Rates Of Tobacco Use Research Articles

Electronic cigarette use and sleep health in young adults.

Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively.

Environmental Exposures and Asthma in Active Duty Service Members.

Reports of respiratory symptoms, including asthma and hyper-reactive airway disease, have been more numerous in the media and medical literature since active duty service members (SM) began to support campaigns in South West Asia (SWA). Numerous environmental exposures have been reported and this review assesses the available evidence surrounding exposures, confounding conditions, and attempts to develop screening mechanisms. While particulate matter exposures and particularly exposure to burn pits have garnered much attention, a 2010 Armed Forces Health Surveillance Center report and 2011 Institute of Medicine publication did not identify a link between exposure to particulate matter with SM respiratory disease. The "Study of Active Duty Military for Pulmonary Disease related to Environmental Deployment Exposure," (STAMPEDE) and STAMPEDE II have not identified effective forms of routine screening and these and other sources point to the importance of other factors in SM respiratory disease. These include higher than anticipated rates of tobacco use in deployed settings, impacts of obesity, recurrence of childhood asthma, and of confounding conditions such as Paradoxical Vocal Fold Motion. As with the general population, a complex set of clinical inputs and environmental exposures surround asthma and similar respiratory processes in SM. Concrete relationships and mechanisms for assessment continue to be assessed and refined, but clear associations and pathways have remained elusive.

Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication.

Purpose: Lesbian, gay, bisexual, and transgender (LGBT) veterans report discrimination in health care, which may be associated with negative health outcomes/behaviors and has implications for LGBT identity disclosure to providers. Quality provider communication may serve to offset some of the deleterious effects of discrimination; however, no research to date has examined provider communication with respect to health among LGBT patients.Methods: Participants were 47 LGBT veterans who completed measures related to past health care experiences, experiences of discrimination in health care, perceptions of provider communication, and measures of anxiety, depression, post-traumatic stress disorder symptoms, and alcohol/tobacco use.Results: The majority of LGBT veterans reported experiencing LGBT-based discrimination in health care, which was associated with higher rates of tobacco use and less comfort in disclosing their LGBT identity to providers. We also found evidence of moderation, such that high-quality provider communication appeared to buffer these associations.Conclusion: LGBT veterans face unique challenges with respect to receiving appropriate health care. The high frequencies of reported discrimination in health care is problematic and warrants further research and intervention. These results highlight the important role of provider communication, and the potential for quality communication to buffer against certain effects, particularly with respect to tobacco use and LGBT identity disclosure, which is an important protective factor.

Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women

Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW’s daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors—including certain locations, situations, and companions—increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.

Smoked Tobacco, Air Pollution, and Tuberculosis in Lao PDR: Findings from a National Sample.

In 2017, more than half of the global burden of incident tuberculosis (TB) came from the Western Pacific region. In Lao People’s Democratic Republic (PDR), the high rates of tobacco use and use of polluting biomass fuels for cooking (e.g., wood, charcoal, crop waste, dung) represent significant risk factors for TB. The purpose of this study was to determine the association between self-reported (1) smoking and TB; and (2) exposure to air pollution (from both cooking fires and environmental tobacco smoke) and TB among adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR—a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Utilizing a nationally representative sample and inferential, multivariable methods, we observed a significant increase in odds of self-reported TB among those who smoked tobacco (OR = 1.73, 95% CI = (1.00 to 2.98)). Larger multivariable models identified independent contributions from exposure to tobacco pipes (OR = 21.51, 95% CI = (6.34 to 72.89)) and communal outdoor fires (OR = 2.27, 95% CI = (1.15 to 4.49)). An index measuring combined exposure to smoked tobacco, environmental tobacco smoke in enclosed workspace, indoor cooking fire, trash fires, and other outdoor communal fires also showed a positive association (OR per added exposure = 1.47, 95% CI = (1.14 to 1.89)). The findings of this study underscore the need for multi-sectoral collaboration between tobacco control, environmental health, TB prevention and treatment programs, national authorities, policy makers, civil groups, and the private sector to address the convergence of potential risk factors impacting respiratory health in Lao PDR.

