Tobacco-related Health Disparities Research Articles

Negative emotional reactivity to racial/ethnic stress among Black adults who smoke

Black/African American (hereafter, Black) adults who smoke are at risk for tobacco-related health disparities in the United States (US). Although racial-based stressors (e.g., discrimination) are associated with smoking among this group, past work has not characterized individual differences in negative emotional reactivity to racial/ethnic stress in terms of smoking. The present investigation sought to address this limitation and evaluate the incremental validity of negative emotional reactivity to racial/ethnic stress on smoking processes after accounting for clinically important covariates. Participants included 517 Black individuals from the US who endorsed daily cigarette smoking (≥5 cigarettes per day, Mage = 45.1 years of age, 51.5% female). Results indicated that negative emotional reactivity to racial/ethnic minority stress was associated with an increased risk of severity of problems when quitting (ΔR 2 = .01), perceived barriers for smoking cessation (ΔR 2 = .03), and addictive (ΔR 2 = .03) as well as negative mood reduction smoking motives (ΔR 2 = .04); with effects evident after adjusting for frequency of racial/ethnic discrimination and other factors (e.g., drug use problems). Overall, the present findings provide novel empirical evidence that negative emotional reactivity to racial/ethnic minority stress among Black adults in the US is associated with several smoking processes implicated in the maintenance and relapse of smoking.

Engaging Specific Populations with Tobacco-Related Health Disparities in Treatment Research: A summary of a SRNT Treatment Research Network Preconference Workshop.

Engaging Specific Populations with Tobacco-Related Health Disparities in Treatment Research: A summary of a SRNT Treatment Research Network Preconference Workshop.

Evaluating chronic disease approaches to ameliorate tobacco-related health disparities: Study protocol of a hybrid type 1 implementation-effectiveness trial

BackgroundBlack, Indigenous, and People of Color (BIPOC) communities experience higher prevalence of cardiovascular disease and related chronic conditions compared to White communities due to disparities in tobacco exposure. Smoking can be effectively treated but evidence-based treatments are less likely to be offered to or used by BIPOC patients. We present the study protocol of the Smoking Cessation Outreach for Racial Equity (SCORE) trial that tests the effect of adding longitudinal care coordination to current standard of care for smoking cessation to promote health equity among BIPOC patients. MethodsLongitudinal Proactive Outreach (LPO; 4 culturally tailored outreach call cycles over one year by motivational interviewing trained counselors to connect patients to cessation counseling and medication) will be added to the current standard of care, Ask-Advise-Connect (AAC; primary care providers asking all patients if they smoke, and if smoking, advising to quit and connecting to treatment). We will conduct a hybrid type 1 implementation-effectiveness trial to examine the direct effect of AAC + LPO (a multilevel health system intervention) vs. AAC on population-level combustible tobacco abstinence at 18 months and treatment utilization among 2000 BIPOC adults who smoke across two healthcare systems in Minnesota. Participants will be surveyed at 6, 12, and, 18 months post-enrollment to assess outcomes. The primary outcome is biochemically confirmed combustible cigarette abstinence at 18 months. DiscussionLPO has potential to promote health equity by addressing barriers caused by structural racism, including access to care, care fragmentation, and provider racism, by systematically reaching out to all BIPOC patients who smoke. ClinicaltrialsgovNCT05671380.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

A qualitative investigation of nicotine and tobacco use in young pregnant and birthing sexual minority people.

