Disparities In Smoking Research Articles

Educational disparities in hypertension, diabetes, obesity and smoking in Brazil: a trend analysis of 578 977 adults from a national survey, 2007–2018

ObjectivesOur study aimed to assess social inequality trends for hypertension, diabetes mellitus, smoking and obesity from 2007 to 2018 in adults from Brazilian capitals.SettingData from the Surveillance of Risk and...

How do educational disparities in smoking develop during early life? A Swedish longitudinal study

Smoking contributes to health inequalities, but how social inequalities in smoking develop in early life remains unclear. This study examines how measures of education attained over the early life course (representing socioeconomic position of origin, socioeconomic position of destination, and in-between) contribute to smoking behavior in a Swedish longitudinal sample. We used data obtained from the Swedish Level-of-Living Surveys in addition to national register data. Young adults (aged 20–28, n = 749) self-reported their educational attainment and smoking behavior (initiation and cessation) in 2010. Ten years earlier, their parents self-reported their own education and smoking behavior. We used linked register data on school performance in adolescence (in grade 9). Logistic regression models showed that lower parental education, lower adolescent school performance, and low young adult educational attainment were respectively associated with young adult smoking initiation. The association between parental education and young adult smoking initiation was explained by adolescent school performance and not parental smoking. Young adult smoking cessation was associated with high parental education and high adolescent school performance (marks in the top quartile), but only school performance remained significant in the final model, which included all measures of education and parental smoking. Results suggest that school performance in adolescence (which connects adolescents’ socioeconomic position of origin with their destination) may play an important role in how educational disparities in smoking form over the life course.

Disparities in smoking during pregnancy by sexual orientation and race-ethnicity

The intersection between sexual orientation and race-ethnicity is emerging as an important dynamic for health. Prior research indicates that sexual orientation can have very different health implications for White, Black, and Latina individuals and that these patterns are unpredictable. Here we use U.S. data from the National Survey of Family Growth (2006–2019, n = 15,163 pregnancies) to examine how an important health indicator – smoking during pregnancy – is shaped jointly by sexual orientation and race-ethnicity. Smoking during pregnancy was more common among sexual minority women (both bisexual-identified and heterosexual-identified who expressed same-gender attraction/behavior), compared to heterosexual women. Second, the association between sexual orientation and smoking during pregnancy differed by race-ethnicity: sexual minority status was more strongly associated with smoking among Latina women, compared to White women. Finally, the subgroup with the highest rates of smoking during pregnancy was bisexual White women. These findings indicate that smoking rates among pregnant sexual minority women warrant attention (regardless of race-ethnicity), particularly as births within this group are rising. It is important to address structural factors that may create more stress for sexual minority women, since smoking is often a response to stress. These findings also highlight the role of heterogeneity: low smoking rates among pregnant Latina women mask within-group disparities.

Psychosocial and psychiatric-related stress and cigarette smoking among Black and Latinx adults with psychiatric disorders

While the cigarette smoking prevalence in the United States has decreased, smoking disparities persist for individuals with psychiatric disorders and individuals who identify as racial/ethnic minorities. These groups also experience higher levels of psychosocial stress. This study was the first to examine the relationship between psychosocial and psychiatric-related stressors and cigarette smoking status in a sample of Black and Latinx adults with psychiatric illness. Stress associated with friend strain, lifetime discrimination, and attending appointments for psychotropic medication management were associated with cigarette smoking. The present results have implications for integrating smoking cessation interventions into mental health treatment settings.

