Did You Know? Strong Local Tobacco Retail Licensing Ordinances Linked to Lower Tobacco Use among Youth


Restricting youth access to tobacco is a central feature of US tobacco regulatory policy, but impact of local tobacco retail licensing (TRL) regulation on cigarette smoking rates remains uncertain. A newly published study examined the effects of TRL on other tobacco product use and use as adolescents reach the age to legally purchase tobacco products. Prevalences of ever and past 30-day cigarette, electronic cigarette (e-cigarette), cigar, and hookah use were assessed in a survey of a cohort of 1553 11th- and 12th-grade adolescents. An American Lung Association (2014) youth access grade was assigned to each of 14 political jurisdictions in which participants lived on the basis of the strength of the local TRL ordinance.


Findings included:

·         At baseline, participants living in 4 jurisdictions with “A” grades (ie, with most restrictive ordinances) had lower odds of ever cigarette use and past 30-day use than participants in 10 D- to F-grade jurisdictions.

·         At follow-up at legal age of purchase, lower odds of cigarette use initiation occurred in jurisdictions with stronger TRL policy.

·         Lower odds of e-cigarette initiation at follow-up and of initiation with past 30-day use were also associated with better regulation.


The researchers concluded that strong local TRL ordinance may lower rates of cigarette and e-cigarette use among youth and young adults.


Source: Astor et al. (2019). Tobacco Retail Licensing and Youth Product Use. Pediatrics, Jan 7. pii: e20173536. doi: 10.1542/peds.2017-3536. [Epub ahead of print]


Did You Know? High Dependence on Tobacco Linked to Clustering of PTSD, Depression, and Pain in Veterans


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Tobacco use is highly prevalent among individuals with posttraumatic stress disorder (PTSD), depressive disorders, and pain. A recently published study examined the clustering of current PTSD, depressive disorders, and clinically significant pain according to current tobacco use and dependence among post-9/11 deployed veterans. The study found that moderate to high dependence on tobacco was associated with substantially increased clustering of PTSD, depression, and clinically significant pain in veterans. The researchers concluded that research examining synergistic interactions among these conditions, biological vulnerabilities shared among them, and the direct impact of tobacco use on the pathophysiology of PTSD, depression, and pain is needed. The results of such work may spur development of more effective integrated treatments to reduce the negative impact of these multi-morbid conditions on veterans’ wellbeing and long-term health.


Source: Fonda et al. (2019). Tobacco dependence is associated with increased risk for multi-morbid clustering of posttraumatic stress disorder, depressive disorder, and pain among post-9/11 deployed veterans. Psychopharmacology, Jan 7. doi: 10.1007/s00213-018-5155-6. [Epub ahead of print]

Did You Know – That Modest Incentives Can Promote Equity in Utilization of Tobacco Cessation Services?

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Certain racial and ethnic minorities have lower utilization of tobacco cessation services, such as Helpline counseling and cessation medications. The goal of the California Medicaid (Medi-Cal) Incentives to Quit Smoking Program was to facilitate successful cessation by promoting modest financial and cessation medication-related incentives to increase engagement with the California Smokers’ Helpline counseling services. A newly published study examined differences in the response to incentives and outreach on engagement with Helpline services among racial/ethnic groups within the Medi-Cal population.
Findings included:
  •  African Americans and English-speaking Hispanics/Latinos had higher engagement with the financial incentive ($20) compared to whites.
  • Spanish-speaking Hispanics/Latinos had lower initial engagement with the financial incentive but higher engagement with Medi-Cal’s all-household mailing.
  • Although African Americans and English-speaking Hispanics/Latinos had similar rates of completing counseling and receiving nicotine replacement therapy as whites, Spanish-speaking Hispanics/Latinos had higher rates compared to whites.
The researchers concluded that the promotion of modest financial and cessation medication incentives through multiple outreach channels increased callers’ engagement with the Helpline and appeared to promote ethnic and linguistic equity with respect to the receipt of counseling and nicotine replacement therapy. Targeted community-based outreach may resonate particularly for African Americans, and language-concordant Medi-Cal insurance plan mailings may have reached newly covered Spanish-speaking Hispanics/Latinos.
Source: Vijayaraghavan et al. (2018). Racial/Ethnic Differences in the Response to Incentives for Quitline Engagement. American Journal of Preventive Medicine, Dec;55(6S2):S186-S195. doi: 10.1016/j.amepre.2018.07.018.