Reasons for Tobacco Use and Perceived Tobacco-Related Health Risks in an Inpatient Psychiatric Population

People with mental illness (MI) have a disproportionate tobacco-related disease burden and mortality. Tobacco-use rates in people with MI are nearly twice that of the general population. Reasons for tobacco-use in this population may be a result of diminished tobacco-related disease risk perceptions. The purpose of this study was to examine the reasons for tobacco-use and perceived tobacco-related health risks among psychiatric inpatients. A correlational design was employed to survey a convenient sample of 137 patients from a psychiatric facility in central Kentucky. Information obtained from participants included demographics, psychiatric diagnoses, tobacco-use and exposure history, medical illness history, reasons for tobacco-use, and tobacco-related illness risk perceptions. The primary reasons participants endorsed for tobacco-use were for stress reduction, followed by addiction, then boredom, psychiatric symptom control, social, and negative mood. In addition, about 72% of participants used tobacco to cope with MI symptoms and 52% to manage the side effects of their medications. Participants were most likely to endorse that tobacco-use caused lung disease (83.2%), heart disease (79.6%), cancer (77.4%), and premature mortality (79.6%) but were less likely to admit that it may cause addiction to other drugs (39.4%) or MI (23.4%). Given the high endorsement of tobacco-use for stress reduction and psychiatric symptom control, it is important for mental health nurses to properly educate consumers on tobacco addiction and evidence of its effects on mental health. Strategies to incorporate our study findings into routine mental health services may address the tobacco-use disparities experienced by people with MI.

Improving Screening for Tobacco Use in Adolescent Inpatients at a Children's Hospital

Introduction: Tobacco use is the leading preventable cause of death and disease in the United States. The majority of tobacco users begin before 19 years of age and approximately 25% of high school students report using tobacco products with 16% of those using electronic cigarettes. Despite high rates of tobacco use in adolescents and known associations with poor health outcomes, screening and treatment in the inpatient setting often is lacking. The specific aims of this quality improvement project were 1) to increase screening for tobacco use to …

Tobacco Use among Women Firefighters.

Firefighters play a crucial role in protecting the lives and property of the communities they serve. Health and readiness for duty among women firefighters is of great concern because they are a significantly understudied group in this critical occupation. A tobacco-free fire service has been strongly promoted, but there are no published data on the extent and types of tobacco use among women firefighters. Data were collected as part of a national online study of the health of women in the fire service. A total of 1,712 women firefighters completed questions regarding tobacco use. Unadjusted smoking and smokeless tobacco rates were 5.1% and 1.2%, respectively. Age standardized smoking rates were lower than those of male firefighters and U.S. adult women. Smokeless tobacco use prevalence was very low compared with male firefighters, but comparable with U.S. adult women. Tobacco users were more likely to have lower education and income and were younger when compared with those who did not use tobacco. There was a strong association between tobacco use and problem and binge drinking. Current findings suggest that the rates of cigarette and smokeless tobacco use are relatively low among women firefighters. Unhealthy lifestyle behaviors such as problem and binge drinking were strongly associated with tobacco use.

Delivery and implementation of an algorithm for smoking cessation treatment for people living with HIV and AIDS

ABSTRACTCompared to the general population, persons living with HIV (PLWH) have higher rates of tobacco use and an increased risk of morbidity from tobacco-related diseases. We conducted a single-arm pilot study of the real-world feasibility of integrating a smoking cessation decisional algorithm within routine clinic visits to engage non-treatment-seeking smokers in smoking cessation therapies. Smokers had an initial study visit during routine care followed by phone contacts at one and three months. Participants completed a baseline survey, followed by the algorithm which resulted in a recommendation for a smoking cessation medication, which was prescribed during the visit. Follow-up phone surveys assessed changes in smoking behavior and use of cessation medications at 1 and 3 months. Participants’ (N = 60) self-reported smoking decreased from a baseline average of 14.4 cigarettes/day to 7.1 cigarettes/day at 3 months (p = .001). Nicotine dependence (FTND) decreased from 5.6 at baseline to 3.6 at 3 months (p < .001). Twenty-seven (45%) made a 24-h quit attempt and 39 (65%) used cessation medication. Insurance prior-authorization delayed medication receipt for seven participants and insurance denial occurred for one. Motivational status did not significantly influence outcomes. The algorithm was successful in engaging participants to use cessation medications and change smoking behaviors.