Sexual minority youth, especially those who identify as bisexual, have higher rates of nicotine and tobacco use and are more likely to become pregnant at a younger age than heterosexual youth. The goal of this study was to investigate the nicotine and tobacco experiences and motivations of sexual minority people before and during pregnancy. Pregnant and birthing individuals ages 16-24 who identified as a sexual minority in an online survey were recruited for semi-structured video interviews about nicotine and tobacco use. Thirteen participants described nicotine and tobacco initiation, current or recent use, and cessation efforts. Using thematic analysis, the research team coded de-identified interview transcripts and identified themes related to their nicotine and tobacco use. Participants were cisgender women (average age = 19.6). Most identified as bisexual (86%) in addition to Black (36%) or Biracial (36%). Four themes about nicotine and tobacco use were identified from participant interviews. Participants' reasons for nicotine and tobacco initiation were social, yet reasons for more regular use were stress related. Participants' use of cigarettes was triggered by their cannabis use, and several substituted cannabis for cigarettes during cessation attempts. Participants identified pregnancy as a strong motivator to quit smoking, and attempted cessation without clinical assistance. Young sexual minority people's greater risk of initiation and dependence on nicotine and tobacco products prior to conception may be related to social needs, stress, and use of cannabis. Current approaches and materials on smoking cessation are not being utilized by this population. This is the first qualitative study of nicotine and tobacco use among young pregnant sexual minority people, primarily bisexual-identified, who are underrepresented in prenatal tobacco research. By telling their own stories, sexual minority participants with lived experience of nicotine and tobacco use described the evolution of their motivations to use these products over time, cannabis use as a precipitant, the importance of pregnancy for smoking cessation, and perceptions about effective and ineffective factors in cessation efforts. The results of this study provide key information for prevention efforts to reduce tobacco-related health disparities for sexual minority people.

Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with HIV.

The leading cause of death in people living with HIV (PLWH) is cardiovascular disease, and the high prevalence of tobacco cigarette (TC) smoking is a major contributor. Switching to electronic cigarettes (ECs) has been promoted as a harm reduction strategy. We sought to determine if acute EC compared to TC smoking had less harmful effects on arrhythmogenic risk factors including acute changes in hemodynamics, heart rate variability (HRV), and ventricular repolarization (VR). In PLWH who smoke, changes in hemodynamics, HRV, and VR were compared pre/post acutely using an EC, TC, or puffing on an empty straw on different days in random order, in a crossover study. Thirty-seven PLWH (36 males, mean age 40.5 ± 9.1 years) participated. Plasma nicotine was greater after TC versus EC use (10.12 ± 0.96 vs. 6.18 ± 0.99 ng/mL, respectively, p = 0.004). HR increased significantly, and similarly, after acute EC and TC smoking compared to control. Changes in HRV that confer increased cardiac risk (LF/HF ratio) were significantly smaller after acute EC versus TC use, consistent with a harm reduction effect. In a post-hoc analysis of PLWH with and without positive concurrent recreational drug use as indicated by point of care urine toxicology testing, this differential effect was only seen in PLWH not currently using recreational drugs. Changes in VR were not different among the three exposures. In PLWH who smoke, EC compared to TC smoking resulted in smaller adverse changes in HRV. This differential effect was accompanied by a smaller increase in plasma nicotine, and was negated by concurrent recreational drug use. Additional studies are warranted in this vulnerable population disproportionately affected by tobacco-related health disparities.

An Almost Empty Scoping Review: State of the Research on Tobacco Prevention and Cessation Messaging Strategies for Black and/or Latine LGBTQ+ Youth and Young Adults

ABSTRACT Research has yet to offer strong recommendations for effective tobacco prevention and cessation messaging that can reduce tobacco-related health disparities among Black and/or Latine LGBTQ+ youth and young adults. As a result of predatory marketing strategies and community stressors, among other factors, LGBTQ+ youth and young adults use tobacco products at higher rates than their non-LGBTQ+ peers. These disparities are uniquely complex among Black and/or Latine youth and young adults within the LGBTQ+ community, but there has been little research addressing the communication strategies that can promote tobacco prevention and cessation for these groups. Given the promise and history of successful health communication campaigns for tobacco control, this research is crucial. We thus conducted a scoping review to identify trends and gaps in the empirical research published from 2002–2022 that analyzed tobacco prevention and cessation communication strategies for Black and/or Latine LGBTQ+ youth and young adults (ages 12–30) living in the United States. Despite an initial search query of 3,182 articles after deleting duplicates, only five articles were eligible for inclusion, three of which evaluated the This Free Life campaign. Accordingly, we view our scoping review as an almost empty review. Although our results offer preliminary insight into messaging strategies used in these campaigns, our larger contribution is to expose the scarcity of tobacco-related communication research being conducted among Black and/or Latine LGBTQ+ communities. Given the marginalization these communities face, we issue a call to action for researchers and campaign designers and offer a series of suggestions for future research.

