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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use. Drug Alcohol Depend 2022; 234:109411. [PMID: 35338898 PMCID: PMC9035622 DOI: 10.1016/j.drugalcdep.2022.109411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis. METHODS The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses. RESULTS DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner. CONCLUSION DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.
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Vuolo M, Lindsay SL, Kelly BC. Further Consideration of the Impact of Tobacco Control Policies on Young Adult Smoking in Light of the Liberalization of Cannabis Policies. Nicotine Tob Res 2022; 24:60-68. [PMID: 34272870 PMCID: PMC8666115 DOI: 10.1093/ntr/ntab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Changing patterns of cannabis consumption related to the liberalization of cannabis policies may have a countervailing effect on tobacco use. We analyzed whether cannabis policies have tempered the effects of tobacco control policies as well as the extent to which they were associated with young adult cigarette smoking. AIMS AND METHODS Combining data on tobacco and cannabis policies at the state, county, and city levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel regression and fixed effect analyses to examine the impact of cannabis policies on any past 30-day cigarette smoking, frequency of smoking, and past 30-day near-daily smoking among young adults while accounting for community and individual covariates. RESULTS Tobacco control policies, including significant effects of comprehensive smoking bans, total vending machine restrictions, single cigarette sale restrictions, and advertising restrictions, remain robust in reducing young adult smoking, net of cannabis policy liberalization, including the legal status of possession, penalties for sale, and medical cannabis. Cannabis policies do not directly affect young adult smoking patterns in an adverse way. CONCLUSIONS This paper provides evidence that the liberalization of cannabis laws has not adversely affected the efficacy of tobacco control efforts. IMPLICATIONS While the effects of tobacco control policies on smoking are well-established, little research has considered how the liberalization of cannabis policies may affect these relationships, which is important given the co-use of these substances. This paper provides evidence that the liberalization of cannabis laws has not adversely affected tobacco control efforts.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, Ohio State University, Columbus, OH, USA
| | - Sadé L Lindsay
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Ahmed ZU, Sun K, Shelly M, Mu L. Explainable artificial intelligence (XAI) for exploring spatial variability of lung and bronchus cancer (LBC) mortality rates in the contiguous USA. Sci Rep 2021; 11:24090. [PMID: 34916529 PMCID: PMC8677843 DOI: 10.1038/s41598-021-03198-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/18/2021] [Indexed: 12/09/2022] Open
Abstract
Machine learning (ML) has demonstrated promise in predicting mortality; however, understanding spatial variation in risk factor contributions to mortality rate requires explainability. We applied explainable artificial intelligence (XAI) on a stack-ensemble machine learning model framework to explore and visualize the spatial distribution of the contributions of known risk factors to lung and bronchus cancer (LBC) mortality rates in the conterminous United States. We used five base-learners-generalized linear model (GLM), random forest (RF), Gradient boosting machine (GBM), extreme Gradient boosting machine (XGBoost), and Deep Neural Network (DNN) for developing stack-ensemble models. Then we applied several model-agnostic approaches to interpret and visualize the stack ensemble model's output in global and local scales (at the county level). The stack ensemble generally performs better than all the base learners and three spatial regression models. A permutation-based feature importance technique ranked smoking prevalence as the most important predictor, followed by poverty and elevation. However, the impact of these risk factors on LBC mortality rates varies spatially. This is the first study to use ensemble machine learning with explainable algorithms to explore and visualize the spatial heterogeneity of the relationships between LBC mortality and risk factors in the contiguous USA.
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Affiliation(s)
- Zia U Ahmed
- Research and Education in Energy, Environment and Water (RENEW) Institute, University at Buffalo, 108 Cooke Hall, Buffalo, NY, 14260, USA.
| | - Kang Sun
- Department of Civil, Structural and Environmental Engineering, University at Buffalo, 230 Jarvis Hall, Buffalo, NY, 14260, USA
| | - Michael Shelly
- Research and Education in Energy, Environment and Water (RENEW) Institute, University at Buffalo, 108 Cooke Hall, Buffalo, NY, 14260, USA
| | - Lina Mu
- Department of Epidemiology and Environmental Health, University at Buffalo, 273A Farber Hall, Buffalo, NY, 14214, USA
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Community- and individual-level risk factors of past month e-cigarette use among adolescents in France. Drug Alcohol Depend 2021; 226:108823. [PMID: 34216860 DOI: 10.1016/j.drugalcdep.2021.108823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Studies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of départements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use. METHODS The ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22,023) and 2017 (n = 39,115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use. RESULTS We find significant département-level variation in both outcomes, with a considerable proportion of this variation explained by département-level factors. Net of numerous significant individual-level covariates, département-level unemployment (OR = 1.049, p < .05), poverty (OR=0.975, p < .05), age structure (OR=0.720, p < .01), and population growth (OR=0.987 p < .01) were associated with any past month use. The département-level percentage of adolescents using conventional tobacco daily was associated with individual-level any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that département-level and individual-level tobacco use together were associated with e-cigarette use. CONCLUSIONS Researchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.
