVE

Increasing numbers of substance users report simultaneous alcohol and marijuana (SAM) use such that their effects overlap. More research is needed to understand what motivates this behavior, especially to inform interventions that address SAM use. A 26-item measure of SAM motives was designed and tested in previous research. The purpose of the current study was to validate that measure and create a briefer version of it.

METHOD

Using two waves of data from a multi-site sample of college students (n = 1,014), exploratory and confirmatory factor analyses were conducted to develop a brief 11-item SAM Motives Measure (B-SMM). Negative binomial regression analyses were conducted to assess the reliability and validity of both the original and brief measures.

RESULTS

The brief measure contains four subscales (conformity, positive effects, calm/coping, and social) that match the empirically supported motivational model of substance use. Internal consistency of the subscales ranged from .77 to .87. Most subscales significantly predicted frequency and consequences of SAM use both concurrently and prospectively.

CONCLUSIONS

The psychometrically sound measure developed in this study facilitates the examination of SAM motives in clinical settings with time-constrained patient contact and can be valuable for research involving frequent and repeated measures of substance use behaviors.

Prevalence and Correlates of Concurrent and Simultaneous Cannabis and Cigarette Use among Past-Year Cannabis-Using US College Students

Background: Cannabis and tobacco use are significant public health concerns among young adults, with concurrent (in the same time period) and simultaneous (at the same time so the effects overlap) use of both substances on the rise. Few studies have examined these behaviors among college students. Objective: We examined the prevalence of concurrent and simultaneous cannabis and cigarette (combustible or electronic) use among a sample of college students and characterized the psychosocial predictors of concurrent and simultaneous use compared to using cannabis alone. Methods: Data on past-3 months cannabis and cigarette use were collected on 1352 college students who were past-year cannabis and alcohol users yielding four groups: cannabis-only users (n = 686), concurrent cannabis and cigarette users (CCAC; n = 235), simultaneous cannabis and cigarette users (SCAC; n = 293), and non-recent users of either substance (n = 138). Multinomial logistic regression analyses were utilized to predict group membership. Results: Relative to the cannabis-only group, White, compared to Non-White students, males, compared to females, frequent, compared to infrequent, alcohol users, including those who used alcohol simultaneously with cigarettes, and illicit drug users were more likely to belong to the CCAC or SCAC group. Conclusions: Findings suggest the need for unique intervention efforts to prevent onset or reduce co-use among male and White students as well as illicit drug users and frequent alcohol users.

Marijuana use is associated with alcohol use and consequences across the first 2 years of college

College entry is associated with marijuana initiation, and co-use of alcohol and marijuana is associated with problematic outcomes, including alcohol-related consequences. The present study explored if: (a) use of marijuana on a given day would be associated with greater alcohol use within the same day; (b) use of marijuana within a given week would be associated with increased alcohol-related consequences in that same week; and (c) the association between marijuana use and alcohol consumption and consequences varies across time or by precollege level of problematic alcohol use. Participants (N = 488 college student drinkers, 59% female) completed assessments of marijuana use, alcohol use, and alcohol consequences across 2 years. Analyses revealed: (a) daily marijuana use predicted greater number of daily drinks and estimated breath alcohol concentration; (b) weekly marijuana use predicted more weekly positive and negative alcohol consequences; (c) the effect of daily marijuana use on alcohol use strengthened over time, while the effect of weekly marijuana use on positive alcohol consequences reduced over time; and (d) precollege level of problematic alcohol use moderated the association between daily marijuana and alcohol use and weekly marijuana use and negative consequences. This study provides the first longitudinal evidence of the association between marijuana use and greater alcohol use and consequences in college students. Future research examining event-level measurement of alcohol and marijuana co-use is important for the prevention of alcohol-related consequences. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Modeling mood variation and covariation among adolescent smokers: application of a bivariate location-scale mixed-effects model

INTRODUCTION

Ecological momentary assessments (EMAs) are useful for understanding both between- and within-subject dynamic changes in smoking and mood. Modeling 2 moods (positive affect [PA] and negative affect [NA], PA and NA) simultaneously will better enable researchers to explore the association between mood variables and what influences them at both the momentary and subject level.

METHODS

The EMA component of a natural history study of adolescent smoking was analyzed with a bivariate location-scale mixed-effects model. The proposed model separately estimates the between- and within-subject variances and jointly models the 2 mood constructs. A total of 461 adolescents completed the baseline EMA wave, which resulted in 14,105 random prompts. Smoking level, represented by the number of smoking events on EMA, entered the model as 2 predictors: one that compared nonsmokers during the EMA week to 1-cigarette smokers, and the second one that estimated the effect of smoking level on mood among smokers.

RESULTS

Results suggest that nonsmokers had more consistent positive and negative moods compared to 1-cigarette smokers. Among those who smoked, both moods were more consistent at higher smoking levels. The effects of smoking level were greater for NA than for PA. The within-subject association between mood constructs was negative and strongest among 1-cigarette smokers; the within-subject association between positive and negative moods was negatively associated with smoking.

CONCLUSIONS

Mood variation and association between mood constructs varied across smoking levels. The most infrequent smokers were characterized with more inconsistent moods, whereas mood was more consistent for subjects with higher smoking levels.

Photon Undulatory Non-Linear Conversion Diagnostic Method for Caries Detection: A Pilot Study

OBJECTIVE

The objective of this study was to evaluate a new optical method - photon undulatory non-linear conversion (PNC)--for use in different stages of caries detection.

BACKGROUND DATA

Caries should be considered an infectious disease managed by risk assessment, early detection, and preventive therapies, rather than simply "drilling and filling."

MATERIAL AND METHODS

Fluorescence emission spectroscopy was performed in vitro on 90 extracted teeth, with intact occlusal surfaces. This system differs from the basic Diagnodent unit in its ability to distinguish between different tissue components with respect to their spectrums. Histological analysis served as the gold standard for verification. The teeth sections correspond to the specific point with the highest reading of the detector. The system was compared to visual inspection, probing, and x-ray methods. The system tested (helium-neon [He-Ne], lambda = 633 nm) has a fiber optic device that delivers radiation to the tooth and a spectrophotometer device that detects bacterial porphyrins fluorescence, allowing detection of caries, fillings, and calculus by simultaneous measurement of backscattering and fluorescence intensity.

RESULTS

The system tested provides quantitatively reproducible measurements and detection even through sound enamel of more than 1 mm in thickness.

CONCLUSION

The PNC method detects different stages of caries lesions in real time, and it exceeds x-rays in sensitivity, without any ionizing radiation. Preliminary results showed a high potential of using the PNC method in clinical practice (98% accuracy) in comparison to the other methods.