Key Informants' Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control.

The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment. This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups. Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color. Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions. This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts.

Menthol versus tobacco e-liquid flavor: Impact on acute subjective effects, puff patterns, and intentions for use among Black and White menthol smokers

BackgroundThe proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco-related health disparities. Whether a menthol e-liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e-liquid use on acute e-cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers. MethodsBlack (n = 47) and White (n = 4) nicotine-deprived menthol smokers with limited e-cigarette experience completed two counterbalanced in-laboratory 30-minute ad libitum vaping sessions with menthol and tobacco nicotine salt-based e-liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post-session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session. ResultsMeasures of puff topography did not differ significantly by e-liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e-cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco-flavored e-liquid. Finally, participants showed comparable reductions in craving (p = .210) and withdrawal (p = .671) from pre- and post-session regardless of e-liquid flavor. ConclusionsAmong menthol smokers in a lab-based setting, findings suggest that menthol vs tobacco e-liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal.

Switching Away From Smoking and Reduction in Cigarette Consumption Among U.S. Adult Purchasers of the JUUL System Across 24 Months Including Diverse Subpopulations Disproportionately Affected by Cigarette Smoking.

Electronic nicotine-delivery systems (ENDS) can reduce tobacco-related health risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking. AWS (age ≥ 21 years) were recruited following their first purchase of a JUUL Starter Kit in 2018. Participants who self-reported switching (no past-30-day cigarette smoking) at 1-, 2-, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24-month follow-ups. Percent switched and percent with substantial smoking reduction (≥50% decrease in cigarettes per day among those who continued smoking) were calculated. Analyses focused on racial and ethnic minorities, persons with low income and education levels, sexual minorities, and those with mental and physical health conditions. Overall rates of switching away from cigarettes increased across follow-ups to 51.2% (month-12) to 58.6% (month-24, 87% of whom used ENDS). Among those who continued to smoke at 24 months, 45.4% reduced cigarettes per day by ≥ 50%. Rates of switching and substantial smoking reduction were largely similar across subgroups, with some statistically significant, but small, differences in month-24 switching rates (eg, education, mental and physical health conditions; switch rate range: 42%-57%). AWS demonstrated progressively increasing switching rates over 2 years after purchasing JUUL products. Similar trends in switching and smoking reduction were observed across populations disproportionately affected by smoking. By facilitating switching and smoking reduction, ENDS products such as JUUL may provide an opportunity to reduce smoking-related harm among some populations disproportionately affected by smoking, potentially reducing tobacco-related health disparities. ENDS have the potential to benefit population health if they can replace cigarettes. This benefit must extend to populations disproportionately affected by smoking. In this real-world study, 59% of JUUL purchasers reported complete switching 2 years later (no past-30-day smoking, with most continuing to use ENDS). Furthermore, 45% of those who continued to smoke reduced cigarette consumption by at least half. These rates of switching and smoking reduction were largely comparable across populations disproportionately affected by smoking (defined, eg, by ethnicity and income). ENDS can serve as an effective harm reduction strategy to complement current efforts to reduce tobacco-related disparities.

Preventing smoking initiation in adolescents living in vulnerable socioeconomic conditions: Study protocol of the KickAsh!-intervention.