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Bratter J, Campbell ME, Saint Onge JM. Living race together: the role of partner's race in racial/ethnic differences in smoking. ETHNICITY & HEALTH 2020; 25:141-159. [PMID: 29096536 DOI: 10.1080/13557858.2017.1398316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objective: Crossing racial lines provides a unique context for understanding racial patterns in smoking. This research explores whether adults whose unions cross racial lines behave more similarly to their own group or their partner'sDesign: Using a sample of respondents from the National Health Interview Survey (2001-2011), we compare the likelihood of current smoking and quitting smoking among adults in mixed-race unions to adults in same-race unions.Results: Adults with different-race partners generally mirror their partner's group; people of color with White partners have a higher likelihood of being current smokers, similar to Whites, while Whites partnered with Asians and Latina/os are, like other Asians and Latino/as, less likely to smoke. There are fewer differences in the likelihood of quitting smoking.
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Affiliation(s)
- Jenifer Bratter
- Sociology DepartmentProgram for the Study of Ethnicity Race and CultureKinder Institute for Urban Research, Rice University, Houston, TX, USA
| | - Mary E Campbell
- Sociology Department, Texas A&M University, College Station, TX, USA
| | - Jarron M Saint Onge
- Sociology DepartmentDepartment of Health Policy and Management, University of Kansas, Lawrence, KS, USA
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Wagner GA, Sanchez ZM, Fidalgo TM, Caetano SC, Carliner H, Martins SS. Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:546-549. [PMID: 30758434 PMCID: PMC6899349 DOI: 10.1590/1516-4446-2018-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
Abstract
Objective: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). Methods: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. Results: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. Conclusions: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.
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Affiliation(s)
- Gabriela A Wagner
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Sheila C Caetano
- Departamento de Psiquiatria, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Hannah Carliner
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Lowrie C, Pearson AL, Thomson G. Inequities in coverage of smokefree outdoor space policies within the United States: school grounds and playgrounds. BMC Public Health 2018; 18:736. [PMID: 29902978 PMCID: PMC6003182 DOI: 10.1186/s12889-018-5602-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree outdoor spaces reduce secondhand smoke exposure and de-normalize smoking. Methods After previously publishing a study of smokefree indoor and outdoor space policies, it was brought to the authors’ attention that the dataset used in analyses was incomplete (Lowrie et al., BMC Public Health 17:456, 2017). The current manuscript is a corrected version. Here, we include analyses for outdoor space policies. We evaluated regional and demographic differences in the proportion of the population (both adult and child) covered by smokefree outdoor space policies for school grounds and playgrounds enacted in the United States prior to 2014. Results Children had a low level of protection in playgrounds and schools (8% covered nationwide in both settings). Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). The odds of having a smokefree playgrounds policy was lower for jurisdictions with higher proportions of poor households, households with no high school diploma, whites and the Alaska/Hawaii region. Increased ethnic heterogeneity was found to be a significant predictor of increased odds of having a smokefree playgrounds policy, meaning that diversity is protective, with differential effect by region (p < 0.001) – which may relate to urbanicity. Conclusions Disparities in smokefree outdoor space policies have potential to exacerbate existing health inequities. A national increase in smokefree outdoor space policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.
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Affiliation(s)
- Christopher Lowrie
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI, 48824, USA
| | - Amber L Pearson
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI, 48824, USA. .,Department of Public Health, University of Otago, Wellington, 6021, New Zealand. .,Environmental Science and Policy Program, Michigan State University, East Lansing, MI, 48824, USA.
| | - George Thomson
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
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Levy JI, Quirós-Alcalá L, Fabian MP, Basra K, Hansel NN. Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease. CURR EPIDEMIOL REP 2018; 5:114-124. [PMID: 30319934 PMCID: PMC6178976 DOI: 10.1007/s40471-018-0149-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Multiple respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), display significant socioeconomic and racial/ethnic disparities. The objective of this review is to evaluate the evidence supporting a link between disproportionate environmental exposures and these health disparities. RECENT FINDINGS Studies suggest that various co-occurring factors related to the home environment, neighborhood environment, non-modifiable individual factors, and individual behaviors and attributes can increase or modify the risk of adverse respiratory outcomes among socioeconomically-disadvantaged and racially/ethnically diverse populations. Pollutants in the home environment, including particulate matter, nitrogen dioxide, and pesticides, are elevated among lower socioeconomic status populations and have been implicated in the development or exacerbation of respiratory-related conditions. Neighborhood crime and green space are socioeconomically patterned and linked with asthma outcomes through psychosocial pathways. Non-modifiable individual factors such as genetic predisposition cannot explain environmental health disparities but can increase susceptibility to air pollution and other stressors. Individual behaviors and attributes, including obesity and physical activity, contribute to worse outcomes among those with asthma or COPD. SUMMARY The root causes of these multifactorial exposures are complex, but many likely stem from economic forces and racial/ethnic and economic segregation that influence the home environment, neighborhood environment, and access to healthy foods and consumer products. Critical research needs include investigations that characterize exposure to and health implications of numerous stressors simultaneously, both to guard against potential confounding in epidemiological investigations and to consider the cumulative impact of multiple elevated environmental exposures and sociodemographic stressors on health disparities.
