Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children

INTRODUCTION

Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children.

DESIGN

A randomized trial with two groups-intervention and control.

SETTING/PARTICIPANTS

A total of 298 participants from predominantly low-income households with an adult smoker and a child aged <14 years. Participants were recruited during 2012-2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites.

INTERVENTION

The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources.

MAIN OUTCOME MEASURES

In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (>15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016-2017.

RESULTS

Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes' average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001).

CONCLUSIONS

Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01634334.

Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services

OBJECTIVES

Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services.

METHODS

We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors.

RESULTS

In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care.

CONCLUSIONS

Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive services may be improved by addressing parents' attitudes and beliefs about having a usual source of care. Future studies should assess causes of these associations.

Feasibility Pilot of a Randomized Faith-Based Intervention to Reduce Secondhand Smoke Exposure Among Korean Americans

INTRODUCTION

Interventions are needed to prevent exposure to secondhand smoke (SHS), which persists in certain immigrant enclaves, including Koreans in the United States. A faith-based and culturally acceptable intervention was developed and pilot tested in collaboration with Korean churches to address SHS exposure among people of Korean descent.

METHODS

A pilot cluster randomized intervention trial was conducted with 11 Korean churches in southern California and 75 Korean adults who were exposed to SHS. Study participants received a multicomponent intervention, which consisted of motivational interviewing by telephone and educational materials tailored with related biblical messages; the intervention was bolstered by church-based group activities and environmental cues. The control group received the same type and frequency of intervention components, but the components related only to fruit and vegetable consumption. Data were collected on the feasibility of the intervention and study procedures. SHS exposure and awareness and knowledge of SHS exposure were assessed by telephone interviews at baseline and follow-up.

RESULTS

At follow-up, a larger percentage of the intervention group than the control group reported correct SHS knowledge and disapproval of SHS. The intervention group's SHS exposure was reduced by 8.5 cigarettes per week (vs a reduction of 1 cigarette per week among the control group).

CONCLUSIONS

Initial findings are promising for improving knowledge, attitudes, and protective behaviors surrounding SHS exposure. Results suggest that a faith-based intervention for Korean Americans who are exposed to SHS is feasible, acceptable, and potentially effective in reducing their exposure to SHS.

The relationships among physical activity, sedentary behaviour, obesity and quitting behaviours within a cohort of smokers in California

BACKGROUND

Smoking, insufficient physical activity (PA), sedentary behaviour (SB) and obesity are leading risk factors for morbidity and premature mortality. Few studies examining the relationship between these behavioural risk factors and quitting behaviours among cohorts of smokers have been published.

PURPOSE

The goals of this study are to examine the cross-sectional relationships among behavioural health risk factors (insufficient PA, SB and obesity) and past year quitting behaviours within a sample of smokers.

METHODS

The California Smokers Cohort, conducted from 2011 through 2013, is a population-based survey of adult smokers in California. Using follow-up data (n = 1050), participants' self-reported health behaviours and past year quitting behaviours were examined in univariate analyses and multivariate logistic regression analyses controlling for demographic covariates.

RESULTS

In univariate analyses examining health behaviours among smokers, all three health behaviours examined (PA, SB and obesity) were related, and significantly more obese smokers with high PA and low SB reported a ≥20% smoking rate reduction than smokers with other combinations of health behaviours (48.8%, Chi-squared = 4.765, P = 0.045). In multivariate models adjusted for sociodemographic characteristics, obese smokers (odds ratio [OR] = 1.450, 95% confidence interval [CI]: 1.088-1.932, P = 0.011) and smokers with higher levels of PA (OR = 1.448, 95% CI: 1.111-1.887, P = 0.006) were more likely to report a past year ≥24-hour quit attempt regardless of SB, and obese smokers (OR = 1.760, 95% CI: 1.095-2.828, P = 0.019) were more likely to report being quit for ≥30 days regardless of PA and SB.

CONCLUSIONS

Overall, the results demonstrated that more physically active and obese smokers were more likely to report positive strides towards quitting. These findings support the potential positive effect of addressing multiple health behaviours along with smoking.

Youth receiving orthodontic care are not immune to poor diet and overweight: a call for dental providers to participate in prevention efforts

OBJECTIVES

While obesity is common in the US, disparities exist. Orthodontic samples are assumed to be more affluent than the general population and not in need of assistance in developing or maintaining healthy lifestyles. This paper evaluates the need of the orthodontic population for intervention by examining diet and weight status of an orthodontic patient sample and describes a role for dental clinicians in obesity prevention efforts.

METHODS

552 patients age 8-14 years, 54% female, 51% non-Hispanic white, 26% Hispanic were recruited from orthodontic practices in Southern California to participate in a randomized controlled trial of clinician-delivered health promotion. Height, weight, demographics, and diet were recorded. Chi-Square analyses were used to test for differences at baseline by gender, age, ethnicity, and income.

RESULTS

13% of the sample was overweight and 9% was obese. Males had a higher rate of obesity than females. Lower income youth had a higher rate than higher income youth. Hispanic youth had a higher rate than non-Hispanic white youth. Failure to meet national dietary guidelines was common, differing significantly by demographic group.

