Alternative Tobacco Product Use, Ownership of Tobacco Promotional Items, and Easy Access to Cigarettes Linked to Increased Smoking Susceptibility Among Youth

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A newly published study examined perceptions and behaviors associated with smoking susceptibility among adolescents in the current tobacco landscape. Participants were 8th and 10th grade never-smokers of conventional cigarettes from Monitoring the Future surveys (2014-2016).

 

Findings included:

  • Among never-smokers of conventional cigarettes, 17% were susceptible to smoking, 6% were past 30-day alternative tobacco product users, and 4% owned tobacco promotional items.
  • Alternative tobacco product use, ownership of tobacco promotional items, and easy access to cigarettes were associated with increased likelihood of smoking susceptibility.
  • Perceived great influence by antismoking ads and higher perceived addictiveness of conventional cigarette smoking were associated with lower odds of smoking susceptibility.

 

The researchers concluded that alternative tobacco product use, ownership of tobacco promotional items, easy access to cigarettes, low influence by antismoking ads, and low perceptions of the addictiveness of conventional cigarettes are significant and actionable risk factors for smoking susceptibility among adolescents.

Source: Owotomo & Maslowsky (2018). Adolescent Smoking Susceptibility in the Current Tobacco Context: 2014-2016. American Journal of Health Behavior, May 1;42(3):102-113. doi: 10.5993/AJHB.42.3.10.

Study Findings Support the Healthy Immigrant Hypothesis

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A study published in February 2019 examined prevalence rates of alcohol, nicotine, and other drug use and major psychiatric disorders (major depressive disorder, persistent depression, bipolar disorder, agoraphobia, social and specific phobias, and antisocial, schizotypal, and borderline personality disorders) between US-born and foreign-born Mexican Americans and non-Hispanic whites and between early entry versus later-entry foreign-born Mexican Americans and non-Hispanic whites. Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed.
Findings included:
  • US-born Mexican Americans and US-born non-Hispanic whites were at greater risk of alcohol, nicotine, and any drug use and their associated disorders and other DSM-5 psychiatric disorders relative to their foreign-born counterparts.
  • Foreign-born Mexican Americans < 18 years old at immigration were at greater risk of drug use, drug use disorders, and nicotine use disorder compared with foreign-born Mexican Americans ≥ 18 years old at immigration.
  • Foreign-born non-Hispanic whites < 18 years old at immigration were more likely to use substances and to develop many psychiatric disorders relative to foreign-born non-Hispanic whites ≥ 18 years old at immigration.
The researchers concluded that the findings of this study support the healthy immigrant hypothesis and adverse role of acculturation for US-born and foreign-born Mexican Americans and non-Hispanic whites.
Source: Kerridge et al. (2019). Substance Use and Psychiatric Disorders Among Mexican Americans and Non-Hispanic Whites by Immigration Status. The Primary Care Companion for CNS Disorders, 21(1).

Immigrant, Black, and Hispanic Hospital Patients Less Likely To Be Prescribed Nicotine Replacement Therapy

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A recently published study explored the differences in nicotine replacement therapy (NRT) prescribing behavior by patient immigrant status. Data from patient surveys and electronic medical-record reviews were used to examine associations between immigrant status and prescription of NRT in-hospital and on discharge. The study population included 1,608 participants, of whom 21% were not born in the United States.

 

Findings included:

·         Nonimmigrants were more likely than immigrants to be prescribed NRT in the hospital and similarly on discharge.

·         Both groups were equally likely to accept NRT in-hospital when prescribed.

·         Being an immigrant, Black, and Hispanic were associated with lower likelihood of being prescribed NRT in-hospital.

·         Provision of NRT prescription at discharge showed no significant difference between immigrants and nonimmigrants.

 

Source: Chen et al. (2018). Disparities in hospital smoking cessation treatment by immigrant status. Journal of Ethnicity in Substance Abuse, May 4:1-14.