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Affiliation(s)
- Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health
| | - Lesliam Quirós-Alcalá
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health
| | - Komal Basra
- Department of Environmental Health, Boston University School of Public Health
| | - Nadia N. Hansel
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
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Thompson O. Gene-Environment Interaction in the Intergenerational Transmission of Asthma. HEALTH ECONOMICS 2017; 26:1337-1352. [PMID: 27633404 DOI: 10.1002/hec.3401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 06/06/2023]
Abstract
Researchers have found strong linkages between parent and child health, but the mechanisms underlying intergenerational health transmission are not well understood. This paper investigates how the importance of genetic health transmission mechanisms varies by environmental conditions in the case of pediatric asthma, the single most common chronic health condition among American children. Using a sample that includes approximately 2000 adoptees and a large number of similar biological families, I find that the relative importance of genetic transmission differs strongly by socioeconomic status (SES). In high SES families, parent-child asthma associations are approximately 75% weaker among adoptees than biological children, suggesting a dominant role for genetic transmission. In lower SES families, parent-child asthma associations are virtually identical across biological and adoptive children, suggesting a negligible role for genetic transmission. A potential interpretation of this difference is that as environmental conditions affecting asthma improve among higher SES children, an increasingly large share of asthma variation is due to genetics. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Owen Thompson
- University of Wisconsin Milwaukee, Milwaukee, WI, USA
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Abstract
: Background: The U.S. Department of Health and Human Services' initiative Healthy People 2020 targets tobacco use, including smoking during pregnancy, as a continuing major health concern in this country. Yet bringing the U.S. Public Health Service's 2008 clinical practice guideline, Treating Tobacco Use and Dependence, into routine prenatal care remains challenging. Our previous nurse-managed intervention study of rural pregnant women found no significant cessation effect and significant discordance between self-reported smoker status and urinary cotinine levels. PURPOSE The overall purpose of this follow-up study was to increase our understanding of the experiences of pregnant smokers and their providers. No qualitative studies could be found that simultaneously explored the experiences of both groups. DESIGN AND METHODS This qualitative descriptive study used focus group methodology. Nine focus groups were held in two counties in upper New York State; six groups consisted of providers and three consisted of pregnant women. Four semistructured questions guided the group discussions, which were audiotaped and transcribed verbatim. Transcripts were read and coded independently by six investigators. Themes were identified using constant comparative analysis and were validated using the consensus process. RESULTS The total sample consisted of 66 participants: 45 providers and 21 pregnant women. Most of the providers were white (93%) and female (93%). A majority worked as RNs (71%); the sample included perinatal and neonatal nursery nurses, midwives, and physicians. The pregnant women were exclusively white (reflecting the rural demographic); the average age was 24 years. All the pregnant women had smoked at the beginning of their pregnancies. Four common themes emerged in both the provider and the pregnant women groups: barriers to quitting, mixed messages, approaches and attitudes, and program modalities. These themes corroborate previous findings that cigarette smoking is used for stress relief, especially when pregnancy itself is a stressor, and that pregnant women may feel guilty but don't want to be nagged or preached to. CONCLUSIONS These results have implications for how smoking cessation programs for pregnant women should be designed. Health care providers need to be cognizant of their approaches and attitudes when addressing the subject of smoking cessation. Specific educational suggestions include "putting a face" to the issue of tobacco use during pregnancy. More research is needed on how best to implement the 2008 clinical practice guideline in specific populations.
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Wiggers J. Real-time video counselling for smoking cessation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Flora Tzelepis
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Christine L Paul
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
| | - Christopher M Williams
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Conor Gilligan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
| | - Tim Regan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Justine Daly
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Rebecca K Hodder
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - John Wiggers
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
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Lowrie C, Pearson AL, Thomson G. Inequities in coverage of smokefree space policies within the United States. BMC Public Health 2017; 17:456. [PMID: 28511682 PMCID: PMC5434634 DOI: 10.1186/s12889-017-4385-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree indoor and outdoor spaces reduce secondhand smoke exposure and denormalize smoking. METHODS We evaluated regional and demographic differences in the proportion of the population covered by smokefree policies enacted in the United States prior to 2014, for both adults and children. RESULTS Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). Smokefree policy coverage was lower for jurisdictions with higher proportions of poor households, households with no high school diploma and the Southeast region. Increased ethnic heterogeneity was found to be a significant predictor of coverage in indoor "public spaces generally", meaning that diversity is protective, with differential effect by region (p = 0.004) - which may relate to urbanicity. Children had a low level of protection in playgrounds and schools (~10% covered nationwide) - these spaces were found to be covered at lower rates than indoor spaces. CONCLUSIONS Disparities in smokefree space policies have potential to exacerbate existing health inequities. A national increase in smokefree policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.
