Did You Know? Tobacco Tax Policy Alone May Not Be Enough To Increase Cessation Among African Americans

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A newly published study examined the effects of cigarette price on intention to quit, quit attempts, and successful cessation among African American smokers in the U.S. and explored whether price effects differed by income level and menthol use status. Researchers analyzed cross-sectional data from 2006-2007 and 2010-2011 Tobacco Use Supplements to the Current Population Survey from 4,213 African American recent active smokers.

Findings included:

·         There was no indication that price was associated with quit attempts or successful cessation, but price was positively associated with increased odds of intending to quit among African American smokers.

·         In contrast, prices were positively associated with intention to quit and quit attempts for White smokers.

·         The association between price and intention to quit was significantly positive for African American low-income and menthol smokers but was not statistically significant for African American high-income and non-menthol smokers.

·         There was no evidence of a price effect on quit attempts and successful cessation for each subgroup of African Americans.

The researchers concluded that tobacco tax policy alone may not be enough to increase quit attempts or successful cessation among African Americans. Community-based cessation programs tailored towards African American smokers, especially low-income menthol smokers, are needed.

Source: Keeler, Max, Yerger, Yao, Wang, Ong & Sung (2018). Effects of cigarette prices on intention to quit, quit attempts, and successful cessation among African American smokers. Nicotine & Tobacco Research, Jul 18, [Epub ahead of print].

Did You Know? Youth Believe that Ads for Flavored E-Liquids Target Them

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The e-cigarette industry argues that flavors are not meant to appeal to youth, yet no study has asked youth what age group they think ads for flavored e-liquids are targeting. A newly published study asked youth which age group they thought ads for flavored e-liquids targeted. A random sample of 255 youth from across California viewed eight ads, presented in randomized order, for fruit-, dessert-, alcohol-, and coffee-flavored e-liquids and indicated the age group they thought the ads targeted: younger, same age, a little older, or much older than them.

 

Findings included:

  • Most participants (94%) indicated the cupcake man flavor ad targeted an audience of people younger than they.
  • Over half felt ads for smoothy (68%), cherry (64%), vanilla cupcake (58%), and caramel cappuccino (50%) targeted their age and for no flavor ad did most feel the primary target age group was much older.
  • Youth believe ads for flavored e-liquids target individuals about their age, not older adults.

 

The researchers concluded that findings support the need to regulate flavored e-liquids and associated ads to reduce youth appeal, which ultimately could reduce youth use of e-cigarettes.

 

Source: McKelvey et al. (2018). Youth say ads for flavored e-liquids are for them. Addictive Behaviors, Aug 29. pii: S0306-4603(18)30957-2. doi: 10.1016/j.addbeh.2018.08.029. [Epub ahead of print]

Did You Know? California has Reduced Smoking Faster than the Rest of the US

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Three cigarette smoking behaviors influence lung cancer rates: how many people start, the amount they smoke, and the age they quit. California has reduced smoking faster than the rest of the US and trends in these 3 smoking behaviors should inform lung cancer trends. A newly published study examined trends in smoking behavior (initiation, intensity, and quitting) in California and the rest of US by regression models using the 1974-2014 National Health Interview Surveys (n=962,174).

 

Findings included:

·                     Among those aged 18- 35 years, California had much larger declines than the rest of the US in smoking initiation and intensity, and increased quitting.

·                     In 2012-14, among this age group, only 19% had ever smoked; smokers consumed only 6.3 cigarettes/day; and 46% of ever-smokers had quit by age 35.

·                     Each of these metrics was at least 24% better than in the rest of the US.

·                     There was no marked California effect on quitting or intensity among seniors. From 1986-2013, annual lung cancer mortality decreased more rapidly in California and by 2013 was 28% lower than in the rest of the US.

·                     California’s tobacco control efforts were associated with a major reduction in cigarette smoking among those under age 35 years.

 

The researchers concluded that these changes will further widen the lung cancer gap that already exists between California and the rest of the US.