Changing patterns and prevalence of daily tobacco smoking among Australian workers: 2007–2016

ObjectiveTo map patterns and prevalence of daily smoking among employed Australians over time. MethodsData from four waves of the triennial National Drug Strategy Household Survey (2007, 2010, 2013 and 2016) were used to assess daily smoking. Frequency analyses and significance testing examined smoking prevalence by sex, age, state, remoteness, Indigeneity, socioeconomic status (SES) and psychological distress. Logistic regression models estimated adjusted effects of demographics on smoking prevalence. ResultsWorkers’ daily smoking prevalence reduced by 32% between 2007 and 2016. The adjusted model showed the lowest smoking reductions among men and non‐metropolitan workers. Other interaction effects showed the highest daily smoking rates for: male workers aged 14–39 years; low SES non‐metropolitan workers; and low SES workers aged 40–59 years. ConclusionsSpecific workplace policies, prevention and intervention strategies are warranted for male workers, especially those aged 14–39; non‐metropolitan workers, especially low SES rural workers; and low SES workers especially 40–59‐year‐olds. Implications for public healthIn spite of significant smoking reductions among workers over time, reductions were unevenly distributed. Tailored, innovative workplace prevention and intervention strategies that apply principles of proportionate universalism and address individual, workplace settings and cultural factors are warranted to reduce smoking disparities among male, rural and low SES workers.

Origins and Destinations, but How Much and When? Educational Disparities in Smoking and Drinking Across Adolescence and Young Adulthood

Origins and Destinations, but How Much and When? Educational Disparities in Smoking and Drinking Across Adolescence and Young Adulthood

State-Level Patterns and Trends in Cigarette Smoking Across Racial and Ethnic Groups in the United States, 2011-2018.

IntroductionReducing racial/ethnic disparities in smoking is a priority for state tobacco control programs. We investigated disparities in cigarette use by race/ethnicity, as well as trends in cigarette use across racial/ethnic groups from 2011 to 2018 in 50 US states and the District of Columbia.MethodsWe used data from the Behavioral Risk Factor Surveillance System. In each state, smoking prevalence and corresponding 95% CIs were estimated for each racial/ethnic group in 2011, 2014, and 2018. We used logistic regression models to examine state-specific linear and quadratic time trends in smoking prevalence from 2011 to 2018.ResultsRacial/ethnic disparities in smoking prevalence varied across states. From 2011 to 2018, compared with White adults, the odds of smoking were lower among Black adults in 14 states (odds ratio [OR] range, 0.58–0.91) and were higher in 9 states (OR range, 1.10–1.98); no differences were found in the odds of smoking in 13 states. Compared with White adults, the odds of smoking were lower among Hispanic adults in most states (OR range, 0.33–0.84) and were typically higher among Other adults (OR range, 1.19–2.44). Significant interactions between year and race/ethnicity were found in 4 states, indicating that time trends varied across racial/ethnic groups. In states with differential time trends, the decline in the odds of smoking was typically greater among Black, Hispanic, and Other adults compared with White adults.ConclusionSome progress in reducing racial/ethnic disparities in smoking has been made, but additional efforts are needed to eliminate racial/ethnic disparities in smoking.

Club Convergence in Cigarette Consumption and Health Policies in Pre-Pandemic Period

Aim: Turkey introduced price and non-price measures in recent years to reduce smoking. The government banned smoking in all enclosed workplaces and public places. Then, they extended the ban to include all restaurants, cafeterias, and the hospitality sector in 2009 and increased the Special Consumption Tax dramatically on tobacco products by 20 percent in 2010. This study aims to examine regional disparities in cigarette consumption across Turkish cities employing provincial-level data by utilizing a club convergence test. Material and Methods: We report some descriptive results for the smoking trend for sub-regions of Turkey. Then, we explore regional disparities in smoking across Turkish provinces, employing monthly provincial-level data, through a club convergence test in pre-pandemic period, 2009-2017. Results: Our results suggest that the initial effects of the anti-tobacco policies resulted in a substantial decline in smoking. It seems that distinct regions behave differently to the policy changes in a way that some areas reduce their cigarette consumption considerably while some regions did not. Club convergence test results demonstrate that it is not proper to conduct a common tobacco control policy in Turkey since there is more than one convergence club in the analyses. Conclusion: We encourage authorities to decentralize power by including local agencies and municipalities in enforcing the anti-tobacco law. We urge authorities to take different policy measures for different regions. Besides, from a pandemic perspective, one can argue that the regional disparities in cigarette consumption is also a signal for the need of diversified health policies across regions in Turkey.

Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics.

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

Anal cancer survival: a socioeconomic analysis.

Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), (p = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12-2.41). In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

Point-of-sale cigarette pricing strategies and young adult smokers’ intention to purchase cigarettes: an online experiment

BackgroundPoint-of-sale tobacco marketing has been shown to be related to tobacco use behaviours; however, specific influences of cigarette price discounts, price tiers and pack/carton availability on cigarette purchasing intention are...

Socio-Economic and Demographic Factors, and Tobacco Use in Togo

Consequences of smoking are disastrous and supported by smokers and non-smokers. Tobacco control policies in Togo seem to have no significant effect. Thus, for more effectiveness in tobacco control policies, it would be appropriate to identify the determinants of the demand for tobacco products or the factors likely to influence it; to better position tobacco control policies in order to better allocate resources. In order to achieve this objective, we analyzed the socioeconomic and demographic determinants of tobacco use in Togo. This study uses the 2014 Togo Demographic and Health Survey (EDST3). A logistic regression is used to estimate the probability of an individual smoking, given a set of socio-economic, geographic and demographic characteristics. We found that tobacco use is influenced by genders, age, region and, educational, religion and work status. Thus, there is a socio-economic, demographic and geographic disparity in smoking and therefore tobacco control policies must be based on this dynamic for greater efficiency

Persistent disparities in smoking among rural Appalachians: evidence from the Mountain Air Project.

BackgroundAdult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior.MethodsA cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015–2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed.ResultsMAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51–2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking.ConclusionsDespite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.

Cities and Smoking

In 1956, 52% of urban men and 42% of rural men smoked cigarettes. By 2010, the disparity had flipped: 24.7% of urban men and 30.6% of rural men smoked. Smoking remains the greatest preventable cause of mortality in the United States, and understanding the underlying causes of place-specific differences in behavior is crucial for policy aimed at reducing regional inequality. Using geocoded data from the National Longitudinal Survey of Youth 1979 Cohort, I estimate a dynamic model that captures smoking behavior, location decisions, and education over thirty years. Simulation of the estimated model demonstrates that selection on permanent unobserved variables that are correlated with smoking cessation, both in native populations and in those who migrate between rural and urban areas, explains 70.9% of the urban/rural smoking disparity. Alternatively, differential tobacco control policies explain only 9.6% of the urban/rural smoking disparity, which suggests that equalizing cigarette taxes across regions may fail to bridge gaps in behavior and health. This paper emphasizes that rural smoking disparities are largely driven by who selects into rural communities.

Association of teleworking and smoking behavior of U.S. wage and salary workers.

IntroductionThe COVID‐19 pandemic has led to a major shift in workspace from office to home. This report examined how telecommuting is related to smoking behavior of wage and salary workers.MethodsSelf‐reported smoking behavior of 1,390 U.S. wage and salary workers aged 16–64 years from the Tobacco Use Supplement of the Current Population Survey 2018/19 were linked to the 2018 American Time Use Survey. Weighted multivariate logistic regression predicting smoking probability and generalized linear regression predicting smoking intensity were used for analysis.ResultsAlmost a fifth (19%) of wage and salary workers reported working from home and over a half (52%) reported working in telecommuting amenable occupations. Nearly 12% were current smokers, smoking 14.7 cigarettes daily on average. Compared to their counterparts, smoking prevalence (percentage points) was lower among those employed in telecommuting amenable occupations (−0.52, p < .001 for all; 0.01, p = .862 for men; −2.40, p < .001 for women) and who worked more frequently from home (−0.21, p < .001 for all; −0.76, p < .001 for men; −0.03, p = .045 for women). Smoking intensity (cigarettes per day) was lower among those employed in telecommuting amenable occupations (−3.39, p = .03 for all; −0.36, p = .90 for men; −4.30, p = .21 for women). We found no statistically significant association between smoking intensity and telecommuting frequency.ConclusionsThe lower likelihood of smoking and lower level of smoking intensity among telecommuting wage and salary workers suggests the need for proactive efforts to address the potential exacerbation in occupation‐related smoking disparities between occupations that are and are not amenable to telecommuting.