CONCLUSIONS

Within a sample not typically thought of as needing assistance, nearly 25% were overweight or obese and the majority failed to meet dietary recommendations. While most patients could benefit from intervention, male, Hispanic, and lower income groups were in greatest need of assistance. Dental providers, who see youth frequently and already discuss nutrition in the context of oral health, have the opportunity to contribute to obesity prevention.

Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012

BACKGROUND

Tobacco smoking and related health problems are still major public health concerns in the United States despite the declining smoking prevalence.

OBJECTIVES

This study explored differences in smoking prevalence between urban and rural areas potentially relevant to tobacco control efforts in California.

METHODS

Public use adult smoking data from the California Health Interview Survey (CHIS) between 2001 and 2011-2012 were analyzed. A total of 282 931 adults were surveyed across the six CHIS cycles. A ZIP code-based geographic classification (Urban, Second-City, Suburban, and Town/Rural) was used to examine the association between smoking prevalence and area of residency.

RESULTS

The overall smoking prevalence in California decreased from 17.0% in 2001 to 13.8% in 2011-2012. Within each CHIS cycle, the Town/Rural areas had the highest smoking prevalence, followed by Urban and Second-City areas, and Suburban areas had the lowest. Pooled data from all CHIS cycles showed a similar pattern, with rates in Urban, Second-City, Suburban and Town/Rural areas being 15.2%, 15.2%, 13.1% and 17.3%, respectively. Weighted multivariate logistic regression analysis indicated significantly higher odds of smoking in Urban, Second-City and Town/Rural areas compared to Suburban areas (all adjusted odds ratios > 1.10), although this trend varied by race/ethnicity, being present in non-Hispanic Whites and not present in Hispanics.

CONCLUSIONS

Town/Rural and Urban populations of California are consistently at higher risk of smoking than Suburban populations. These results indicate a need for population-specific tobacco control approaches that address the lifestyle, behavior, and education of disparate populations within the same state or region.

Compliance with smoke-free policies in korean bars and restaurants in california: a descriptive analysis

BACKGROUND

Compliance with California's smoke-free restaurant and bar policies may be more a function of social contingencies and less a function of legal contingencies. The aims of this study were: 1) to report indications of compliance with smoke-free legislation in Korean bars and restaurants in California; 2) to examine the demographic, smoking status, and acculturation factors of who smoked indoors; and 3) to report social cues in opposition to smoking among a sample of Koreans in California.

MATERIALS AND METHODS

Data were collected by telephone surveys administered by bilingual interviewers between 2007-2009, and included California adults of Korean descent who visited a Korean bar or restaurant in a typical month (N=2,173, 55% female).

RESULTS

1% of restaurant-going participants smoked inside while 7% observed someone else smoke inside a Korean restaurant. Some 23% of bar-going participants smoked inside and 65% observed someone else smoke inside a Korean bar. Presence of ashtrays was related to indoor smoking in bars and restaurants. Among participants who observed smoking, a higher percentage observed someone ask a smoker to stop (17.6%) or gesture to a smoker (27.0%) inside Korean restaurants (N=169) than inside Korean bars (n=141, 17.0% observed verbal cue and 22.7% observed gesture). Participants who smoked inside were significantly younger and more acculturated than participants who did not. Less acculturated participants were significantly more to likely to be told to stop smoking.

CONCLUSIONS

Ten years after implementation of ordinances, smoking appears to be common in Korean bars in California.

Lifestyle Behaviors Predict Negative and Positive Changes in Self-reported Health

Studies of changes in health following immigration are inconsistent, and few are based on longitudinal designs to test associations based on change. This study identified factors that predicted changes in self-reported health (SRH) among California residents of Korean descent. A sample of California residents of Korean descent were interviewed and followed-up 2 or 3 times by telephone during 2001-2009. The questionnaires dealt with SRH, lifestyle behaviors (smoking, physical activity, and fast food consumption), and socioeconomic measures. Statistical analysis included random-intercepts longitudinal regression models predicting change in SRH. A similar percentage of respondents reported improved and deteriorating SRH (30.3% and 29.1%, respectively). Smoking, consumption of fast foods, age, percentage of life spent in the United States, and being female were predictors of deteriorating SRH, whereas physical activity, education, and living with a partner were predictive of improvement in SRH. The effect of immigration on SRH is influenced by socioeconomic factors and lifestyle practices. Results support promotion of healthy lifestyle practices among immigrants.

Benzene uptake in Hookah smokers and non-smokers attending Hookah social events: regulatory implications

BACKGROUND

Benzene is a human hematotoxicant and a leukemogen that causes lymphohematopoietic cancers, especially acute myelogenous leukemia. We investigated uptake of benzene in hookah smokers and non-smokers attending hookah social events in naturalistic settings where hookah tobacco was smoked exclusively.

METHODS

We quantified S-phenylmercapturic acid (SPMA), a metabolite of benzene, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home.

RESULTS

Urinary SPMA levels in hookah smokers increased significantly following a hookah social event (P < 0.001). This increase was 4.2 times higher after hookah lounge events (P < 0.001) and 1.9 times higher after home events (P = 0.003). In non-smokers, urinary SPMA levels increased 2.6 times after hookah lounge events (P = 0.055); however, similar urinary SPMA levels were detected before and after home events, possibly indicating chronic exposure to benzene (P = 0.933).