Tobacco, alcohol and marijuana use among Indigenous youth attending off-reserve schools in Canada: cross-sectional results from the Canadian Student Tobacco, Alcohol and Drugs Survey.

Ongoing surveillance of youth substance use is essential to quantify harms and to identify populations at higher risk. In the Canadian context, historical and structural injustices make monitoring excess risk among Indigenous youth particularly important. This study updated national prevalence rates of tobacco, alcohol, and marijuana use among Indigenous and non-Indigenous students. Differences in tobacco, alcohol, and marijuana use were examined, using logistic regression, among 1700 Indigenous and 22 800 non-Indigenous youth in Grades 9-12 who participated in the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey. Differences by sex were also examined. Mean age of first alcohol and marijuana use was compared in the two populations using OLS regression. Results were compared to 2008/09 data. While smoking, alcohol, and marijuana rates have decreased compared to 2008/09 in both populations, the gap between the populations has mostly not. In 2014/15, Indigenous youth had higher odds of smoking (odds ratio [OR]: 5.26; 95% confidence interval [CI]: 3.54-7.81) and past-year drinking (OR: 1.43; 95% CI: 1.16- 1.76) than non-Indigenous youth. More Indigenous than non-Indigenous youth attempted quitting smoking. Non-Indigenous males were less likely to have had at least one drink in the past-year compared to non-Indigenous females. Indigenous males and females had higher odds of past-year marijuana use than non-Indigenous males (OR: 1.84; 95% CI: 1.32-2.56) and females (OR: 2.87; 95% CI: 2.15-3.84). Indigenous youth, especially males, drank alcohol and used marijuana at younger ages. Additional policies and programs are required to help Indigenous youth be successful in their attempts to quit smoking, and to address high rates of alcohol and marijuana use.

Adolescent Tobacco and Betel Nut Use in the US-Affiliated Pacific Islands: Evidence From Guam.

To determine the prevalence of, and the risk and protective factors associated with, tobacco product use among adolescents in Guam, a US-Affiliated Pacific Island (USAPI) territory. To examine disparities in risk and protective factors across indigenous and nonindigenous groups. Quantitative; cross-sectional. Middle and high schools in Guam. The Global Youth Tobacco Survey sample included a representative sample of 2449 6th to 12th graders (71% response rate). Sample for the supplemental study included 670 middle school students (76% response rate across randomly selected classrooms). Self-reported measures of lifetime and past 30-day tobacco and betel nut use, social competence, resistance self-efficacy, risk perceptions, friend and family tobacco product use, and ease of access to tobacco products. Multilevel logistic regression and analysis of covariance. The prevalence rates of current cigarette, smokeless tobacco, and e-cigarette use among middle school students were 8%, 8%, and 25%, respectively. Ability to resist social pressure to use tobacco/betel nut use was strongly associated with lower likelihood of tobacco (odds ratio [OR] = 0.76; 95% confidence interval [CI]: 0.68-0.84) and betel nut use (OR = 0.74; 95% CI: 0.67-0.82). Indigenous Pacific Islanders scored significantly lower on protective and higher on risk factors. Tobacco product use rates among Guam middle school students appear to be 4 to 5 times higher than the US national average rates. There is an urgent need for developing tobacco and betel nut use prevention programs for USAPI youth that are tailored to the needs of indigenous Pacific Islanders.

A study of tobacco abuse as a risk factor for adrenal cortical carcinoma.