Adolescents living in vulnerable socioeconomic conditions are confronted with tobacco-related health disparities. As school-based interventions appear to be less effective among these youngsters, other approaches are necessary. One promising avenue is youth social work settings that offer sport and recreational activities (SR-settings). SR-settings have been examined as a levering context for health promotion, but evidence regarding smoking prevention is currently lacking. This study describes the protocol of a non-randomised cluster controlled trial evaluating a smoking prevention intervention for adolescents. At least 24 SR-settings are needed for the intervention and control group. A mixed-method design will be used. Quantitative measures will be used to assess effectiveness, involving validated questionnaires on smoking initiation behaviour and influencing factors (i.e. attitude, self-efficacy, social influence and risk perception). In addition, feasibility will be assessed with regard to intervention fidelity, dose and reach. Data will be collected at baseline, three and nine months following the intervention. To gain deeper understanding on the impact and underlying processes of the intervention, we will conduct qualitative interviews with users (adolescents) and implementers (youth workers within the SR-settings) of the intervention. Conducting this trial will offer novel insights into the effectiveness of a smoking prevention intervention designed for adolescents living in vulnerable socioeconomic conditions. A mixed-method design will enable to measure impact, implementation and underlying processes of the intervention. Overall, this design will enhance our understanding on the suitability of SR-settings as contexts for smoking prevention initiatives targeting hard-to-reach youth. This trial is registered on Clinicaltrials.gov: NCT05920772.

Cigar Cessation Prevalence and Trends by Demographic Characteristics Among US Adults, TUS-CPS, 2010-2019.

Disproportionate rates of cigar smoking across demographic groups can contribute to tobacco-related health disparities in the United States. We assessed overall and demographic-specific cigar cessation rates from 2010 to 2019. To characterize cessation prevalence among selected demographic groups over time, we analyzed data from the 2010-2011, 2014-2015, and 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Individuals who reported either (1) current cigar smoking for at least 2 years or (2) quitting cigar smoking within the past 12 months were included in the study (n = 5262 in 2010-2011; n = 4741 in 2014-2015; n = 3741 in 2018-2019). Among this group, individuals who reported not smoking a cigar within the past 6 months were considered cigar quitters. Chi-square tests were used to test differences in cessation prevalence between the two survey waves within demographic groups as well as between different groups within survey waves. The prevalence of cigar cessation decreased from 2010-2011 to 2018-2019 for non-Hispanic (NH) White individuals, Hispanic individuals, and both males and females. (p < .05 for all groups). NH White individuals had significantly higher cessation prevalence than individuals who identified as NH Black (33.8% vs. 25.0%, respectively, in 2010-2011; 33.4% vs. 20.4% in 2014-2015; 31.1% vs. 22.3% in 2018-2019; p < .05 for all differences). Overall cigar cessation prevalence significantly decreased from 2010-2011 to 2018-2019. Findings from the study could provide an opportunity to implement strategies that promote cessation strategies targeting certain subpopulations. Cigar cessation patterns are starkly different across different demographic groups, which leads to a disproportionate burden of health-related effects of continued use of these products. These results can inform policy actions around cigar cessation efforts. Future research to close this disparity should be focused on populations that have lower cessation prevalence.

The Scientific Basis for the Regulation of Flavors in Tobacco Products.

Effective tobacco policies are important for reducing the harm of tobacco use and can have a broad impact at the population level. This review provides an overview of how clinical science can inform tobacco policies with a focus on policies related to flavored tobacco products, using menthol cigarettes as an illustrative example. Specifically, this review summarizes the role of flavors in tobacco use and the history of regulation of flavored tobacco products by the US Food and Drug Administration (FDA), provides an overview of clinical research methods used to contribute to the scientific evidence to inform FDA tobacco policies, discusses key findings related to menthol tobacco products using these methods, and proposes future directions for clinical research. As the tobacco marketplace continues to evolve with new products and flavor chemicals, ongoing clinical science will be essential for establishing evidence-based policies to protect public health and reduce tobacco-related health disparities.