CONCLUSIONS

Our data provide the first evidence for uptake of benzene in hookah smokers and non-smokers exposed to hookah tobacco secondhand smoke at social events in private homes compared with their counterparts in hookah lounges. Hookah tobacco smoke is a source of benzene exposure, a risk factor for leukemia.

IMPACT

Because there is no safe level of exposure to benzene, our results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, initiate labeling of hookah-related products, and include hookah smoking in clean indoor air legislation.

Recall of anti-tobacco advertisements and effects on quitting behavior: results from the California smokers cohort

OBJECTIVES

We assessed whether an anti-tobacco television advertisement called "Stages," which depicted a woman giving a brief emotional narrative of her experiences with tobacco use, would be recalled more often and have a greater effect on smoking cessation than 3 other advertisements with different intended themes.

METHODS

Our data were derived from a sample of 2596 California adult smokers. We used multivariable log-binomial and modified Poisson regression models to calculate respondents' probability of quitting as a result of advertisement recall.

RESULTS

More respondents recalled the "Stages" ad (58.5%) than the 3 other ads (23.1%, 23.4%, and 25.6%; P<.001). Respondents who recalled "Stages" at baseline had a higher probability than those who did not recall the ad of making a quit attempt between baseline and follow-up (adjusted risk ratio [RR]=1.18; 95% confidence interval [CI]=1.03, 1.34) and a higher probability of being in a period of smoking abstinence for at least a month at follow-up (adjusted RR=1.55; 95% CI=1.02, 2.37).

CONCLUSIONS

Anti-tobacco television advertisements that depict visceral and personal messages may be recalled by a larger percentage of smokers and may have a greater impact on smoking cessation than other types of advertisements.

E-cigarette use in the past and quitting behavior in the future: a population-based study

OBJECTIVES

We examined whether smokers who used e-cigarettes are more likely to quit after 1 year than smokers who had never used e-cigarettes.

METHODS

We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up.

RESULTS

Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97).

CONCLUSIONS

Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.

Predicting use of assistance when quitting: a longitudinal study of the role of quitting beliefs

BACKGROUND

A growing literature addresses the need to reduce cigarette smoking prevalence by increasing the use of assistance when quitting. A key focus is to identify strategies for enhancing adoption of effective interventions in order to increase utilization of evidence-based treatments.

PURPOSE

To examine the effect of beliefs regarding ability to quit on utilization of assistance for smoking cessation. A mediation model was hypothesized whereby the relationship between smoking and use of assistance is influenced by beliefs in ability to quit.

METHODS

The present study includes 474 of 1000 respondents to baseline and follow-up California Smokers Cohort surveys conducted from 2011 to 2013. Included were baseline smokers who reported a 24-h quit attempt at follow-up. Baseline variables were used to predict use of assistance when quitting.

RESULTS

The hypothesized model was tested using a product of coefficients method, controlling for demographics. Greater heaviness of smoking and lower belief in ability to quit were significantly related to use of assistance. Quitting beliefs significantly mediated the relationship between nicotine dependence and use of assistance.

CONCLUSIONS

The present data support a mechanism whereby the effect of smoking rate on treatment utilization is mediated by beliefs in ability to quit. Greater belief in one's ability to quit may represent an obstacle to treatment utilization by reducing the likelihood of successful cessation. The present findings suggest the value of targeted messages from health care providers that normalize the need for assistance when attempting to change an addictive behavior and emphasize the difficulty of quitting without assistance.

Stress, illness, and the social environment: depressive symptoms among first generation mandarin speaking Chinese in greater Los Angeles

This study documents the indirect effects of social and environmental variables as mediated by immigrant stress and physical health. Using data from a large dual frame sample of first generation mandarin speaking Chinese immigrants in metropolitan Los Angeles counties with the largest groups of Chinese immigrants, this study uses a path analytic approach to trace how predictors are related to depressive symptoms and to measure direct and indirect influences of variables. Although bivariate analyses suggested that many predictors were associated with depressive symptoms, multivariate path analysis revealed a more complex structure of mediated associations. In the multivariate path analysis only reports of physical health and immigrant stress were directly related to depressive symptoms (P < 0.05), while acculturation, time in the US, income, US citizenship, and distance of persons on whom one could rely were related to stress (but not to physical health status) and only to depressive symptoms as mediated by stress. Age and educational attainment were related to health status (and to stress as mediated by physical health) and to depressive symptoms as mediated by both health and stress. These variables were also unrelated directly to health status and to depressive symptoms. Associations were evaluated using statistical significance, P < 0.05. This study demonstrates the significance of stress and health as mediators of variables in the larger context of the physical environment and suggests that the mechanisms linking ecological characteristics of immigrants to depressive symptoms may be stress and physical health among immigrants.

Osteoporosis and milk intake among Korean women in California: relationship with acculturation to U.S. lifestyle

The Korean population in the US increased by a third between 2000 and 2010. Korean women in the US report low calcium intake and relatively high rate of fractures. However, little is known about the prevalence of osteoporosis among Korean American women. This paper examined the relationship between prevalence of osteoporosis and milk consumption, and their relationship with acculturation among a representative sample of immigrant California women of Korean descent. Bilingual telephone surveys were conducted from a probability sample (N = 590) in 2007. Lower acculturation significantly related to lower milk consumption for women during the age periods of 12-18 and 19-34 years. Acculturation was related to higher prevalence of osteoporosis among post-menopausal, but not pre-menopausal Korean women in California. Future research should include larger cohorts, objective measures of osteoporosis, other sources of calcium specific to Korean cuisine, and assessment of bone-loading physical activity.