Testing the Feasibility and Acceptability of a Religiously-Tailored Text Messaging Intervention to Reduce Smoking Among Somali Muslim Men During Ramadan.

The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke. Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence. The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p < 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey. Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study. Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers. ClinicalTrial.gov: NCT03379142.

Reactions to targeted tobacco control messaging: Transgender and gender diverse young adult perspectives

IntroductionTobacco interventions specifically created for transgender and gender diverse young adults appear almost non-existent. The Food and Drug Administration’s This Free Life is the first large scale campaign specifically designed to address the smoking disparities of sexual and gender minority (SGM) young adults. The purpose of this study was to gauge the reactions and receptivity to This Free Life from a gender diverse young adult sample using interviews conducted in spring and summer 2018. MethodsParticipants were 25 young adults recruited in Austin, Texas (M age = 23.2, 64.0 % non-Hispanic White, 70 % assigned female at birth) for semi-structured one-on-one interviews as part of a larger project focusing on the reasons and settings for tobacco use. Data in the current study pertain to attitudes and reactions to online video content from This Free Life. ResultsPositive reactions to video content related to visible queer representation and depictions of gender non-conformity in videos that were positive and affirming in tone. Negative reactions related to what was perceived as sexist stereotypes perpetuated in videos, and an over-reliance on cisgender gay bar culture. Some participants felt that messaging discouraging social/occasional smoking did not take into account their own important reasons for smoking. ConclusionsTransgender and gender diverse young adults have been overlooked in many efforts to address SGM smoking disparities. Targeted efforts such as This Free Life have the potential to help curb the disproportionate tobacco burden of gender diverse young adults by including diverse gender representation in affirming messages that emphasize freedom and autonomy.

Cigarette taxes, prices, and disparities in current smoking in the United States.

Increasing cigarette taxes has been the cornerstone of tobacco control policy. Recent work has argued that raising cigarette taxes alone may no longer be an effective strategy for lowering smoking rates. We largely confirm these findings but also find that increases in price continue to predict lower smoking participation in most model specifications. We argue that raising cigarette prices via taxation remains an effective public health policy. We discuss the advantages of homogeneous tax environments and minimum price laws for eliminating opportunities for consumers to offset tax increases by searching for lowest taxes.

Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia.

Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P = .001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized.

Healthy People 2020: Social Determinants of Cigarette Smoking and Electronic Cigarette Smoking among Youth in the United States 2010-2018.

The purpose of this study was to determine social determinants of cigarette smoking and ever using electronic cigarettes (e-cigarettes) among young adults aged 18 to 25 years in the United States between 2010 and 2018. Using secondary data from National Health Interview Surveys (NHIS) across the 2010, 2014, and 2018 survey years, this study analyzed the prevalence rates of cigarette smoking and ever using e-cigarettes between 2010 and 2018, demographic and socioeconomic disparities in smoking, and the relationship between previous e-cigarette use and current smoking. First, the past decade witnessed a notable decline in conventional cigarette smoking and a sharp increase in e-cigarette use among youth. These trends were consistent regardless of socioeconomic status. Second, demographic and socioeconomic disparities persisted in cigarette smoking. Non-Hispanic white male youth were more likely to become smokers as they grew older. Young people with lower educational attainment, living below the U.S. federal poverty level, and having a poor physical health status had a higher smoking prevalence. Third, previous e-cigarette use was more likely to relate to subsequent cigarette use among young people. To achieve the Healthy People 2020 objectives, tobacco control programs and interventions need to be more specific in higher prevalence groups and service providers should not assume that there is a one-size-fits-all model for youth.