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Affiliation(s)
- Christopher Lowrie
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, MI, 48824, USA
| | - Amber L Pearson
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, MI, 48824, USA. .,Department of Public Health, University of Otago, Wellington, 6021, New Zealand. .,Environmental Science and Policy Program, Michigan State University, East Lansing, MI, 48824, USA.
| | - George Thomson
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
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Vuolo M, Kadowaki J, Kelly BC. A Multilevel Test of Constrained Choices Theory: The Case of Tobacco Clean Air Restrictions. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:351-372. [PMID: 27601410 DOI: 10.1177/0022146516653790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
According to Bird and Rieker's sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts-including policy, community, and work/family-in which they are formulated. While each level received attention in the original and subsequent research, we contend their constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a comprehensive database of tobacco policies with the National Longitudinal Survey of Youth 1997 from ages 19 to 31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking and dependence while controlling for other policy-, city-, and individual-level constraints. We also find unique between- and within-person effects, as well as gender effects, for the constraint levied by smoking bans. We argue for the theory's broad applicability beyond commonly cited findings regarding gender and biological influences.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Joy Kadowaki
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Duncan DT, Rienti M, Kulldorff M, Aldstadt J, Castro MC, Frounfelker R, Williams JH, Sorensen G, Johnson RM, Hemenway D, Williams DR. Local spatial clustering in youths' use of tobacco, alcohol, and marijuana in Boston. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:412-21. [PMID: 27096932 DOI: 10.3109/00952990.2016.1151522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods. OBJECTIVES The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana. METHODS Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13-19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included "none," "1-2," "3-9," and "10 or more." The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package. RESULTS Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models. CONCLUSION Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.
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Affiliation(s)
- Dustin T Duncan
- a Department of Population Health , New York University School of Medicine , New York , NY , USA.,b College of Global Public Health , New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , New York University College of Nursing , New York , NY , USA.,d Population Center , New York University College of Arts and Science , New York , NY , USA.,e Center for Data Science , New York University , New York , NY , USA
| | - Michael Rienti
- f Department of Geography , University at Buffalo, State University of New York , Buffalo , NY , USA.,g Center for Health and Social Research , SUNY Buffalo State, Buffalo , NY , USA
| | - Martin Kulldorff
- h Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA
| | - Jared Aldstadt
- f Department of Geography , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Marcia C Castro
- i Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,j Harvard Center for Population and Development Studies , Harvard University , Cambridge , MA , USA
| | - Rochelle Frounfelker
- k Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - James H Williams
- a Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Glorian Sorensen
- l Center for Community-based Research , Dana-Farber Cancer Institute , Boston , MA , USA.,m Lung Cancer Disparities Center , Harvard T.H. Chan School of Public Health , Boston , MA USA.,n Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Renee M Johnson
- n Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - David Hemenway
- o Department of Health Policy and Management , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - David R Williams
- k Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,m Lung Cancer Disparities Center , Harvard T.H. Chan School of Public Health , Boston , MA USA.,p Departments of African and African American Studies, and Sociology , Harvard University , Cambridge , MA , USA
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Rolle IV, Beasley DD, Kennedy SM, Rock VJ, Neff L. National Surveys and Tobacco Use Among African Americans: A Review of Critical Factors. Nicotine Tob Res 2016; 18 Suppl 1:S30-40. [PMID: 26980862 PMCID: PMC6200134 DOI: 10.1093/ntr/ntv195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Beginning in the 1970s, US national surveys showed African American youth having a lower prevalence of cigarette smoking than white youth. Yet, during adulthood, African Americans have a smoking prevalence comparable to white adults. Data sources chosen can contribute in different ways to understanding tobacco use behaviors among African American youth and adults; this article is a review of national and/or state-based health surveys to examine their methodology, racial and ethnic classifications, and tobacco-use related measures. METHODS Eleven national and/or state based surveys were selected for review. Eight surveys were multitopic and included questions on tobacco use and three surveys were tobacco specific. Survey methods included telephone (4), household (3), and school (4). Three major characteristics examined for each survey were: (1) survey design and methods, (2) racial and ethnic background classification, and (3) selected tobacco smoking questions. Within these three characteristics, 15 factors considered to be important for examining tobacco use behaviors by African Americans were identified a priori using previously published reviews and studies. RESULTS Within survey design and methods, the majority of surveys (≥7) oversampled African Americans and did not use proxy respondents for tobacco questions. All surveys used Office of Management and Budget standard classification for race/ethnicity classification. The majority of surveys (≥7) captured five of the seven tobacco-related smoking questions. CONCLUSIONS Programmatic objectives and/or research questions should guide the selection of data sources for tobacco control programs and researchers examining African American tobacco use behaviors. IMPLICATIONS This review of 11 national and state tobacco-related surveys shows that these surveys provide much needed estimates of tobacco use behaviors. However, as tobacco programs and researchers seek to examine tobacco use behaviors among African Americans, it is important to consider multiple surveys as each can contribute to informing the tobacco experience in African Americans. Most importantly, programmatic objectives and/or research questions should guide the selection of data sources for tobacco control programs and researchers examining African American tobacco use behaviors.