e16119 Background: Smoking has been suggested as a risk factor for adrenal cortical carcinoma (ACC), but, due to the rarity of this tumor, this hypothesis has only been inferred from single study using a mixed population of adrenal tumors that included pheochromocytoma and neuroblastoma as well as ACC. Methods: De-identified IRB exempted records were analyzed for age, gender, and smoking history in adult patients diagnosed with ACC in both the West Virginia University database containing 2,699,193 patients and, in the larger TriNetX database of 21,426,477 patients from 2008-2018. In addition, the statewide ratio of smoking to ACC prevalence was computed in all 50 states using data from SEER and the CDC. Results: Given the high rate of both tobacco use and ACC in the West Virginia Health System, we hypothesized that smoking contributed to increased prevalence of ACC in our state. We compared the rates of ACC and smoking in all 50 states using data from SEER. Among the 50 states, West Virginia had the highest smoking rate and the second highest rate of ACC. Utah had the lowest rate of smoking and the third lowest rate of ACC. The sample correlation between statewide smoking and ACC is .4177 indicating a significant association between the two (p = .0035). From 2008 to 2018, 20 patients with ICD10 code c74.0 (ACC) were abstracted from our EMR system. Examination of the individual charts determined 15 of the 20 patients had confirmed ACC diagnosis. This cohort was compared with matched age and gender matched controls. In the control group, there 13.3% were smokers while in the ACC group, 60% were smokers. The difference is significant (p = .0005) (OR) = 9.75 (95% CI; (2.54, 37.38). We next reviewed the larger TriNetX database and found that the prevalence of smoking in the ACC group to be 35.2% as compared to 9.0% in the TriNetX group(p-value &lt; .0001). Conclusions: Our retrospective review strongly supports smoking as a major risk factor ACC. To our knowledge, this is the first study to demonstrate a strong association of smoking in a cohort of biopsy proven ACCs.

Symptom Chronicity and Tobacco Use: Differences in Athletic and Nonathletic Candidates for Cartilage Surgery.

To determine whether there are differences in symptomatic knee cartilage defects and rates of tobacco use among age-matched athletes versus nonathletes undergoing initial arthroscopic knee surgery who meet demographic and radiographic criteria for cartilage restoration surgery. Age-matched athletes (n = 186) and nonathletes (n = 159) age 40 or less with a body mass index (BMI) of 35 kg/m2 or less (mean 26.8 SD 4.1) and <50% joint space narrowing on weight-bearing radiographs were included. All patients had a symptomatic Outerbridge grade 2 or higher cartilage defect visualized during knee arthroscopy. Relationship between athletic status and chronicity of knee symptoms prior to surgery and tobacco use status, cartilage defect Outerbridge grade, size, and location at time of surgery were characterized. Nonathletes were more likely to smoke (P < 0.001) and had higher BMI (P = 0.005). Duration of symptoms prior to surgery was shorter among athletes (P < 0.001). Grade 4 defects were equally prevalent (P = 0.96) as were multicompartment grade 3-4 lesions (P = 0.12). Mean grade 3-4 defect size was similar in lateral (P = 0.96) and medial compartments (P = 0.82). There was a trend toward larger anterior compartment defects in nonathletes (P = 0.07). Among age-matched athletes and nonathletes with symptomatic cartilage defects who meet demographic criteria for cartilage restoration, nonathletes were more likely to smoke and have a longer duration of symptoms prior to treatment. Athletes tended to present earlier but with similar size defects compared to nonathletes, supporting accelerated treatment of defects in athletes and caution toward allowing continued athletic participation in patients with known cartilage defects.

Trends of Tobacco Consumption Among Women Admitted to and Visiting the Psychiatric Inpatient Unit of a Tertiary Care Center in Mumbai: A Cross-Sectional Study.

To gain insight into the current prevalence of tobacco consumption in various forms among female psychiatric inpatients and their visiting female relatives in Mumbai, India. In this cross-sectional study, survey questionnaires were administered to 127 female inpatients and 110 of their visiting female relatives from July to October 2016. A total of 100 patients and 108 of their relatives completed responses. Additionally, a modified version of the Fagerström Test for Nicotine Dependence was incorporated into the survey to assess the level of nicotine dependence, with higher scores corresponding to higher levels of dependence. The rates of tobacco use were higher in the patients than in their relatives (χ² = 12.13, P = .0003). Patients had shorter periods of abstinence and lower World Health Organization Quality of Life Assessment parameters. This study sheds light on certain data that may be utilized for future health programs and in the development of treatment plans for women with mental illness.​​.

Culturally-tailored text-messaging intervention for smoking cessation in rural American Indian communities: Rationale, design, and methods.