Smoking Quit Attempts and Associated Factors Among Rural Adults Who Smoke Daily in the United States.

Rural American communities are heavily affected by tobacco-related health disparities. This study aims to evaluate the prevalence of quit attempts (QAs) and factors that promote or impede QA among rural adults who smoke daily. Data from Wave 5 of the Population Assessment of Tobacco and Health study were analyzed. Multivariable logistic regression was used to identify factors associated with QA. Backward selection was used to identify variables included in the final model with statistical significance set at p < .05. Among 1610 rural adults who smoked daily, the prevalence of a QA in the past 12 months was 25.6% (95% confidence interval [CI]: 23.2, 28.2). Factors associated with greater QA odds: having greater education (adjusted odds ratio [aOR] = 1.35, 95% CI: 1.03, 1.77), e-cigarette use (aOR = 1.35 95% CI: 1.03, 1.80), disapproval of smoking from friends/family (aOR = 1.46, 95% CI: 1.09-1.94), greater frequency of thinking about the harm of tobacco (aOR = 1.48, 95% CI: 1.28, 1.71), fair/poor physical health (aOR = 1.31, 95% CI: 1.00, 1.70), and being advised to quit by a doctor (aOR = 1.63, 95% CI:1.25, 2.13). Smokeless tobacco use (aOR = 0.67, 95% CI: 0.47, 0.96) and greater cigarettes per day (aOR = 0.67, 95% CI: 0.47, 0.96) were associated with QA lower odds. Only one in four rural adults who smoke made a past-year QA. Interventions that promote provider advice to quit smoking, tobacco health harms, and normative beliefs may increase QAs in rural communities. Along with higher smoking rates and lower QAs, rural communities face limited access to programs, medication, and health care professionals as tools to help them quit smoking. Public Health initiatives should focus on developing cultural sensitivity training targeting health care professionals to advise patients to quit smoking and the role of multiple tobacco product use. Furthermore, given the low rates of smoking QAs, future mixed-methods research is needed to inform policies and interventions targeted at eliminating tobacco-related health disparities.

Examining Smoking Prevalence Disparities in Virginia Counties by Rurality, Appalachian Status, and Social Vulnerability, 2011-2019.

Objectives. To estimate county-level cigarette smoking prevalence in Virginia and examine cigarette use disparities by rurality, Appalachian status, and county-level social vulnerability. Methods. We used 2011-2019 Virginia Behavioral Risk Factor Surveillance System proprietary data with geographical information to estimate county-level cigarette smoking prevalence using small area estimation. We used the Centers for Disease Control and Prevention's social vulnerability index to quantify social vulnerability. We used the 2-sample statistical t test to determine the differences in cigarette smoking prevalence and social vulnerability between counties by rurality and Appalachian status. Results. The absolute difference in smoking prevalence was 6.16 percentage points higher in rural versus urban counties and 7.52 percentage points higher in Appalachian versus non-Appalachian counties in Virginia (P < .001). Adjusting for county characteristics, a higher social vulnerability index is associated with increased cigarette use. Rural Appalachian counties had 7.41% higher cigarette use rates than did urban non-Appalachian areas. Tobacco agriculture and a shortage of health care providers were significantly associated with higher cigarette use prevalence. Conclusions. Rural Appalachia and socially vulnerable counties in Virginia have alarmingly high rates of cigarette use. Implementation of targeted intervention strategies could reduce cigarette use, ultimately reducing tobacco-related health disparities. (Am J Public Health. 2023;113(7):811-814. https://doi.org/10.2105/AJPH.2023.307298).

Strengthening Tobacco 21 implementation and enforcement to reduce tobacco-related health disparities: A stakeholder engagement project.

