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”


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]

Did You Know: That Higher SES is Linked To Higher Electronic Nicotine Delivery System Use?

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A newly published study investigated the association between socioeconomic status (SES) (education, income, and employment status) and current and former electronic nicotine delivery system (ENDS) use. Researchers analyzed data from the American Heart Association Tobacco Regulatory and Addiction Center (A-TRAC) online survey.

Findings included:

  • College educated persons (vs. those with less than a high school diploma) had a 37% greater prevalence of current ENDS use and a 16% greater prevalence of former ENDS use.
  • Persons with household incomes above $90K (vs. less than $20,000) had a greater prevalence of current and former ENDS use.
  • Those who were employed (vs. not employed) had a 13% greater prevalence of current ENDS use.
  • Higher SES (vs. lower SES) persons were more likely to use ENDS.
Source: Glover et al. (2018). The social patterning of electronic nicotine delivery system use among US adults. Preventive Medicine, Aug 29;116:27-31. doi: 10.1016/j.ypmed.2018.08.038. [Epub ahead of print]

Did You Know? Rural Women Lag Behind Rural Men, Urban Men And Urban Women In Decreasing Smoking

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Smoking prevalence is declining at a slower rate in rural than urban settings in the U.S. and known predictors of smoking do not readily account for this trend difference. A recently published study examined whether smoking trends are different for rural and urban men and women. Researchers analyzed data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas.


Findings included:

  • Whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat.
  • Controlling for demographic, socioeconomic and psychosocial predictors of smokingdid not explain rural women’s significantly different trend from those of the other three groups.


The researchers concluded that rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smokingamong rural women.

New Publication on Rural Health Equity from the National Academies of Sciences, Engineering, and Medicine
Achieving Rural Health Equity and Well-Being: Proceedings of a Workshop (2018)
Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop.

Did You Know? Waterpipe Tobacco Smoking More Common Among Black And White Latinos Compared To Non-Hispanic Whites


A recently published study examined intra-ethnic racial differences in waterpipe tobacco smoking (WTS) among Latinos using a nationally representative sample. Researchers analyzed pooled data from the National Adult Tobacco Survey, 2012-2014.

 Findings included:

·         Black Latinos and White Latinos exhibited an increased prevalence of lifetime WTS compared to their non-Hispanic white counterparts.

·         Black Latino men exhibited increased prevalence of lifetime WTS compared to their non-Hispanic white men counterparts. 

·         Black Latinas and white Latinas exhibited increased prevalence of WTS compared to their non-Hispanic white women counterparts.

 The researchers concluded that among the U.S. general adult population, intra-ethnic racial differences in WTS behaviors exist among Latinos; and is shaped by gender. Future efforts to eliminate racial disparities in WTS should be attentive to intra-ethnic racial differences among Latinos.

Source: Ortiz et al. (2018). Intra-Ethnic Racial Differences in Waterpipe Tobacco Smoking among Latinos? Substance Use & Misuse, Jul 20, 1-10. [Epub ahead of print]

Did You Know? How to Tailor Technology-Based Cessation Programs for Socioeconomically Disadvantaged African American Smokers

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Communication technology-based interventions are increasingly being employed to help smokers quit. Understanding preferences for such strategies among socioeconomically disadvantaged smokers can inform targeted intervention planning. A newly published study examined socioeconomically disadvantaged smokers’ use of and access to communication technology and elucidated preferences for receiving quitting information and support via email and text message. A self-administered survey and focus groups were conducted with a sample of 15 predominantly African American, socioeconomically disadvantaged smokers aged 21-64 years.

Findings included:

·         Smartphone ownership was high, although use of communication-based cessation resources such as web sites and smartphone apps was low.

·         Four themes emerged relevant to preferences for receiving quitting information and support via email and text message: access, appropriateness, intended use, and satisfaction.

·         Although initially participants were mixed in their preferences for receiving emails vs texts, 80% preferred emails over texts when presented with sample emails and text messages containing cessation information.

The researchers concluded that although email and text message strategies may be acceptable to socioeconomically disadvantaged smokers generally, issues such as access and intended use should be considered to inform specific disparity-reducing intervention approaches.

Source: Alcaraz et al. (2018). To Text or Not to Text? Technology-based Cessation Communication Preferences among Urban, Socioeconomically Disadvantaged Smokers. Ethnicity & Disease, Jul 12, 28(3), 161-168.

Did You Know? Urban Residents Are More Likely To Self-Impose Indoor Household Tobacco Restrictions


A newly published study examined factors related to self-imposed indoor household tobacco restrictions, with emphasis on children in the household and associations with combustible and noncombustible product use. Researchers analyzed data from a cross-sectional survey of urban and rural Ohio adult tobacco users classified participants as exclusive combustible users, smokeless tobacco (SLT) users, e-cigarette users, or dual users.

 Findings included:

  • 1210 tobacco users participated, including 25.7% with children living in the home. Half allowed combustible and two thirds allowed noncombustible tobacco use indoors.
  • Urban location, younger age, male sex, college education, household income of more than $15,000, and being married were associated with a higher likelihood of banning combustible products indoors.
  • SLT and e-cigarette users were more likely to have indoor bans compared to combustible users.
  • Children in the household, older age, and nonwhite race were associated with a higher likelihood of banning noncombustible products indoors.
  • Combustible and e-cigarette users were more likely than SLT users to have indoor bans.


The researchers concluded that indoor restrictions on tobacco use remain infrequent in homes with children and are associated with user type and socioeconomic factors. Recommendations included targeting modifiable risk factors for in-home secondhand smoke exposure through public policy.

Source: Kopp et al. (2018). Impact of Presence of Children on Indoor Tobacco Restrictions in Households of Urban and Rural Adult Tobacco Users. Academic Pediatrics, Apr 10. pii: S1876-2859(18)30165-7. doi: 10.1016/j.acap.2018.04.002. [Epub ahead of print]