Did You Know? Study Shows that Tobacco 21 Policies are Effective in Reducing Smoking Among 18-20 Year Olds

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States and municipalities are increasingly restricting tobacco sales to those under age-21, in an effort to reduce youth and young adult smoking. A recently published study examined the effectiveness of such policies. Researchers analyzed 2011 – 2016 data from the Behavioral Risk Factor Surveillance System’s Selected Metropolitan/Micropolitan Area Risk Trends dataset.

 

Findings included:

·         Current smoking rates fell from 16.5 percent in 2011 to 8.9 percent in 2016 among 18-20 year-olds in these data.

·         A tobacco-21 policy covering one’s entire metropolitan and micropolitan statistical areas (MMSA) yields an approximately 3.1 percentage point reduction in 18 to 20 year-olds’ likelihoods of smoking.

·         Accounting for partial policy exposure – tobacco-21 laws implemented in some but not all jurisdictions within an MMSA implies that the average exposed 18 to 20 year-old experienced a 1.2 percentage point drop in their likelihood of being a smoker.

 

The researchers concluded that local tobacco-21 policies yield a substantive reduction in smoking among 18 to 20 year-olds living in metropolitan and micropolitan statistical areas. This finding provides empirical support for efforts to raise the tobacco purchasing age to 21 as a means to reduce young adult smoking. Moreover, it suggests that state laws preempting local tobacco-21 policies may impede public health.

 

Source: Friedman & Wu (2019). Do Local Tobacco-21 Laws Reduce Smoking among 18 to 20 Year-Olds? Nicotine & Tobacco Research, Jul 26. pii: ntz123. doi: 10.1093/ntr/ntz123. [Epub ahead of print]

Using the Internet to Reach Smokers who are Homeless

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The prevalence of cigarette smoking among people experiencing homelessness is 70%. A recently published study examined exposure to tobacco messaging among homeless smokers.  The researchers recruited a sample of adults experiencing homelessness who were current cigarette smokers (i.e. smoked in the past 30 days) from shelters and service sites in San Francisco. The survey explored self-reported use of internet and online streaming services, and exposure to tobacco messaging.

 

Findings included:

  • 75% of respondents reported using the internet and 67% reported using online streaming video in a typical week.
  • Many participants had seen online advertisements for tobacco products (42%) or anti-tobacco industry messages (46%), although participants reported seeing both advertisements and warnings related to tobacco more frequently offline than online.
  • Respondents who reported using the internet for more than 4 h in a typical week were more likely to recall seeing tobacco-related warnings or advertisements online.
  • Respondents who reported seeing tobacco-related warnings and advertisements were more likely to have attempted to quit smoking within the past year.

 

The researchers concluded that these findings suggest an opportunity to use the internet to communicate the harms of tobacco products with messages tailored towards adults experiencing homelessness.

Source: Elser et al. (2019). Exposure to pro- and anti-tobacco messages online and off-line among people experiencing homelessness. Preventive Medicine Report, Jul 3, 15, 100944.

Did You Know? Low Income Linked to E-Cigarette Use

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A recently published study examined associations between sociodemographic factors and e-cigarette use in a nationally representative sample of adults in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) for years 2015-2016 were analyzed to assess e-cigarette use.

 

Findings included:

  • Compared with adults aged ≥55 years, odds of e-cigarette use were 4.77 times higher among ages 18 to 34 years and 2.16 times higher among ages 35 to 54 years.
  • Higher odds of e-cigarette use were observed among widowed/divorced/separated participants compared with those who were married/living with a partner, among participants with less than high school or high school/general educational development (GED) education compared with those with college degrees/some college, and among those with incomes below the poverty level compared with above the poverty level.
  • For non-smokers of conventional cigarettes, higher odds of e-cigarette use were observed among males compared with females, Mexican Americans/Other Hispanics compared with non-Hispanic whites, and non-working participants compared with those who were working.

 

Overall findings indicate that individuals who are widowed/divorced/separated, individuals with lower education, and with incomes below the poverty level are more likely to report ever use of e-cigarettes.

Source: Stallings-Smith & Ballantyne (2019). Ever Use of E-Cigarettes Among Adults in the United States: A Cross-Sectional Study of Sociodemographic Factors. Inquiry, Jan-Dec, 56:46958019864479.