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Affiliation(s)
- Italia V Rolle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Derrick D Beasley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA
| | - Sara M Kennedy
- Division of Biostatistics and Epidemiology, Research Triangle Institute (RTI), Atlanta, GA
| | - Valerie J Rock
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Tramontano AC, Sheehan DF, McMahon PM, Dowling EC, Holford TR, Ryczak K, Lesko SM, Levy DT, Kong CY. Evaluating the impacts of screening and smoking cessation programmes on lung cancer in a high-burden region of the USA: a simulation modelling study. BMJ Open 2016; 6:e010227. [PMID: 26928026 PMCID: PMC4780060 DOI: 10.1136/bmjopen-2015-010227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE While the US Preventive Services Task Force has issued recommendations for lung cancer screening, its effectiveness at reducing lung cancer burden may vary at local levels due to regional variations in smoking behaviour. Our objective was to use an existing model to determine the impacts of lung cancer screening alone or in addition to increased smoking cessation in a US region with a relatively high smoking prevalence and lung cancer incidence. SETTING Computer-based simulation model. PARTICIPANTS Simulated population of individuals 55 and older based on smoking prevalence and census data from Northeast Pennsylvania. INTERVENTIONS Hypothetical lung cancer control from 2014 to 2050 through (1) screening with CT, (2) intensified smoking cessation or (3) a combination strategy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were lung cancer mortality rates. Secondary outcomes included number of people eligible for screening and number of radiation-induced lung cancers. RESULTS Combining lung cancer screening with increased smoking cessation would yield an estimated 8.1% reduction in cumulative lung cancer mortality by 2050. Our model estimated that the number of screening-eligible individuals would progressively decrease over time, indicating declining benefit of a screening-only programme. Lung cancer screening achieved a greater mortality reduction in earlier years, but was later surpassed by smoking cessation. CONCLUSIONS Combining smoking cessation programmes with lung cancer screening would provide the most benefit to a population, especially considering the growing proportion of patients ineligible for screening based on current recommendations.
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Affiliation(s)
- Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deirdre F Sheehan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela M McMahon
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Emily C Dowling
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theodore R Holford
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Karen Ryczak
- Northeast Regional Cancer Institute, Scranton, Pennsylvania, USA
| | - Samuel M Lesko
- Northeast Regional Cancer Institute, Scranton, Pennsylvania, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Vuolo M, Kelly BC, Kadowaki J. Independent and Interactive Effects of Smoking Bans and Tobacco Taxes on a Cohort of US Young Adults. Am J Public Health 2016; 106:374-80. [PMID: 26691133 PMCID: PMC4758814 DOI: 10.2105/ajph.2015.302968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the mutual effects of smoking bans and taxes on smoking among a longitudinal cohort of young adults. METHODS We combined a repository of US tobacco policies at the state and local level with the nationally representative geocoded National Longitudinal Survey of Youth 1997 (2004-2011) from ages 19 to 31 years and Census data, to examine the impact of tobacco policies on any current and daily pack smoking. The analytic sample amounts to 19,668 observations among 4341 individuals within 487 cities. RESULTS For current smoking, we found significant effects for comprehensive smoking bans, but not excise taxes. We also found an interaction effect, with bans being most effective in locales with no or low taxes. For daily pack smoking, we found significant effects for taxes, but limited support for bans. CONCLUSIONS Social smoking among young adults is primarily inhibited by smoking bans, but excise taxes only deter such smoking in the absence of a ban. Heavy smokers are primarily deterred by taxes. Although both policies have an impact on young adult smoking behaviors, their dual presence does not intensify each policy's efficacy.
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Affiliation(s)
- Mike Vuolo
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Brian C Kelly
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Joy Kadowaki
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
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Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010106. [PMID: 26751461 PMCID: PMC4730497 DOI: 10.3390/ijerph13010106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 01/19/2023]
Abstract
Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.
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Armah FA, Quansah R, Luginaah I, Chuenpagdee R, Hambati H, Campbell G. Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk. PLoS Negl Trop Dis 2015; 9:e0003939. [PMID: 26241050 PMCID: PMC4524715 DOI: 10.1371/journal.pntd.0003939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/29/2015] [Indexed: 11/06/2022] Open
Abstract
Background In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. Methods and Findings We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. The multivariate analysis explained 95% of the variance in the relationship between NTD risks and the theoretically-relevant covariates. Compositional (biosocial and sociocultural) factors explained more variance at the neighbourhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. Conclusions NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions. Neglected Tropical Diseases (NTDs) are characterized by their high incidence in low-income countries, thus maintaining the disastrous poverty-disease-poverty cycle. Apart from poverty, however, little is known of the magnitude of importance of both compositional and contextual factors in creating disease risk at the local level, although this knowledge is critical to disease control and policy action. In this study, we show that the order of importance of both sets of factors is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity.