Complete home smoking bans and antitobacco contingencies: a natural experiment

INTRODUCTION

The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico.

METHODS

A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders.

RESULTS

Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable.

CONCLUSIONS

Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.

Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study

OBJECTIVE

To assess whether smoking ban policies are associated with smoking reduction and quit attempts among California smokers.

METHODS

Data were examined for 1718 current smokers from follow-up telephone interviews conducted in 2011 of persons previously identified as smokers in a representative sample of the adult population of California. Population weighted logistic regressions controlling for demographic and other variables were used to evaluate the association between smoking ban policies (home, work, and town) and changes in tobacco use (past year quit attempt or reduction in smoking rate).

RESULTS

Living in a home with a total ban was significantly associated with smoking reduction (adjusted odds ratio, AOR: 2.4, 95% CI: 1.4-4.2) and making a quit attempt (AOR: 2.3, 95% CI: 1.3-3.9) compared to living in a home with no home ban. Self-reported perception of an outdoor ban in one's city/town was associated with smoking reduction (AOR: 1.7, 95% CI: 1.02-2.7) and making a quit attempt (AOR: 1.8, 95% CI: 1.05-2.9).

CONCLUSION

These results indicate that smoking bans not only protect nonsmokers from the harms of secondhand smoke, but are also associated with smoking reduction and cessation.

Perceived neighborhood environment and physical activity in 11 countries: do associations differ by country?

BACKGROUND

Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.

METHODS

Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.

RESULTS

Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.

CONCLUSION

There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Do christian denominations exhibit higher rates of alcohol consumption? A study of Korean American women in California

Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. This cross-sectional study examined the associations of religious denomination and religious commitment to alcohol consumption among Korean American women in California. Polychotomous regression models were used to provide estimates of the associations between religious denomination and religious commitment to alcohol consumption. Catholic Korean American women (OR 5.61 P < 0.01) and Independent Christian women (OR 4.87 P < 0.01) showed stronger associations to heavy alcohol consumption when compared to Conservative Christian Korean American women. Path analysis suggested that specific denominations had both direct and indirect effects on the outcome of interest, and that religious commitment and drinking models served as moderators for this phenomenon.

Smoking trajectories among Koreans in Seoul and California: exemplifying a common error in age parameterization

Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001-2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Korean and Korean American men. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.

Perceived price sensitivity by ethnicity and smoking frequency among California Hispanic and non-Hispanic white smokers

OBJECTIVES

Little is currently known about price sensitivity across ethnic groups as well as for non-daily smokers. To address this issue, this study compared perceived price sensitivity across smoking status (daily and non-daily) and within ethnicity (Hispanic and non-Hispanic White) in a recent representative population survey of California smokers.

METHODS

This study employed data from the 2008 California Tobacco Survey (CTS), a large population-based random-digit-dialed telephone survey. Participants were 1,777 non-Hispanic White and 450 Hispanic respondents who had smoked at least 100 cigarettes and currently smoked daily or on some days.

RESULTS

Differences in perceived price sensitivity were found by ethnicity when controlling for age, gender, and cigarette consumption. Comparisons across ethnic groups indicated that Hispanic smokers, in general, have more price-sensitive perceptions than non-Hispanic White smokers. However, daily versus non-daily status had no effect on price sensitivity when controlling for cigarette quantity.

CONCLUSIONS

These findings indicate that pricing increases may be differentially influential for Hispanic compared with non-Hispanic White smokers across smoking status categories.

Prevalence and Correlates of Intimate Partner Violence Among Young, Middle, and Older Women of Korean Descent in California

This research examined the prevalence and correlates of intimate partner violence (IPV) among younger, middle-aged, and older Korean American women. Data were drawn from telephone interviews of a population-based, representative probability sample (N = 592) of female adults of Korean descent residing in California, with a completion rate of 70%. Data were grouped by age. In each group, psychological aggression was the most common type of IPV in the past year, followed by a moderate form of sexual coercion, while physical assault and injury were infrequent. Immigration stress was associated with psychological aggression in all three groups, and partner alcohol use was associated in none. Other predictors varied by group. Results suggest that psychological abuse is a serious issue, and that women's life stage is an important consideration in IPV among Korean Americans. Findings, which sometimes diverged from those of prior studies of this population, merit further investigation.

The environment modifies the relationship between social networks and secondhand smoke exposure among Korean nonsmokers in Seoul and California

This study compared risks of secondhand smoke exposure (SHSe) among Korean nonsmokers in Seoul, South Korea and California, United States. Social networks were hypothesized to contain more smokers in Seoul than in California, and smokers were hypothesized to produce more secondhand smoke in Seoul than California, as Seoul's policies and norms are less restrictive. Telephone interviews were conducted with Korean adults in Seoul (N = 500) and California (N = 2830). In all, 69% (95% confidence interval [CI] = 64-74) of Koreans and 31% (95% CI = 29-33) of Korean Americans reported any SHSe. A total of 44% (95% CI = 40-47) of Korean family members smoked versus 29% (95% CI = 28-30) of Korean American family members (t = 7.84, P < .01). A 25% to 75% increase in the proportion of family members that smoked corresponded with a 13% (95% CI = 5-21) higher probability of any SHSe among Koreans compared with 6% (95% CI = 2-10) among Korean Americans. Network interventions in combination with policies and/or health campaigns may help reduce SHSe globally.