BackgroundAmerican Indian (AI) and Alaska Native (AN) communities experience disproportionately high rates of tobacco use when compared to the overall U.S. population, especially among rural populations.MethodsWe implemented a single-blind, randomized clinical trial of a text messaging-based smoking cessation intervention through the tobacco quitlines of five states (Alaska, Minnesota, New Mexico, Oklahoma, and Wisconsin) with high percentages of AI residents. We partnered with state quitlines and Optum, a multi-state entity that manages quitlines. Participants who called the quitlines and identified as AI/AN were given the option to enroll in this trial. Upon consent, they were randomly assigned to either the standard quitline program (control) or a program culturally tailored for AI/ANs (intervention), which used a text messaging intervention to encourage smoking cessation. We adapted the text messages based on key informant and focus group input. Baseline data was analyzed for differences across age, sex, and the Fagerström Test for Nicotine Dependence.ResultsWe recruited n = 487 AIs into the trial. Participants had an average age of 41.9 years (SD = 11.7) and 66% were female. The average Fagerström Test for Nicotine Dependence score was 5.38 (SD = 2.37). The intervention and control arms did not significantly differ across any of the baseline characteristics.ConclusionImplementation of this trial illustrated important lessons in adapting, implementing, and evaluating trials in collaboration with AI communities and local and national organizations. This work will inform future efforts to implement culturally-tailored interventions with AI/ANs and advance our knowledge about adapting and implementing smoking cessation interventions.

Tobacco Use among Adult Muslims in the United States

Background: Compared with the general United States (US) population, Muslims in the US exhibit elevated rates of tobacco use. As a result, they might be at a higher risk for preventive disease and premature death as compared with the general US population. Objective: This study investigated the Social Cognitive Theory (SCT) factors that are associated with tobacco use among a sample of adult Muslims in the US. Methods: Data were collected (November 2016–March 2017) using a cross-sectional, on-line survey from a convenience sample of adult (≥ 18 years) US Muslims. Participants with a lung cancer history were excluded. Associations between SCT factors and tobacco use were investigated with bivariate analyses and multinomial logistic regression models. Results: Eligible participants (n = 271) from 30 states completed the survey; 52.8% reported current tobacco use. A higher rate of current tobacco use was reported by men (62.8%) as compared to women (41.3%), x2(1, N = 271) = 12.49, p < .001. In terms of cognitive factors, individuals who (1) expected more personal consequences for tobacco use on health, and (2) had more confidence regarding ability to abstain from tobacco use, were less likely to report current tobacco use. In terms of environmental factors, individuals whose family members did not use tobacco were less likely to report current tobacco use. Conclusion: The study findings suggest that family-oriented interventions emphasizing self-efficacy and personal consequences to prevent tobacco use can potentially be effective in reducing tobacco use rates in the adult US Muslim population.

Cardiovascular disease risk factors are elevated among a cohort of young sexual and gender minorities in Chicago.

To date, little research has examined cardiovascular (CVD) risk among young sexual and gender minorities, a population which behavioral research has suggested may be at unique risk of poor CVD outcomes. We assessed behavioral risk factors and biomarkers of CVD risk among young sexual and gender minorities (YSGM) aged 16-29 in Chicago who are participants in the RADAR cohort (analytic N = 936). Multiplex cytokine and inflammatory biomarker assays were run on plasma from all HIV+ participants and demographically-matched HIV- participants (n = 237). Geographic data were used to assess mean C-reactive protein (CRP) level per community area of residence in Chicago. YSGM in this cohort exhibited lower rates of obesity (19.2% in RADAR vs. 35.7% in earlier studies of heterosexual youth) and comparable rates of past 30-day tobacco use (37.9 vs. 38.1%). Conversely, higher rates were observed among several other risk factors including C-reactive protein (mean = 6.9mg/L vs. 2.1mg/L), marijuana use (72.5 vs. 45.3%), perceived stress (mean = 15.5 vs. 14.2), and HIV (20.0 vs. < 1% nationally). Finally, we observed geographic heterogeneity in mean CRP values by community area across the Chicago region with the highest and lowest values both found in neighborhoods on the North side of the city. In sum, these analyses demonstrate that YSGM may be at increased risk of CVD beginning from an early age. Future research should assess whether sexual minority-related stressors increase long-term CVD risk and should also longitudinally study the role of multiple risk factors on CVD morbidity and mortality among YSGM.