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Affiliation(s)
- Frederick Ato Armah
- Environmental Health and Hazards Laboratory, Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health College of Health Science, University of Ghana, Legon, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, College of Health Science, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Ratana Chuenpagdee
- Department of Geography, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Herbert Hambati
- Department of Geography, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Gwyn Campbell
- Indian Ocean World Centre (IOWC), Montréal, Quebec, Canada
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Islami F, Ward EM, Jacobs EJ, Ma J, Goding Sauer A, Lortet-Tieulent J, Jemal A. Potentially preventable premature lung cancer deaths in the USA if overall population rates were reduced to those of educated whites in lower-risk states. Cancer Causes Control 2015; 26:409-18. [PMID: 25555993 DOI: 10.1007/s10552-014-0517-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/19/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE Death rates for lung cancer, the leading cause of cancer death in the USA, vary substantially by the level of education at the national level, but this has not previously been analyzed by state. METHODS We examined age-standardized lung cancer death rates by educational attainment, race/ethnicity, and state in men and women (aged 25-64 years) in the USA in 2008-2010 and estimated the proportion of potentially avoidable premature lung cancer deaths for each state if rates were reduced to those achieved among more educated non-Hispanic whites in five states with low lung cancer rates, using data on 134,869 lung cancer deaths. RESULTS Age-standardized lung cancer mortality rates differed substantially by state and education level. Among non-Hispanic white men, for example, rates per 100,000 ranged from below 6 in more educated men (≥16 years of education) in Utah, Colorado, and Montana to >75 in less educated men (≤12 years of education) in Mississippi, Oklahoma, and Kentucky. An estimated 73 % of lung cancer deaths in the USA (32,700 deaths annually in 25- to 64-year-old individuals alone) would be prevented. This proportion was ≥85 % among men in Arkansas, Alabama, Kentucky, and Mississippi, and ≥80 % among women in West Virginia and Kentucky. CONCLUSION Most premature lung cancer deaths in the USA are potentially avoidable. As most of these deaths can be attributed to smoking, our findings underscore the importance of increasing tobacco control measures in high-risk states and targeting tobacco control interventions to less educated populations in all states.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA,
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Daw J, Boardman JD, Peterson R, Smolen A, Haberstick BC, Ehringer MA, Ennett ST, Foshee VA. The interactive effect of neighborhood peer cigarette use and 5HTTLPR genotype on individual cigarette use. Addict Behav 2014; 39:1804-10. [PMID: 25127196 DOI: 10.1016/j.addbeh.2014.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/12/2014] [Accepted: 07/08/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous cross-sectional research has shown that adolescents' cigarette use is interactively associated with that of their school peers and their 5HTTLPR genotype, such that the cigarette use of persons with more copies of the 5HTTLPR*S' allele is more dependent on school peers' cigarette use behaviors than their counterparts. This analysis seeks to extend this novel finding by examining whether the same conclusion can be reached when substituting neighborhood peers for school peers and examining the timing of the initiation of any and regular smoking in adolescence. METHODS This analysis employs an independent sample with longitudinal measures of cigarette use among 6th through 8th graders clustered in 82 neighborhoods, of whom 1098 contributed genetic data. The proportion of respondents who had ever smoked cigarettes by the first wave was calculated for each census block group in the study. 5HTTLPR genotype was assayed using the method of Whisman et al. (2011). The timing of any or regular smoking initiation and over four years were modeled as dependent variables using Cox proportional hazard models. RESULTS The interaction of neighborhood peer smoking behavior in the first wave and 5HTTLPR genotype statistically significantly predicted any smoking initiation (hazard ratio: 3.532; p-value=0.002) and regular smoking initiation (hazard ratio: 5.686; p-value=0.000), net of controls for sex, race/ethnicity, grade in the first wave of data, and parental educational attainment. These findings reach the same conclusions as previous cross-sectional research. CONCLUSIONS These results differ in the model of gene-environment interaction that they support. The findings for any smoking initiation are consistent with the diathesis-stress model of gene-environment interaction; the findings for regular smoking initiation are consistent with the differential susceptibility model.
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Affiliation(s)
- Jonathan Daw
- Department of Sociology, University of Alabama-Birmingham, United States.
| | - Jason D Boardman
- Department of Sociology, University of Colorado-Boulder, United States; Institute of Behavioral Science, University of Colorado-Boulder, United States; Institute for Behavioral Genetics, University of Colorado-Boulder, United States
| | - Rachel Peterson
- Department of Sociology, University of Colorado-Boulder, United States; Institute of Behavioral Science, University of Colorado-Boulder, United States
| | - Andrew Smolen
- Institute for Behavioral Genetics, University of Colorado-Boulder, United States
| | - Brett C Haberstick
- Institute for Behavioral Genetics, University of Colorado-Boulder, United States
| | - Marissa A Ehringer
- Institute for Behavioral Genetics, University of Colorado-Boulder, United States; Department of Integrative Physiology and Institute for Behavioral Genetics, University of Colorado-Boulder, United States
| | - Susan T Ennett
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, United States
| | - Vangie A Foshee
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, United States
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Chan KS, Roberts E, McCleary R, Buttorff C, Gaskin DJ. Community characteristics and mortality: the relative strength of association of different community characteristics. Am J Public Health 2014; 104:1751-8. [PMID: 25033152 DOI: 10.2105/ajph.2014.301944] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. METHODS . We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998-2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100,000 or greater (n = 458). RESULTS Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. CONCLUSIONS Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk.