Did You Know – There Are Racial Disparities in Tobacco Use Among Persons in Addiction Treatment?

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Persons in addiction treatment have among the highest smoking prevalence of any population. A recently published study examined racial and ethnic disparities in tobacco use prevalence, behaviors, and services among persons in addiction treatment.
Findings included:
  • There was no difference in cigarette smoking prevalence across racial/ethnic groups.
  • Hispanics and African Americans, compared to Whites, were less likely to be daily smokers, use smokeless tobacco, or use e-cigarettes.
  • African Americans and Hispanics reported more past-year quit attempts and higher use of menthol compared to Whites.
  • Hispanics were more interested in quitting while in treatment than Whites.
  • African Americans reported receiving more tobacco cessation advice and services while in treatment than Whites.
The researchers concluded that the findings indicate the need for continued engagement of African Americans and Hispanics in cessation services while in addiction treatment, and for addressing heavier tobacco use and lack of interest in cessation during treatment among White clients.
Source: Pagano et al. (2018). Differences in tobacco use prevalence, behaviors, and cessation services by race/ethnicity: A survey of persons in addiction treatment. Journal of Substance Abuse Treatment, Nov; 94:9-17. doi: 10.1016/j.jsat.2018.08.003. Epub 2018 Aug 8.

Urban and Rural Differences in Tobacco Retailer Exposure among Adolescents


A newly published study whether self-reported and geographically estimated tobacco retailer exposures differ by participant or neighborhood characteristics among urban and rural adolescents. The data for this study were part of a cohort study of 1220 adolescent males residing in urban and rural (Appalachian) regions in Ohio. The baseline survey asked participants how often they visited stores that typically sell tobacco in the past week (self-reported exposures). The number of tobacco retailers between home and school was determined using ArcGIS software (potential exposures).


Findings included:

·         Adolescents who were non-Hispanic black or other racial/ethnic minority, had used tobacco in the past, and lived in rural areas had higher self-reported exposures.

·         Urban adolescents, non-Hispanic black or other racial/ethnic minority, and those living in neighborhoods with a higher percentage of poverty had more potential exposures to tobacco retailers in their path between home and school.


The researchers concluded that rural adolescents had more self-reported marketing exposures than urban adolescents. However, urban adolescents had more potential tobacco exposures between home and school. Thus, point of sale marketing limitations might be a more effective policy intervention in rural areas whereas limits on tobacco retailers might be more effective for urban areas.


Source: Burgoon et al. (2019). Exposures to the tobacco retail environment among adolescent boys in urban and rural environments. American Journal of Drug and Alcohol Abuse, Jan 2:1-10. doi: 10.1080/00952990.2018.1549562. [Epub ahead of print]

Did You Know? Smoking Prevalence Differs by Marital Status and Race/Ethnicity


It is unclear whether health risk behaviors differ by nuanced marital statuses and race/ethnicity. A recently published study examined the association between detailed marital status and current cigarette smoking among U.S. adults by race/ethnicity. Data were from four Health Information National Trends (HINTS) study cycles collected in 2011-2017 with a nationally representative sample of adults 30 years and older (n = 11,889).


Findings included:

·         Adults who had the highest prevalence of cigarette smoking were non-Hispanic Black cohabiters (36%), separated non-Hispanic White adults (35%), and single/never married Hispanic adults (28%).

·         Widowed adults had lower cigarette smoking prevalence than those who were divorced or separated across races/ethnicities.  


Source: Ramsey et al. (2019). Association between marital status and cigarette smoking: Variation by race and ethnicity. Preventive Medicine, Feb;119:48-51. doi: 10.1016/j.ypmed.2018.12.010. Epub 2018 Dec 18.

Study Examines why Bisexual Young Adults Use Tobacco at Higher Rates


Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. A newly published study examined everyday smoking contexts and practices of bisexual individuals. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer.


Findings included:

·         Survey smoking patterns and situational predictors were similar to other young adults’.

·         However, interviews revealed unique roles of tobacco use in participants’ navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management.


Source: McQuoid et al (2019). Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults. Health & Place, Jan 10. pii: S1353-8292(18)30669-5. doi: 10.1016/j.healthplace.2018.12.010. [Epub ahead of print]

Emotional Abuse, in Combination with Physical and/or Sexual Abuse, Predicts Youth Smoking

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A recently published study examined the role of emotional abuse in predicting youth smoking. Data were drawn from the Longitudinal Studies of Child Abuse and Neglect. The study found that emotional abuse, in combination with physical and/or sexual abuse, predicted youth smoking, whereas the other types of abuse (physical and/or sexual abuse), or emotional abuse alone, did not. The researchers concluded that it is important to document critical influential factors to better inform intervention efforts.


Source: Lewis et al. (2019). The Role of Emotional Abuse in Youth Smoking. American Journal of Preventive Medicine, Jan;56(1):93-99. doi: 10.1016/j.amepre.2018.08.020.

Did You Know? Sexual Minority Individuals More Likely to Have Severe Tobacco Use Disorder

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Sexual minority individuals have heightened risk for substance use; however, previous studies have not assessed severity of alcohol use disorders (AUDs), tobacco use disorders (TUDs), and drug use disorders (DUDs) among lesbian/gay and bisexual individuals and those “not sure” of their sexual identity compared with heterosexual individuals. A newly published study examined how three dimensions of sexual orientation (identity, attraction, and behavior) relate to severity of AUD, TUD, and DUD. This study used cross-sectional national data (N = 36,309) from the National Epidemiologic Survey on Alcohol and Related Conditions-III.


Findings included:

·         Sexual minority respondents had higher odds of severe AUD or TUD than heterosexual respondents.

·         Those “not sure” of their sexual identity had higher odds of severe AUD, TUD, and DUD than heterosexual respondents.


The researchers concluded that bisexual and “not sure” U.S. adults are more likely to have a severe AUD and TUD. They also demonstrate the importance of treatment strategies that address sexual minority-specific risks, particularly for bisexual individuals and those “not sure” of their sexual identity.


Source: Boyd et al. (2019). Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their “Not Sure” Counterparts. LGBT Health, Jan;6(1):15-22. doi: 10.1089/lgbt.2018.0122. Epub 2019 Jan 14.

Did You Know? Availability of Cheaper Cigarettes may Diminish Effects of Tobacco Price and Tax Increases


A newly published study conducted focus groups with low-income smokers in order to understand the tobacco acquisition practices of low-income smokers in New York State in light of high cigarette prices due to high cigarette taxes. The qualitative data analysis revealed that some smokers switched to untaxed cigarettes from Native American reservations, whereas low-income smokers in NYC described convenient sources of bootlegged cigarettes (packs or loosies) in their local neighborhood stores, through acquaintances, or on the street. Familiarity with the retailer was key to accessing bootlegged cigarettes from retailers. The researchers concluded that access to cheaper cigarettes discouraged quit attempts and allowed continued smoking. The availability of lower priced cigarettes may attenuate public health efforts aimed at reducing smoking prevalence through price and tax increases.


Source: Curry et al. (2018). How Low-Income Smokers in New York Access Cheaper Cigarettes. American Journal of Health Promotion, Oct 9:890117118805060. doi: 10.1177/0890117118805060. [Epub ahead of print]