Short- and Long-Term Effects of a Tobacco-Free Executive Order on Employee Tobacco Use.

Smoke-free workplace policies encourage cessation, reduce tobacco consumption, and shift the pro-tobacco norm. However, no research exists evaluating the impact of mandated tobacco-free policies on government property. The purpose of our study was to examine short- and long-term effects of a tobacco-free policy (executive order 2014-747) implemented in November 2014, prohibiting tobacco use on state executive property. Cross-sectional online surveys were administered at two time points to a total of 27,000 employees of the executive branch of the Commonwealth of Kentucky. The short-term evaluation (March 2015) comprised 4,170 employees and the long term (August 2015) included 3,070. Tobacco use, plans to quit using tobacco, personal characteristics, whether the county of their workplace was covered by a smoke-free policy, and social norms for tobacco use were assessed 4- and 9-month post-policy implementation. Current tobacco use and plans to quit were compared between short- and long-term evaluations using multiple logistic regression with relevant covariates included. Controlling for demographics and employment location, employees reported lower rates of tobacco use and higher rates of planning to quit in the long term than in the short term. Tobacco-free policies reduce tobacco use prevalence and promote plans to quit, particularly over time. We found differences in tobacco use prevalence and plans to quit using tobacco products from 4 to 9 months after the policy took effect, as reported by employees following implementation of the tobacco-free policy. These findings support the potential for avoiding long-term health care costs as a result of reduced tobacco use from these policies. Nurses can play an important advocacy and policy evaluation role to promote and assess the impact of tobacco-free policies.

Tobacco Marketing at SNAP- and WIC-Authorized Retail Food Stores in the United States.

Background. Lower-income families in the United States are at increased risk for food insecurity and have higher rates of tobacco use. Many retailers accepting government food assistance benefits also sell tobacco products, whose marketing promotes smoking initiation and undermines quit attempts. We examined the presence of tobacco marketing in authorized retailers in the Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), compared with nonauthorized retailers. Method. A nationally representative sample of tobacco retailers in the contiguous United States (N = 2,054) were audited for tobacco marketing in 2015. Using generalized estimating equations, we examined the association between WIC and SNAP authorization and presence of tobacco marketing, adjusted for store type and neighborhood demographics. Results. Both WIC-authorized (odds ratio [OR] 1.7, 95% confidence interval [CI] [1.1, 2.4]) and SNAP-authorized retailers (OR 2.3, 95% CI [1.7, 3.1]) had greater odds of displaying interior tobacco price promotions, compared with stores that were not WIC/SNAP authorized. SNAP-authorized stores (compared with nonauthorized) had almost 3 times greater odds of displaying interior tobacco advertisements (OR 2.9, 95% CI [1.9, 4.5]), while WIC-authorized retailers had 80% lower odds of displaying exterior tobacco advertisements (OR 0.2, 95% CI [0.1, 0.3]). Conclusion. Millions of lower-income American families may be disproportionately exposed to tobacco marketing at food retailers. Federal, state, and local policies could create healthier retail environments by restricting the marketing and availability of tobacco products and increasing promotions and access to healthy food options.

Substance Use, Depression, and Illness Perception Among Cancer Patients.

Objectives: Research demonstrates a link between alcohol and tobacco use in the development of cancer, but limited research exists regarding substance use after a cancer diagnosis. In this study, we examine the rates of alcohol and tobacco use in advanced cancer patients, investigate the link between depression and tobacco and alcohol use pre- and post-diagnosis, and determine the relationship between illness perception and tobacco and alcohol use post-diagnosis.Methods: We performed a secondary data analysis on 2 prospective studies of patients with advanced gastrointestinal cancers. We administered a battery of questionnaires to assess substance use, depression, and illness perception. Results: Patients who reported tobacco use post-diagnosis had higher levels of depressive symptoms when compared to patients with a history of tobacco use or no alcohol or tobacco use (Kruskal-Wallis = 25.77, p < .0125). Patients who reported being more emotionally affected by their illness reported greater tobacco use (Mann-Whitney U = 17, 284.5, p < .003). Conclusions: Tobacco use post-diagnosis was associated with higher levels of depression.