As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law. Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December 2021 among stakeholders (n=31) with experience in T21 policy, evaluation, subject matter, and implementation. Participating T21 stakeholders reported on eight themes from four main topic areas: 1) Implementation, 2) Enforcement, 3) Equity outcomes, and 4) Recommended changes from stakeholders. Stakeholders shared insights on both passive and active implementation methods used in their communities, and highlighted major barriers such as the absence of a standardized tobacco retail licensing mandate and insufficient resources. Regarding T21 enforcement, stakeholders believed that current deterrents for retail violations might not be effective. They noted that vape and tobacco shops and online sales of tobacco products are emerging major challenges in T21 enforcement. Stakeholders also discussed possible health inequities that may be exacerbated by heterogenous implementation of the T21 law. To strengthen T21 and mitigate potential exacerbation of existing health inequities, greater alignment of federal, state, and local efforts to reduce heterogeneity of implementation and enforcement of the T21 law is recommended.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014.

Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

Monday-Enhanced CEASE Program for Underserved Ethnic Minorities: a Mixed-Methods Study.

Due to the persistence of tobacco-related health disparities in the U.S., there is a need for innovative strategies to reach the underserved ethnic minority populations who are most at risk. As contemplations for health behavior modification tend to surge on Mondays, we explored the feasibility and effect of a Monday-enhanced smoking cessation program on quitting outcomes in a low-income ethnic minority community. To compare a Monday-enhanced with a standard Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program and understand the overall experiences of participants in the program. In this mixed-methods study, affordable housing complexes (n = 4) and a church were randomly assigned either a Monday-enhanced (n = 3) or standard (n = 2) CEASE smoking cessation program. CEASE comprised twelve weekly group counseling sessions facilitated by trained peer motivators plus nicotine replacement products. Participants in the Monday-enhanced arm were encouraged to pick Mondays as a quitting day. Quantitative and qualitative data were collected during the program and at 3-month post-graduation. Seventy-seven participants were enrolled in the study arms. In both groups combined, tobacco consumption reduced from 7.7 to 5.6 cig/day (mean reduction, 2.1; 95% CI: 0.9 to 5.1, p = 0.08). Although no significant difference in quit rate was observed between the two arms, more participants completed the follow-up survey in the Monday-enhanced than standard CEASE program [82.4% vs. 36.0%, p < 0.05]. While qualitative data suggested an overall satisfaction of participants with the program, motivation for quitting was higher in the Monday-enhanced CEASE program compared to the standard CEASE program. The Monday-enhanced program is promising and may enhance participants' engagement and willingness to quit smoking, particularly in low-income ethnic minority communities. Further research should include larger sample sizes to better assess the efficacy of a Monday-enhanced program across diverse populations.

Role of perceived discrimination and anxiety sensitivity in cigarette smoking among english-speaking latinx adults living in the United States.

The Latinx/Hispanic (hereafter, Latinx) population in the United States (US) experiences significant tobacco-related health disparities. Extant work suggests social determinants of health (SDoH) such as perceived discrimination is an individual differences factor for cigarette smoking behavior among Latinx individuals who smoke cigarettes. Other research has suggested sensitivity to internal cues, referred to as anxiety sensitivity, is related to smoking among Latinx adults, but this work has not explored whether anxiety sensitivity may moderate the association between perceived discrimination and smoking behavior. Therefore, the present investigation sought to explore the main and interactive association of perceived discrimination and anxiety sensitivity in relation to cigarettes smoked per day, severity of problems experienced when quitting, and perceived barriers for smoking cessation among 338 English-speaking Latinx individuals living in the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female) who smoke cigarettes. Results supported statistically significant main effects for perceived discrimination and anxiety sensitivity in relation to increased severity of problems experienced when quitting and perceived barriers for smoking cessation. These associations were evident after adjusting for a sociodemographic covariates. Overall, the present investigation suggests that both perceived discrimination and anxiety sensitivity are important constructs relevant to understanding smoking processes among Latinx adults who smoke cigarettes and should be integrated in theoretical models of smoking among this population.

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective