Did You Know? Cigars, Cigarillos and Little Cigars Used Primarily By Male, Black Youth


A recently published study examined the association between risk perceptions of youths’ personal and parental attitudes toward smoking cigarettes, cigars, and marijuana with current use of cigars, cigarillos or little cigars (CCLCs) or modified CCLCs (i.e., freaking or blunting). Researchers analyzed data from the 2013 Cuyahoga County Youth Risk Behavior Survey.

Findings included:

  • 23.5% of youth reported current use of CCLCs in some way; 11.0% reported current freaking and 18.5% reported current blunt use.
  • CCLC users tended to be male and Black.
  • Perceiving all smoking behaviors as risky, wrong, or wrong by parents reduced odds of youth using CCLCs.
  • Blacks had increased odds of using CCLCs if they perceived smoking cigarettes as harmful, which was not found among other race/ethnicity categories.
  • Having parents who believed that smoking CCLCs is wrong increased the odds of youth freaking or blunting among all CCLC users.
  • Odds of blunting were greater for those who believed CCLCs were more risky among all CCLC users.

The findings suggest that CCLC users may think cigars are safer than cigarettes, and that modifiers may think their use is safer and more in line with their parents’ views than non-modified CCLCs.

Source: Trapl et al. (2018). Attitudes and Risk Perceptions Toward Smoking Among Adolescents Who Modify Cigar Products. Ethnicity & Disease, Jul 12, 28(3), 135-144.

Did You Know? Tobacco Use More Prevalent Among Bisexual Adults And Sexual Identity-Attraction Discordant Women

A newly published study examined tobacco use among U.S. adults and variations by age, race/ethnicity, and sexual identity-attraction concordance/discordance. Data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions were analyzed.
Findings included:
  • Tobacco use was more prevalent among sexual minority-identified adults compared with heterosexual-identified adults.
  • Tobacco use among sexual minorities was most prevalent among younger lesbian women and gay men, and all age groups of bisexual men and women.
  • Tobacco use was significantly greater among sexual identity-attraction discordant women and significantly lower among sexual identity-attraction discordant men.
The researchers concluded that self-identified bisexual adults and sexual identity-attraction discordant women appear to be at higher risk for adverse smoking-related health consequences as a result of their elevated rates of cigarette smoking.
Source: McCabe et al. (2018). Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity-Attraction Differences. American Journal of Preventive Medicine, Apr 9. pii: S0749-3797(18)31636-2. doi: 10.1016/j.amepre.2018.03.009. [Epub ahead of print]

Did You Know? Study Highlights Smoking Patterns Among Adults Receiving Housing Assistance


A recently published study examined patterns of cigarette smoking (current, former, never) by sociodemographic, household, and chronic disease characteristics and correlates among US adults receiving housing assistance from the US Department of Housing and Urban Development (HUD) during 2007-2012. 

Findings included:

  • Overall, 48% of HUD-assisted adults were never smokers, 33% were current smokers, and 19% were former smokers.
  • The percentage of never smokers was significantly higher among adults aged 18 to 44 (54%) or 65 years or older (50%) than among adults aged 45 to 64 (38%).
  • The percentage of never smokers was significantly higher among women (51%) than men (41%).
  • The percentage of never smokers was significantly higher among Hispanic adults (59%) and non-Hispanic black adults (55%) than non-Hispanic white adults (37%)


Source: Wang et al. (2018). Characteristics and Correlates of Cigarette Smoking Status Among US Adults Receiving Federal Housing Assistance. Preventing Chronic Disease, Mar 22;15:E48. doi: 10.5888/pcd15.170395.


Did You Know? African American And Low SES Children With Asthma Have More Exposure To Passive Tobacco Smoke


A newly published study examined the risk of asthma in children exposed to passive tobacco smoke. Researchers analyzed National Health and Nutrition Examination Survey (NHANES) data collected from 2003 to 2014 (n = 8064).

Findings included:

  • The proportion of children living with household smokers decreased from 24.9% in the 2003-2004 cycle to 11.4% in the 2013-2014 cycle.
  • Highly exposed asthmatic children were primarily Non-Hispanic Black and whose family incomes were below poverty guidelines.
  • Overall results reveal passive smoke exposure level among children ages 3-11 in the US decreased over the study period.
  • Nevertheless, higher exposure to passive smoke is still associated with higher odds of childhood asthma.

 The researchers concluded that targeted smoking cessation interventions in clinical practices are needed to reduce tobacco smoke exposure and related asthma risk in children, particularly in low-income and minority groups.


Source: Zhang et al. (2018). Decreasing trend in passive tobacco smoke exposure and association with asthma in U.S. children. Environmental Research, May 31;166:35-41. doi: 10.1016/j.envres.2018.05.022. [Epub ahead of print]

We’re Thinking of Those Who Are Battling Wildfires


Due to the current high volume of fires in California, we know this is a difficult time. We want you to know that we are thinking about you and it is our hope that you are safe and well.

According to CA.GOV CAL FIRE, current fires are in the following counties:








San Bernardino




The residents of these counties are in our thoughts,

The LOOP Team

Did You Know? Receptivity to Tobacco Advertising Is Associated With Progression Toward Use In Adolescents


A newly published study investigated whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking. For that purpose, researchers analyzed data from the Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) which was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10,989).

Findings included:

  • Receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years but highest for those aged 18 to 21 years.
  • E-Cigarette advertising had the highest receptivity among all age groups.
  • For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products.
  • Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2.

 The researchers concluded that receptivity to tobacco advertising was significantly associated with progression toward use in adolescents. Receptivity was highest for e-cigarette advertising and was associated with trying a cigarette.


Source: Pierce et al. (2018). Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study. JAMA Pediatrics, Mar 26. doi: 10.1001/jamapediatrics.2017.5756. [Epub ahead of print]



Did You Know? A Quarter Of Youth Who Have Never Used Tobacco Products Are Open To Using E-Cigarettes

A newly published study examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey were analyzed.

Findings included:

  • Among respondents who never used tobacco products, 24% were open to using e-cigarettes and 25% were curious.
  • Respondents that perceived e-cigarettes to cause a lot of harm had lower odds of both openness and curiosity about e-cigarettes compared to those with lower harm perception.
  • Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use and highly curious compared to those not highly exposed.


The researchers concluded that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.

Source: Margolis et al. (2018). E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine, Apr 17, 112:119-125. doi: 10.1016/j.ypmed.2018.04.017. [Epub ahead of print]

Smoking Becomes More Prevalent Among Black Immigrants With Each Generation

black smoking

Using data from the 1995-2011 waves of the Tobacco Use Supplements of the Current Population Survey, researchers examined variation in current smoking status among first-, second-, and third/higher- generation black immigrants.

Findings included:

  • Relative to third/higher generation blacks, first-generation black immigrants are less likely to report being current smokers.
  • Within the first-generation, immigrants who migrated after age 13 have a lower probability of smoking relative to those who migrated at or under age 13.
  • Disparities in smoking prevalence among the first-generation by age at migration are largest among black immigrants from Latin America.
  • Second-generation immigrants with two foreign-born parents are generally less likely to smoke than the third/higher generation.
  • Among individuals with West Indian, Haitian, Latin American, and African ancestry, the probability of being a current smoker increases with each successive generation.
  • The intergenerational increase in smoking, however, is slower among individuals with African ancestry.
  • Intergenerational gaps in smoking behavior are larger among women compared to men.

Source: Hamilton & Green (2017). Intergenerational differences in smoking among West Indian, Haitian, Latin American, and African blacks in the United States. SSM Population Health, Feb 7;3:305-317. doi: 10.1016/j.ssmph.2017.01.007. eCollection 2017 Dec.

Did You Know? Youth Exposure to E-Cigarette Advertising is Highest in Retail Stores

smoking kids

A newly published Morbidity and Mortality Report (CDC, March 2018) focused on the exposure to electronic cigarette advertising among middle and high school students. To assess patterns of self-reported exposure to four e-cigarette advertising sources (retail stores, the Internet, television, and newspapers and magazines), CDC researchers analyzed data from the 2014, 2015, and 2016 National Youth Tobacco Surveys (NYTSs).

Findings included:

  • Overall, exposure to e-cigarette advertising from at least one source increased each year during 2014-2016 (2014: 68.9%; 2015: 73.0%; 2016: 78.2%).
  • In 2016, exposure was highest for retail stores (68.0%), followed by the Internet (40.6%), television (37.7%), and newspapers and magazines (23.9%).
  • During 2014-2016, youth exposure to e-cigarette advertising increased for retail stores (54.8% to 68.0%), decreased for newspapers and magazines (30.4% to 23.9%), and did not significantly change for the Internet or television.


Recommendations include reducing youth exposure to e-cigarette advertising from a range of sources, including retail stores, television, the Internet, and print media such as newspapers and magazines.