Did You Know? Cigarette Use is Lower Among American Indians and Alaska Natives Living on Tribal Lands

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A recently published study examined whether cigarette use among American Indians and Alaska Natives (AI/AN) is lower in metropolitan areas than in rural areas and tribal lands (which are predominantly rural).

 

Findings included:

·         Metropolitan (large or small) areas versus rural areas: no statistically significant differences in cigarette use were found.

·         Metropolitan (large or small) areas versus tribal lands: days of cigarette use and daily use were significantly lower in tribal lands.

·         Tribal lands were also lower than small metropolitan areas regarding number of cigarettes used and nicotine dependence.

·         Rural areas versus tribal lands: cigarette measures were consistently lower in tribal lands. For example, the prevalence of current smokers, daily users and nicotine dependence, respectively, was 37.9%, 25.9%, and 16.3% in rural areas and 27.4%, 13.6%, and 8.9% in tribal lands.

 

The researchers concluded that differences in cigarette use between AI/AN in nontribal rural and metropolitan areas were not indicated. Instead, the place differences found were lower cigarette use in tribal lands than in nontribal rural areas and, to some extent, metropolitan areas.

 

Source: Cunningham et al. (2019). Cigarette Use Among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands. Journal of Public Health Management and Practice, Sep/Oct; 25 Suppl 5.

Did You Know? Cigarette Use Patterns Over Time Differ for White and Hispanic White Youth

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A newly published study examined whether adolescent cigarette and e-cigarette use patterns over time differ by ethnicity. Data were pooled from three cohort studies of adolescents in California and Connecticut.

 

Findings included:

·         Among non-Hispanic White (NHW) participants, ever e-cigarette or cigarette users at baseline (vs. never users) had significantly higher odds of past 30-day use tobacco use pattern at follow-up.

·         Among Hispanic White (HW) participants, compared with never users, exclusive e-cigarette users at baseline had increased odds of continued e-cigarette use but not of transition to exclusive cigarette use at follow-up and HW exclusive cigarette users at baseline had greater odds of continued cigarette use but not of transition to exclusive e-cigarette use at follow-up.

 

Findings that NHW youth report more transitional use patterns and HW youth report more stable use patterns suggest a potential for differential impacts of e-cigarettes, by ethnicity, in increasing subsequent transition to or cessation from cigarette smoking.

 

Source: Barrington-Trimis et al. (2019). Ethnic Differences in Patterns of Cigarette and E-Cigarette Use Over Time Among Adolescents. The Journal of Adolescent Health, Jun 24. pii: S1054-139X(19)30199-5. doi: 10.1016/j.jadohealth.2019.04.002. [Epub ahead of print]

56% of Adolescent Electronic Nicotine Delivery Systems Users Also Use Other Tobacco Products

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A newly published study examined how adolescents use electronic nicotine delivery systems (ENDS), and compared youth who are only use ENDS and polytobacco users (ENDS and at least one other tobacco product). Researchers surveyed a nationally representative sample of 3,517 13-25-year olds.

Findings included:

·         4.5% of adolescents and 10% of young adults reported past 30-day ENDS use.

·         ENDS users were 38.8% female and 70.6% white.

·         Over half (55.9%) were polytobacco ENDS users.

·         The most common patterns of polytobacco ENDS use were ENDS and cigarettes (11.5%), ENDS and cigars (7.7%), and ENDS, cigars, and waterpipe (5.2%).

·         Those who perceived ENDS to be less harmful than cigarettes were more likely to be exclusive ENDS users than those who perceived ENDS to be as or more harmful than cigarettes.

·         There were no differences between ENDS groups on age, race, sex, parental education, sexual orientation, or ENDS use frequency.

The researchers concluded that the Food and Drug Administration is responsible for communicating product risk to consumers and should consider common patterns of use and relative risk perceptions in its ENDS public education efforts.

Source: King et al. (2018). Polytobacco Use Among a Nationally Representative Sample of Adolescent and Young Adult E-Cigarette Users. The Journal of Adolescent Health, Aug 13. pii: S1054-139X(18)30186-1. doi: 10.1016/j.jadohealth.2018.04.010. [Epub ahead of print]