Korean American women's preventive health care practices: stratified samples in California, USA

Using data from a larger study, we explored the characteristics of preventive health care practices (influenza vaccination, mammogram, and Pap test) among a representative sample of 1,786 Korean American women residing in California by telephone. Three preventive health care practices were related to the goals set by Healthy People 2010. Participants with no education in the United States, who were born in Korea, resided in the United States longer, and had a primary care provider were more likely than others to reach these goals. Our findings indicate that a behavioral model was suitable to explain the three preventive health care practices.

South Korean military service promotes smoking: a quasi-experimental design

PURPOSE

The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status.

MATERIALS AND METHODS

Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies.

RESULTS

Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling.

CONCLUSION

These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.

Increasing hookah use in California

Hookah use is gaining popularity nationwide. We determined the correlates and trends for hookah use from the California Tobacco Survey. Between 2005 and 2008 hookah use increased more than 40%, and in 2008, 24.5% of young men reported ever using a hookah. Hookah use was more common among the young (18-24 years), the educated, the non-Hispanic Whites, and the cigarette smokers. Hookah use is increasing in California, especially among young adults, and in 2008 reached the highest prevalence ever reported for both genders.

Cultural and social network predictors of drinking among Korean American women

This study estimated the association of cultural and social mechanisms with Korean American women's drinking behaviors. Data were drawn from telephone interviews with 591 Korean women selected from a random sample of households in California with Korean surnames during 2007. About 62% of eligible respondents completed the interview. Respondents reported any lifetime drinking (yes/no), drinking volume (typical number of drinks consumed on drinking days), level of acculturation, and described their social network by assessing who encouraged or discouraged drinking (drinking support) or drank (drinking models). Multivariable regressions were used for analyses. About 70% (95% confidence interval [95%CI]:, 67, 74) of Korean American women reported any lifetime drinking and current drinkers drank 1.18 (95%CI: 1.07, 1.28) drinks on drinking days. Acculturation was not significantly associated with any lifetime drinking or drinking volume, whereas models and support for drinking were statistically significantly associated with a higher probability of any lifetime drinking and drinking more on drinking days. Each additional encourager, or one or fewer discourager, for drinking in women's social networks was associated with a 2% (95%CI: 1, 3) higher probability of any lifetime drinking and drinking 0.25 (95%CI: -0.53, 1.18) more drinks on drinking days. Each additional drinker in women's networks was associated with a 4% (95%CI: 1, 8) higher probability of any lifetime drinking and drinking 0.26 (95%CI: -0.05, 0.60) more drinks on drinking days. Korean American women's drinking appears to be strongly related to their social networks, although how women take on traits of their new environment was not.

Measuring immigration stress of first-generation female Korean immigrants in California: psychometric evaluation of Demand of Immigration Scale

OBJECTIVES

Immigration involves challenges and distress, which affect health and well-being of immigrants. Koreans are a recent, fast-growing, but understudied group of immigrants in the USA, and no study has established or evaluated any immigration stress measure among this population. This study explores psychometric properties of Korean-translated Demands of Immigration (DI) Scale among first-generation female Korean immigrants in California. Analyses included evaluation of factor structure, reliability, validity, and descriptive statistics of subscales.

DESIGN

A surname-driven sampling strategy was applied to randomly select a representative sample of adult female Korean immigrants in California. Telephone interviews were conducted by trained bilingual interviewers. Study sample included 555 first-generation female Korean immigrants who were interviewed in Korean language. The 22-item DI Scale was used to assess immigration stress in the study sample.

RESULTS

Exploratory factor analysis suggested six correlated factors in the DI Scale: language barriers; sense of loss; not feeling at home; perceived discrimination; novelty; and occupation. Confirmatory factor analysis validated the factor structure. Language barriers accounted for the most variance of the DI Scale (29.11%). The DI Scale demonstrated good internal consistency reliability and construct validity.

CONCLUSION

Evidence has been offered that the Korean-translated DI Scale is a reliable and valid measurement tool to examine immigration stress among Korean immigrants. The Korean-translated DI Scale has replicated factor structure obtained in other ethnicities, but addition of cultural-specific items is suggested for Korean immigrants. High levels of language and occupation-related stress warrant attention from researchers, social workers, and policy-makers. Findings from this study will inform future interventions to alleviate stress due to demands of immigration.

Smoking on both sides of the pacific: home smoking restrictions and secondhand smoke exposure among Korean adults and children in Seoul and California

INTRODUCTION

This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States.

METHODS

A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001-02. Multivariable regressions were used for analyses.

RESULTS

Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16-23) versus 66% (95% CI: 64-68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60-69) versus 5% (95% CI: 4-6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76-86) versus 36% (95% CI: 17-57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7-13) versus 7% (95% CI: 3-13).

CONCLUSIONS

Consistent with ecological frameworks, exposure to California's antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.

It's others, not the police: smoking, reprimand, and fines among adults of Korean descent in California

OBJECTIVE

This study assesses the association of immediate social and legal reprimand and current smoking status among Californians of Korean descent.

DESIGN

Data were drawn from a population-based probability sample using a telephone survey conducted by bilingual, professional interviewers (N = 2085). About 85.0% of eligible respondents completed interviews and 86.3% of participants preferred to be interviewed in Korean.

MAIN OUTCOME MEASURE

Smoking status was measured using Centers for Disease Control and Prevention criteria, ever smoked 100 cigarettes and currently smoke every day or some days.

RESULTS AND CONCLUSION

Reports of immediate criticism by others in several settings was associated with nonsmoking, but likelihood of immediate legal penalties was unrelated. Participants were far less likely to expect legal than social sanction. Results were replicated after controlling for reinforcers of smoking and ecologically relevant variables including models of smoking, primary group social support for smoking, acculturation, sex, acculturation by sex (male) interaction, age, and education. It may be efficacious to target public health interventions encouraging appropriate social sanctions of smoking in public among persons of Korean descent, and to encourage strict enforcement of legal penalties for smoking in public places.

Adolescents validly report their exposure to secondhand smoke

OBJECTIVE

This study examined the validity of child-reported exposure to secondhand smoke (SHS) and investigated factors, such as child's age, which might affect accuracy of recall.

STUDY DESIGN AND SETTING

Participants were drawn from a nonprobability sample of 380 families who completed baseline assessment as part of a randomized trial of an SHS reduction intervention conducted in an urban setting in Southern California. Parents and children (aged 8-13 years) retrospectively reported child's exposure to SHS using timeline followback methodology; reports were compared with child's urine cotinine.

RESULTS

Validity coefficients for parents and children were comparable (r=0.58 vs. r=0.53), but parents recalled three times more exposure than children (2.2 vs. 0.8 cigarettes per day; P<0.001). Regression models predicting cotinine indicated that including child in addition to parent reports resulted in better prediction than either alone.

CONCLUSION

When there is a choice, parent reports are preferable over child reports because of decreased underreporting. However, child-reported SHS exposure had adequate validity (r>0.50) and might be appropriate in some situations. Researchers might consider collecting both parent and child reports because each made a unique contribution to the prediction of cotinine.

Engaging community businesses in human immunodeficiency virus prevention: a feasibility study

PURPOSE

To explore the feasibility of engaging community businesses in human immunodeficiency virus (HIV) prevention.

DESIGN

Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures, both of which were provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-program, and post-program. Customer feedback was obtained through an online survey.

SETTING

Participants were selected from a San Diego, California neighborhood with a high rate of acquired immune deficiency syndrome.

PARTICIPANTS

Fifty-one business owners/managers who represented 10 retail categories, and 52 customers.

MEASURES

Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction, and business owners'/managers' willingness to provide future support for HIV prevention were measured.

ANALYSIS

Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data.

RESULTS

The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or who refused to participate (41%; p < .05). Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures (p < .05). More than 90% of customers supported distributing condoms and brochures in businesses, and 96% of business owners/managers described their program experience as positive.

CONCLUSION

Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.

Determinants and prevalence of late HIV testing in Tijuana, Mexico

Timely diagnosis of HIV is essential to improve survival rates and reduce transmission of the virus. Insufficient progress has been made in effecting earlier HIV diagnoses. The Mexican border city of Tijuana has one of the highest AIDS incidence and mortality rates in all of Mexico. This study examined the prevalence and potential correlates of late HIV testing in Tijuana, Mexico. Late testers were defined as participants who had at least one of: (1) an AIDS-defining illness within 1 year of first positive HIV test; (2) a date of AIDS diagnosis within 1 year of first positive HIV test; or (3) an initial CD4 cell count below 200 cells per microliter within 1 year of first positive HIV test. Medical charts of 670 HIV-positive patients from two HIV/AIDS public clinics in Tijuana were reviewed and abstracted; 362 of these patients were interviewed using a cross-sectional survey. Using multivariate logistic regression, we explored potential correlates of late HIV testing based on the Behavioral Ecological Model. From 342 participants for whom late testing could be determined, the prevalence of late testing was 43.2%. Multivariate logistic regression results (n = 275) revealed five significant correlates of late testing: "I preferred not to know I had HIV" (adjusted odds ratio [AOR] = 2.78, 1.46-5.31); clinic (AOR = 1.90, 1.06-3.41); exposure to peers engaging in high-risk sexual behavior (AOR = 1.14, 1.02-1.27); stigma regarding HIV-infected individuals (AOR = 0.65, 0.47-0.92); and stigma regarding HIV testing (AOR = 0.66, 0.45-0.97). These findings may inform the design of interventions to increase timely HIV testing and help reduce HIV transmission in the community at large.

Gender modifies the relationship between social networks and smoking among adults in Seoul, South Korea

OBJECTIVE

To evaluate the interaction of gender with social network mechanisms and smoking behaviors in Seoul, South Korea, where smoking is common among men but not women.

METHODS

During 2002, telephone surveys were completed with 500 adults drawn from a probability sample in Seoul. Respondents described their smoking status, smoking rate (number of cigarettes smoked per day) and social networks by assessing who discouraged or encouraged smoking (smoking support) or smoked (smoking models). Multivariable regressions were used for analyses.

RESULTS

Women encountered significantly less smoking support than men, 88% (95% confidence interval [95% CI], 85-91) versus 70% (95% CI 66-73) net discouragement of smoking in their network. A difference in smoking support from 25 to 75% net discouragement was associated with a 27% (95% CI 9-49) lower probability of smoking among women, significantly stronger (z = 3.18, p < 0.01) than among men who had a 19% (95% CI 8-27) lower probability of smoking. A similar difference in smoking support was associated with male smokers smoking 6.38 (95% CI 0.86-12.30) fewer cigarettes per day, or 2,329 (95% CI 314-4,490) fewer cigarettes per year. The later association could not be observed among women due to the small proportion of female smokers. Smoking models were not significantly associated with any smoking behaviors across genders.

CONCLUSIONS

Social network mechanisms were differentially associated with the high smoking prevalence among men and low prevalence among women and should be targeted by interventions tailored to these differences.

Exploring religious mechanisms for healthy alcohol use: religious messages and drinking among Korean women in California

OBJECTIVE

This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California.

METHOD

Data were drawn from telephone interviews with female adults (N = 591) selected from a random sampling of persons in California with Korean surnames during 2007. Approximately 70% of attempted interviews were completed, with 92% conducted in Korean. Respondents were asked about any lifetime drinking (yes/no), drinking rate (typical number of drinks consumed on drinking days among current drinkers), and messages discouraging "excessive drinking" from religious leaders or congregants. Bivariable and multivariable regressions were used for analysis.

RESULTS

Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1.10 (1.22) drinks on drinking days. About 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability (odds ratio = 0.775, 95% confidence interval [CI]: 0.626, 0.959) of any lifetime drinking. also, each congregant's message was associated with a 13.8% (B = -0.138; 95% CI: -0.306, 0.029) lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate.

CONCLUSIONS

Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors.

Can religion help prevent obesity? Religious messages and the prevalence of being overweight or obese among Korean women in California

This research examines the influence of messages from religious leaders and congregants on whether Korean women are overweight or obese. Data were drawn from telephone interviews with a probability sample (N = 591) of women of Korean descent living in California. Overweight or obese prevalence was measured using World Health Organization standards for Asians (BMI > 23). Respondents reported the frequency of messages discouraging “excessive eating” or encouraging “exercise” from religious leaders and congregants during a typical month. When conditioned on leaders’ messages, the frequency of congregants’ messages was associated with a significantly lower probability of being overweight or obese, although messages from either in the absence of the other were unassociated with being overweight or obese. At least for Korean women, religion may help prevent obesity via religious-based social mechanisms.

Parent/Child training to increase preteens' calcium, physical activity, and bone density: a controlled trial

PURPOSE

To test effects of parent/child training designed to increase calcium intake, bone-loading physical activity (PA), and bone density.

DESIGN

Two-group randomized controlled trial.

SETTING

Family-based intervention delivered at research center.

SUBJECTS

117 healthy children aged 10-13 years (58.1% female, 42.7% Hispanic, 40.2% White). Ninety-seven percent of participants had at least one parent graduate from high school and 37.2 % had at least one parent graduate from a 4-year university.

INTERVENTION

Children and parents were randomly assigned to diet and exercise (experimental) or injury prevention (control) interventions. Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries. Parents were taught behavior management techniques to modify children's behaviors.

MEASURES

Measures at baseline and at 3, 9, and 12 months included 24-hour diet and PA recalls, and bone mineral density (BMD) by dual-energy x-ray absorptiometry.

ANALYSIS

Analysis of variance and generalized estimating equations (GEE) assessed group by time differences. Comparisons were conducted separately for boys and girls.

RESULTS

For boys, cross-sectional differences between experimental and control groups were achieved for 3- and 9-month calcium intake (1352 vs. 1052 mg/day, 1298 vs. 970 mg/day, p < .05). For girls, marginal cross-sectional differences were achieved for high-impact PA at 12 months (p < .10). For calcium intake, a significant group by time interaction was observed from pretest to posttest for the full sample (p = .008) and for girls (p = .006) but not for boys. No significant group by time differences in calcium were observed across the follow-up period. No group by time differences were observed for high-impact PA. Among boys, longitudinal group by time differences reached significance for total hip BMD (p = .045) and femoral neck BMD (p = .033), even after adjusting for skeletal growth. Similar differential increases were observed among boys for bone mineral content (BMC) at the hip (p = .068) and total body (p = .054) regions. No significant group by time interaction effects were observed for girls at any bone site for BMD. For BMC, control girls showed a significant increase (p = .03) in spine BMC compared to intervention girls.

CONCLUSION

This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA. Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during preadolescent years.

Counseling to reduce children's secondhand smoke exposure and help parents quit smoking: a controlled trial

INTRODUCTION

We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking.

METHODS

After baseline, mothers who exposed their children younger than 4 years to 10 or more cigarettes/week were randomized to the intervention (n = 76) or usual care control condition (n = 74). Outcomes were assessed at 3, 6, 12, and 18 months. Intervention families were offered 10 in-person at home and 4 telephone counseling sessions over 6 months, and additional pre- and postquit telephone sessions. Counseling procedures included behavioral contracting, self-monitoring, and problem solving.

RESULTS

Parents' reports of their smoking and children's exposure showed moderate and significant correlations with children's urine cotinine levels and home air nicotine (r = .40-.78). Thirteen (17.1%) intervention group mothers and 4 (5.4%) controls reported that they quit smoking for 7 days prior to 1 or more study measurements, without biochemical contradiction (p = .024). Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers' smoking in the counseled group compared with controls. Reported indoor smoking and children's urine cotinine decreased, yet group differences for changes were not significant.

DISCUSSION

Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.

Longitudinal study of household smoking ban adoption among Korean Americans

BACKGROUND

Few longitudinal studies have examined the adoption of bans on smoking in private homes.

PURPOSE

This longitudinal study examined: (1) the prevalence of home smoking bans at baseline, (2) the incidence and predictors of new ban implementation by follow-up, and (3) the reasons for banning smoking and the difficulties with enforcement.

METHODS

The sample consisted of 1360 adults of Korean descent residing in California who were interviewed by telephone (in English/Korean) at baseline during 2001-2002 and re-interviewed in 2006-2007. Data analyses were conducted in 2007-2008.

RESULTS

The proportion of respondents with a complete household smoking ban grew from 59% at baseline to 91% by the follow-up interview. Among the 552 respondents who did not have a ban at baseline, 84% had adopted a ban by follow-up. Three baseline factors independently predicted ban adoption during the follow-up period: the presence of a nonsmoking respondent or spouse, the presence of nonsmoking family members, and respondent's belief that secondhand smoke caused lung cancer. The most highly rated reasons for banning smoking were as follows: because smoke annoys others, to protect family members, to avoid the odor, to discourage youth from smoking, and to encourage smokers to quit. Finally, respondents indicated that they would find it most difficult to ask their parent-in-law not to smoke.

CONCLUSIONS

The proportion of households with smoking bans increased substantially, but households with smokers or family members who smoke remained less likely to implement bans. The importance of culturally sensitive programs to promote household bans cannot be overstated.

Employment and social "determinants" of smoking in urbanizing China: a representative survey

INTRODUCTION

This study explored social determinants of smoking among a sample of male Chinese adults in Changqiao, a community representing the transition from traditional to a "mobile" urban culture in China. New commercial systems have introduced high profits but also layoffs in the absence of government security systems.

METHODS

In-person interviews were conducted by trained interviewers with 123 male participants selected at random. Bivariate and multivariate analyses were computed based on the Behavioral Ecological Model (BEM). About 61% of male participants were ever-smokers and 48% were current smokers.

RESULTS

Current smoking was associated with involuntary unemployment (odds ratio [OR] = 6.52), the absence of home smoking restrictions (OR = 0.34), and social reinforcement such as friends' smoking (OR = 4.02) and receiving smoking-related gifts (OR = 6.39).

DISCUSSION

Findings support the BEM. It is especially important to verify the relationship between unemployment and smoking, given the recent rise in involuntary job loss due to the transitional economy in China.

Rethinking Acculturation: A Study of Alcohol Use of Korean American Adolescents in Southern California

Given the considerable variability in drinking practices among Asian American groups, the generalizations that suggest an increase in their alcohol use associated with acculturation need to be questioned. Also, the experience of children of immigrants growing up in the United States may be much more complex than a focus on acculturation can capture. Informed by the theory of segmented assimilation, this study addresses two research questions: 1) Is acculturation associated with alcohol use of Korean American adolescents? and 2) What other social, economic, and cultural forces influence their alcohol use? Survey data collected from 202 adolescents of Korean descent in Southern California were used. Multivariate regression analyses revealed that acculturation was not a significant predictor of most measures of alcohol use, while peer influence, scholastic achievement/aspirations, and current smoking were predictive. Gender and social class were unrelated to drinking. Findings suggest focusing research on an integrative approach to understanding drinking in complex social, economic, and social contexts may be useful.

Home smoking restrictions among Koreans in Seoul

The prevalence and correlates of home smoking bans in the Republic of Korea were examined using population-based data from telephone interviews with 500 Seoul adult residents in 2002. Most (97%) respondents indicated that they smoked, or that their spouse, other family member, or a regular friend smoked. Nearly all indicated that environmental tobacco smoke (ETS) is harmful. Only 19% of homes banned smoking, 65% allowed smoking anywhere, and 16% allowed smoking by special guests or in certain areas. The odds of having a full ban were significantly greater for men, married individuals, those less than 35 years or more than 50 years of age, non-smokers, individuals whose nonspouse family members did not smoke, and individuals with more sources of anti-ETS messages. Home smoking bans should be promoted by media campaigns and other tobacco control activities, because knowledge of the effects of ETS was already high.

Children's exposure to secondhand smoke at home in Seoul, Korea

here is little information about Korean children's secondhand smoke (SHS) exposure at home. This paper examines the extent and determinants of their SHS exposure at home. A population-based random digit dial telephone survey was conducted in 2002 with 500 adults in Seoul. We analyzed data for 207 adults with children living in the household. Thirty-one percent of respondents reported children' s SHS exposure at home. The mean weekly dose was 5 cigarettes among exposed children. Multiple logistic regression results showed that children's odds of SHS exposure at home increased if the respondent or spouse smoked, if the respondent's parent smoked, if smoking was allowed in the home, and if fewer groups discouraged smoking. Stronger protective measures are urged, such as widespread increase in home smoking bans and discouragement of smoking.