Source: Marynak et al. (2018). Exposure to Electronic Cigarette Advertising Among Middle and High School Students – United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018 Mar16, 67(10), 294-299.

Did You Know? Smoking Cessation Could Improve HIV Outcomes For Sexual Minority Men With HIV

Cigarette smoking is particularly harmful for sexual minority men living with HIV. A newly published study examined the benefits of quitting by examining relationships between smoking and sustained HIV RNA suppression, recent CD4 count, ART medication adherence, and engagement in HIV medical care. Sexual minority men (n = 346), former or current smokers, received HIV care at a community health center. Most patients were Caucasian (87%), 148 (46%) had incomes below the poverty level and 80% had sustained HIV RNA suppression. Compared to current smokers, former smokers had increased odds of sustaining HIV RNA suppression, of reporting > 90% treatment adherence, and were less likely to miss appointments. Heavier smokers and patients who smoked the longest had reduced odds of sustaining HIV RNA suppression. The researchers concluded that smoking assessment, treatment, and referral could augment HIV outcomes for sexual minority men with HIV.
Source: King et al. (2018). Treatment Outcomes Associated with Quitting Cigarettes Among Sexual Minority Men Living with HIV: Antiretroviral Adherence, Engagement in Care, and Sustained HIV RNA Suppression. AIDS and Behavior, Apr 21. doi: 10.1007/s10461-018-2116-3. [Epub ahead of print]



That Tobacco Cessation Programs May Want To Target Low SES Sexual Minorities Within A Context Of Co-Occurring Substance And Alcohol Use?

Cigarette smoking is substantially more prevalent and rates of smoking cessation are lower in low-SES adults. Financial strain may be one explanation for this. A newly published study assessed the link between financial strain, quit attempts, and successful smoking cessation among adult smokers in the U.S. Data from the Population Assessment of Tobacco and Health Study (2013-2015) were analyzed.

Findings included:

  • Smokers with financial strain made more quit attempts than smokers without financial strain, but financial strain was not associated with abstinence at follow-up.
  • Low income was associated with less abstinence at follow-up.
  • Smokers with baseline financial strain who quit at follow-up had lower odds of financial strain at follow-up.

The researchers concluded that financially strained smokers made slightly more quit attempts than non-strained smokers but were no more likely to successfully quit.

Source: Kalkhoran et al. (2018). Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers. American Journal of Preventive Medicine, Apr 5. pii: S0749-3797(18)30068-0. doi: 10.1016/j.amepre.2018.01.036. [Epub ahead of print]

Read the abstract at: https://www.ncbi.nlm.nih.gov/pubmed/29628382

Did You Know? Hookah Smoking is Common Among College Students

hookah 2
A recently published study reported on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. 
Findings included: 
  • Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. 
  • Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. 
  • Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. 
  • Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. 
  • Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product.
The researchers’ recommendations include broadening prevention efforts beyond a focus on combustible cigarettes.
Source: Kulak et al. (2018). Examining Hookah as an Introduction to Nicotine Products among College Students. Substance Use & Misuse, Mar 13:1-9. doi: 10.1080/10826084.2018.1441308. [Epub ahead of print]

Lack of Public Health Messages About Hookah Use Maybe Interpreted As Sign That Hookah Use is Safe

The rate of Hookah use among college students during the last decade is about 30%. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. A recently published review of the scientific literature assessed hookah use while focusing on the consequences for regulatory policy.
Findings included:
  • Hookah use may initiate smoking among tobacconaïve college students.
  • College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior.
  • Few public health messages target college-age adults with anti-hookah messages.
  • A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of “safety” which inadvertently may imply a suggestion of no need for safety measures.
Source: Fevrier et al. (2018). Policy Implications and Research Recommendations: A Review of Hookah Use Among US College Students. Journal of Community Health, Mar 30. doi: 10.1007/s10900-018-0502-4. [Epub ahead of print]

Study Finds Weaker Protective Effect of Higher Education On Smoking For Blacks Than Whites


A newly published study examined whether higher socioeconomic status (SES) has the same protective effects on smoking for Blacks and Whites. This cross-sectional study used the Health Information National Trends Survey (HINTS), a national survey of American adults.

Findings included:

  • Higher educational attainment was associated with lower odds of ever and current smoking.
  • There was a stronger protective effect of higher education against current smoking for Whites than Blacks.
  • Race did not interact with the effect of educational attainment on odds of ever smoking .

In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks.

Source: Assari & Mistry (2018). Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return. International Journal of Environmental Research and Public Health, Apr 16;15(4). pii: E763. doi: 10.3390/ijerph15040763.