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Affiliation(s)
- Kitty S Chan
- All of the authors are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Dwyer-Lindgren L, Mokdad AH, Srebotnjak T, Flaxman AD, Hansen GM, Murray CJ. Cigarette smoking prevalence in US counties: 1996-2012. Popul Health Metr 2014; 12:5. [PMID: 24661401 PMCID: PMC3987818 DOI: 10.1186/1478-7954-12-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/30/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action. METHODS We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011. RESULTS Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile. CONCLUSIONS County-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.
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Affiliation(s)
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA 98121, USA.
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Levy JI, Fabian MP, Peters JL. Community-wide health risk assessment using geographically resolved demographic data: a synthetic population approach. PLoS One 2014; 9:e87144. [PMID: 24489855 PMCID: PMC3904963 DOI: 10.1371/journal.pone.0087144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/21/2013] [Indexed: 01/07/2023] Open
Abstract
Background Evaluating environmental health risks in communities requires models characterizing geographic and demographic patterns of exposure to multiple stressors. These exposure models can be constructed from multivariable regression analyses using individual-level predictors (microdata), but these microdata are not typically available with sufficient geographic resolution for community risk analyses given privacy concerns. Methods We developed synthetic geographically-resolved microdata for a low-income community (New Bedford, Massachusetts) facing multiple environmental stressors. We first applied probabilistic reweighting using simulated annealing to data from the 2006–2010 American Community Survey, combining 9,135 microdata samples from the New Bedford area with census tract-level constraints for individual and household characteristics. We then evaluated the synthetic microdata using goodness-of-fit tests and by examining spatial patterns of microdata fields not used as constraints. As a demonstration, we developed a multivariable regression model predicting smoking behavior as a function of individual-level microdata fields using New Bedford-specific data from the 2006–2010 Behavioral Risk Factor Surveillance System, linking this model with the synthetic microdata to predict demographic and geographic smoking patterns in New Bedford. Results Our simulation produced microdata representing all 94,944 individuals living in New Bedford in 2006–2010. Variables in the synthetic population matched the constraints well at the census tract level (e.g., ancestry, gender, age, education, household income) and reproduced the census-derived spatial patterns of non-constraint microdata. Smoking in New Bedford was significantly associated with numerous demographic variables found in the microdata, with estimated tract-level smoking rates varying from 20% (95% CI: 17%, 22%) to 37% (95% CI: 30%, 45%). Conclusions We used simulation methods to create geographically-resolved individual-level microdata that can be used in community-wide exposure and risk assessment studies. This approach provides insights regarding community-scale exposure and vulnerability patterns, valuable in settings where policy can be informed by characterization of multi-stressor exposures and health risks at high resolution.
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Affiliation(s)
- Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Maria Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Junenette L. Peters
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Perkins RB, Sherman BJ, Silliman RA, Battaglia TA. We can do better than last place: improving the health of us women. Glob Adv Health Med 2013; 2:86-93. [PMID: 24416700 PMCID: PMC3833572 DOI: 10.7453/gahmj.2013.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Life expectancy for US women lags behind that for women in other countries. Factors contributing to inequitable health for women are complex and include policy, community, healthcare access, and the interaction between the patient and her healthcare provider working within the healthcare system. We propose a societal pyramid of health accounting for the effects of these different factors and their impact on prevention, screening, diagnosis, and management of disease using the examples of smoking and obesity, two of the most important yet modifiable risk factors for chronic disease and death among US women.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Massachusetts, United States
| | - Bonnie J Sherman
- Women's Health Unit/Department of General Internal Medicine, Boston University School of Medicine, Massachusetts, United States
| | - Rebecca A Silliman
- Department of Geriatrics, Boston University School of Medicine, Massachusetts, United States
| | - Tracy A Battaglia
- Women's Health Unit/Department of General Internal Medicine, Boston University School of Medicine, Massachusetts, United States
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Wang YC, Li HY, Wei JN, Lin MS, Shih SR, Hua CH, Smith DJ, Vanio J, Chuang LM. Serum vascular adhesion protein-1 level is higher in smokers than non-smokers. Ann Hum Biol 2013; 40:413-8. [PMID: 23802578 DOI: 10.3109/03014460.2013.788679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Semicarbazide-sensitive amine oxidase (SSAO)/vascular adhesion protein-1 (VAP-1) is involved in the pathogenesis of both atherosclerosis and cancer. Because chemical components and metabolites of cigarettes are deaminated by SSAO, the relationship between smoking and serum SSAO/VAP-1 was studied in humans. METHODS A total of 451 non-diabetic and normoalbuminuric Han Chinese subjects were recruited to participate in this study. Smoking history was obtained by using a questionnaire and those who smoked more than 100 cigarettes during a 6-month period were considered smokers. Serum VAP-1 concentration was measured by time-resolved immunofluorometric assay. Age, gender, waist circumference and estimated glomerular filtration rate (GFR) were adjusted in different statistical models. RESULTS Smokers were mainly male (85.7% versus 26.3%) and were more obese than non-smokers (p < 0.05). Subjects with higher serum VAP-1 concentrations were older (p < 0.001) and tended to have larger waist circumferences and lower estimated GFR. Serum VAP-1 concentration was higher in smokers than in non-smokers (p < 0.05) after adjusting for age, gender, waist circumference, estimated GFR, liver biochemistry and lipid profile. CONCLUSIONS Cigarette smoking is associated with elevated serum VAP-1 concentration. Whether VAP-1 and its SSAO activity link the relationship between cigarette smoking, atherosclerosis and cancer requires further investigation.