 

Source: Pierce et al. (2018). Trends in lung cancer and cigarette smoking: California compared to the rest of the United States. Cancer Prevention Research, Oct 10. pii: canprevres.0341.2018. doi: 10.1158/1940-6207.CAPR-18-0341. [Epub ahead of print]

A Study Examines Perceived Positive And Negative Traits Of Adolescent E-Cigarette Users

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A newly published study examined the relationship between adolescents’ positive opinions of e-cigarette users and willingness to use e-cigarettes. Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016.
Findings included:
  • The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users.
  • Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users.
  • Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users.
  • Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users.
  • Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users.
Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.
Source: McKelvey et al. (2018). Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PloS One, Nov 7;13(11):e0206352. doi: 10.1371/journal.pone.0206352. eCollection 2018.
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Top Reason for E-Cigarette Use Among Young Adults: “They come in flavors I like”
A newly published study examined whether strong local policies may reduce e-cigarette initiation rates by influencing the appeal of these products. Online questionnaires were completed by Southern California Children’s Health Study participants in 2015-2016 (mean age?=?18.9?years).

Findings included:

  • The top reason for e-cigarette use was “They come in flavors I like” (57%).
  • Using e-cigarettes to quit smoking was uncommon (13%).
  • Participants in jurisdictions with weaker tobacco retail licensing ordinances were more likely to report use of e-cigarettes because they are less harmful than cigarettes (50% vs. 36%), more acceptable to non-tobacco users (38% vs. 25%), and because they can use e-cigarettes in places where smoking is prohibited (31% vs. 18%).
The study authors recommend targeted policy that conveys the adverse impact of e-cigarettes, and restricts use in public places may reduce e-cigarette use among adolescents and young adults.
Source: Hong et al. (2018). The impact of local regulation on reasons for electronic cigarette use among Southern California young adults. Addictive Behaviors, Nov 16. pii: S0306-4603(18)31329-7. doi: 10.1016/j.addbeh.2018.11.020. [Epub ahead of print]

Our Tailored Assistance Trainers

 

A major feature of The LOOP is the provision of tailored assistance responsive to grantees’ requests, enabling them to implement more effectively their local tobacco control interventions and initiatives. This is a free service provided to statewide CTCP grantees. Subject matter experts have been identified and recruited to provide trainings and tailored assistance that cover a range of tobacco control topics, as well as other areas pertinent to reaching and serving California’s diverse populations.
 
You can currently make a request for tailored assistance by contacting us at theloop@ucsf.edu. This is a partial list of our tailored assistance trainers and their expertise.

Tobacco Advertising                      American Indian Casinos                            Advertising

Advocacy                                         Educational Materials Development         Evaluation

Community Organizing                Housing and Urban Development             Budget/Fiscal

Faith-Based Organizations           Outdoor Dining, Beaches, Parks                Coalition Build.

Grant Writing                                 Smokeless Tobacco/Cigars                           Fundraising

Health Disparities                          Health Policy Development                        Legal Issues

Leadership Development             Multi-Cultural Issues                                    Social Media

Multi-Unit Housing                        Social Marketing Campaigns                      Tobacco Litter

Research                                          Social Media                                                   Stake Act

Youth Coalition                               Tobacco Control Funding                            Harm Reduction

Did You Know? Tobacco Use Is A Major Cardiovascular Risk Factor For American Indians

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Heart disease is the leading cause of death in American Indians (AIs). A newly published study examined cardiovascular risk factors in Northern Plains American Indians undergoing coronary artery bypass grafting surgery. AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7%) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0%). The researchers concluded that AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use.

Source: Anderson et al. (2018). Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting. Health Equity, Aug 1;2(1):152-160.

Did You Know? Rural Residents Less Supportive Of Secondhand Smoke Restrictions

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A newly published study compared support for secondhand smoke (SHS) restrictions across rural and urban areas. Smoking inside the home was assessed along with attitudes toward smoking in bars, casinos, playgrounds, cars, and cars with kids.

Findings included:

·         Urban respondents were significantly more supportive of all SHS policies: (e.g. smoking in bars [57.9% vs. 51.4%]; support for kids in cars [94.8% vs. 92.5%].

·         Greatest difference between urban-rural residents was in Mid-Atlantic (bar restrictions) and Southeast (home bans): almost 10% less supportive.

·         Rural residents were least likely to support SHS in homes, in cars, on playgrounds and in bars.