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Li DX, Guindon GE. Income, income inequality and youth smoking in low- and middle-income countries. Addiction 2013; 108:799-808. [PMID: 23216738 DOI: 10.1111/add.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/09/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
Abstract
AIMS To examine the relationships between income, income inequality and current smoking among youth in low- and middle-income countries. DESIGN Pooled cross-sectional data from the Global Youth Tobacco Surveys, conducted in low- and middle-income countries, were used to conduct multi-level logistic analyses that accounted for the nesting of students in schools and of schools in countries. PARTICIPANTS A total of 169 283 students aged 13-15 from 63 low- and middle-income countries. MEASUREMENTS Current smoking was defined as having smoked at least one cigarette in the past 30 days. Gross domestic product (GDP) per capita was our measure of absolute income. Contemporaneous and lagged (10-year) Gini coefficients, as well as the income share ratio of the top decile of incomes to the bottom decile, were our measures of income inequality. FINDINGS Our analyses reveal a significant positive association between levels of income and youth smoking. We find that a 10% increase in GDP per capita increases the odds of being a current smoker by at least 2.5%, and potentially considerably more. Our analyses also suggest a relationship between the distribution of incomes and youth smoking: youth from countries with more unequal distributions of income tend to have higher odds of currently smoking. CONCLUSIONS There is a positive association between gross domestic product and the odds of a young person in a low- and middle-income country being a current smoker. Given the causal links between smoking and a wide range of youth morbidities, the association between smoking and income inequality may underlie a substantial portion of the health disparities observed that are currently experiencing rapid economic growth.
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Affiliation(s)
- David X Li
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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Wade B, Lariscy JT, Hummer RA. Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking. POPULATION RESEARCH AND POLICY REVIEW 2013; 32:353-371. [PMID: 25339787 DOI: 10.1007/s11113-013-9275-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n=44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25-34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.
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Affiliation(s)
- Becky Wade
- Department of Sociology, Rice University, 6100 S. Main Street, Houston, TX 77005
| | - Joseph T Lariscy
- Population Research Center and Department of Sociology, University of Texas at Austin, 305 E. 23rd St, G1800, Austin, TX 78712
| | - Robert A Hummer
- Population Research Center and Department of Sociology, University of Texas at Austin, 305 E. 23rd St, G1800, Austin, TX 78712
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Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, Hartge P, Gapstur SM. 50-year trends in smoking-related mortality in the United States. N Engl J Med 2013; 368:351-64. [PMID: 23343064 PMCID: PMC3632080 DOI: 10.1056/nejmsa1211127] [Citation(s) in RCA: 756] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear. METHODS We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up. RESULTS For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates. CONCLUSIONS The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.
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Affiliation(s)
- Michael J Thun
- Department of Epidemiology, American Cancer Society, Atlanta, GA 30303-1002, USA.
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Chahine T, Schultz BD, Zartarian VG, Xue J, Subramanian SV, Levy JI. Modeling joint exposures and health outcomes for cumulative risk assessment: the case of radon and smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:3688-711. [PMID: 22016710 PMCID: PMC3194111 DOI: 10.3390/ijerph8093688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022]
Abstract
Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors.
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Affiliation(s)
- Teresa Chahine
- Harvard School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02215, USA; E-Mails: (SV.S.); (J.I.L.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-617-669-2235; Fax: +1-617-384-8859
| | - Bradley D. Schultz
- US Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC 27711, USA; E-Mails: (B.D.S.); (V.G.Z.); (J.P.X.)
| | - Valerie G. Zartarian
- US Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC 27711, USA; E-Mails: (B.D.S.); (V.G.Z.); (J.P.X.)
| | - Jianping Xue
- US Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC 27711, USA; E-Mails: (B.D.S.); (V.G.Z.); (J.P.X.)
| | - SV Subramanian
- Harvard School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02215, USA; E-Mails: (SV.S.); (J.I.L.)
| | - Jonathan I. Levy
- Harvard School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02215, USA; E-Mails: (SV.S.); (J.I.L.)
- Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA 02118, USA
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