·         South Central rural residents were significantly less likely to support SHS policies-home bans, smoking in cars with kids, on playgrounds, in bars and casinos; while Heartland rural residents were significantly more supportive of policies restricting smoking in cars, cars with kids and on playgrounds.

Source: Stillman et al. (2018). Variations in support for secondhand smoke restrictions across diverse rural regions of the United States. Preventive Medicine, Sep 24;116:157-165. doi: 10.1016/j.ypmed.2018.09.014. [Epub ahead of print]

Read the paper at: https://www.sciencedirect.com/science/article/pii/S0091743518302925?via%3Dihub

A New Study Examines Stealthy Vapor Devices Popular With Youth

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A newly published article examined stealthy vapor devices, as well as low-odor and low-vapor e-juices, via a comprehensive online search between March and June 2018. As evidence of their popularity, a search for ‘stealth vaping’ on YouTube found 18,200 videos. A variety of cleverly designed vapor devices disguised as USB sticks, pens, remote controls, car fobs, smart phones, sweatshirt drawstrings and even asthma inhalers are on the market. JUUL, which resembles a USB stick, is the archetype of these devices and is especially popular among youth. A search of ‘JUUL’ on YouTube yielded 148 000 videos with 57 videos having >100 000 views. Searches on ‘JUUL at school’ (15 500), ‘JUUL in class’ (6840), ‘hiding JUUL in school’ (2030) and ‘JUUL in school bathroom’ (1040) illustrate the product’s popularity among students. Some e-juices promote themselves as having low visibility plumes while others profess to be of subtle odor to avoid detection. Numerous techniques have been described to hide the exhaled vapor plume such as by swallowing it or blowing it into one’s clothing or into a backpack.

The researchers concluded that the vaping industry has demonstrated much ingenuity in devising discreet vaporizers and de-emphasizing exhaled vapor plumes and their aroma. The US market for vaping devices with stealthy characteristics is anything but inconspicuous, with JUUL alone accounting for 70.5% of sales (July 2018).

Source: Ramamurthi et al. (2018). JUUL and other stealth vaporizers: hiding the habit from parents and teachers. Tobacco Control, Sep 15. piitobaccocontrol-2018-054455. doi: 10.1136/tobaccocontrol-2018-054455. [Epub ahead of print]

Did You Know: This Study Explores How To Recruit LGBT Population For Evaluation Of Smoking Intervention “This Free Life”

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Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time. A newly published study described two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies. Researchers recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads or intercept in LGBT social venues for the survey.

Findings included:

  • Lesbian or gay women, bisexual men and women, gender minorities, and other sexual minorities were more likely than gay men to be recruited via social media (than intercept).
  • Hispanic and other or multiracial, non-Hispanic participants were less likely than white, non-Hispanic participants to be recruited via social media.
  • As age increased, odds of recruitment via social media decreased.
  • Participants with some college education were more likely than those with a college degree to be recruited via social media.
  • Participants who reported past-year pride event attendance were more likely to be recruited via social media.
  • Participants who reported using Instagram at least once daily were less likely to be recruited via social media.
  • Social media recruitment was faster and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues-a larger percentage of social media respondents were lost because of duplicate and low-quality responses compared with intercept respondents lost to interviewer misrepresentation.

The researchers concluded that social media combined with intercept provided access to important LGBT subpopulations (e.g., gender and other sexual minorities) and a more diverse sample. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations.

Source: Guillory et al. (2018). Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults. Journal of Medical Internet Research, Jun 18;20(6):e197. doi: 10.2196/jmir.9461.

Did You Know: That Smoking Cessation Interventions That Include Proactive Outreach May Help To Reduce Socioeconomic Disparities In Quitting?

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Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. A newly published study evaluated the role of SES in smokers’ response to a population-based proactive smoking-cessation intervention. Researchers analyzed data from the Veterans Victory Over Tobacco Study, a smoking-cessation intervention. Findings included that proactive outreach is associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting.
Source: Danan et al. (2018). The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial. American Journal of Preventive Medicine, Aug 20. pii: S0749-3797(18)31934-2. doi: 10.1016/j.amepre.2018.05.023. [Epub ahead of print]