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Majeed T, Hopkin G, Wang K, Nepal S, Votruba N, Gronholm P, Gurung D, Semrau M, Bagade T, Farina N, Musyimi C, Pingani L, Breuer E, Lund C, Thornicroft G, Evans-Lacko S. Anti-stigma interventions in low-income and middle-income countries: a systematic review. EClinicalMedicine 2024; 72:102612. [PMID: 38707913 PMCID: PMC11066569 DOI: 10.1016/j.eclinm.2024.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Stigma exacerbates power imbalances and societal disparities, significantly impacting diverse identities and health conditions, particularly for low and middle-income countries (LMICs). Though crucial for dismantling harmful stereotypes, and enhancing healthcare utilisation, existing research on anti-stigma interventions is limited with its condition-focused approach. We aimed to thoroughly evaluate peer-reviewed and non-peer-reviewed literature for a comprehensive review of anti-stigma interventions for diverse identities and all health conditions in LMICs. Methods This review systematically explored peer-reviewed and non-peer-reviewed literature, in ten electronic databases up to January 30, 2024, covering all anti-stigma interventions across various stigmatised identities and health conditions in LMICs. Quality assessment for this systematic review was conducted as per Cochrane Collaboration's suggested inclusions. The review was registered with PROSPERO (Registration: 2017 CRD42017064283). Findings Systematic synthesis of the 192 included studies highlights regional imbalances, while providing valuable insights on robustness and reliability of anti-stigma research. Most studies used quasi-experimental design, and most centred on HIV/AIDS or mental health related stigma, with very little work on other issues. Certain high-population LMICs had no/little representation. Interpretation The interventions targeted diverse segments of populations and consequently yielded a multitude of stigma-related outcomes. However, despite the heterogeneity of studies, most reported positive outcomes underscoring the effectiveness of existing interventions to reduce stigma. Funding This study is supported by the UK Medical Research Council Indigo Partnership (MR/R023697/1) award.
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Affiliation(s)
- Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Gareth Hopkin
- National Institute for Health and Care Excellence, United Kingdom
| | - Katie Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health, United Kingdom
| | | | - Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Petra Gronholm
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dristy Gurung
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Transcultural Psychosocial Organization, Kathmandu, Nepal
| | - Maya Semrau
- Centre of Excellence for Global Health Research, Brighton & Sussex Medical School, Brighton, UK
| | - Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Nick Farina
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Erica Breuer
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
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Auriol C, Raynal P, Cantisano N. Stigmatization of drinking patients with liver cancer: The role of socioeconomic status. Heliyon 2024; 10:e29105. [PMID: 38623242 PMCID: PMC11016613 DOI: 10.1016/j.heliyon.2024.e29105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/08/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Patients with liver cancer may face stigmatization due to cancer, alcohol consumption, or both. This study addresses gaps in the existing literature regarding stigmatization of alcohol-related liver cancer patients, particularly its connection with socioeconomic status (SES). The study explores whether the SES of a fictional character with alcohol addiction and liver cancer influences stigma levels reported by participants. Additionally, it investigates how participants' personal characteristics, such as alcohol consumption and healthcare professional status, impact stigmatization. This study aims to provide new insights regarding the role of stigmatization in liver cancer treatment and management, emphasizing in socioeconomic determinants. The method is based on three scenarios describing a woman character with alcohol abuse and liver cancer. The scenarios depicted a woman character with either low, medium or high SES. Each participant (N = 991) was randomly assigned to one of the three scenarios. After reading it, each participant answered questionnaires assessing negative attitudes towards the character. Four scales were used: "Negative attributions about people with health problems", "Causality of cancer", "Controllability of drinking" and "Reluctance to helping behavior". Data were analyzed using ANOVA and t-tests. The scenario describing a character with a low SES significantly received more "Negative attributions about people with health problems" than the character with medium or high SES. Participants having higher alcohol consumption themselves showed lower stigma scores for three out of four scales than participants with lower consumption. In addition, participants identified as health professionals had lower stigma scores regarding the scales "Negative attributions about people with health problems" and "Controllability of drinking", and higher scores for the subscale "Reluctance to helping behavior", compared with non-professionals. A character with low SES received more negative attributions than the one with higher SES. Participants' own alcohol consumption and professional status (being health professional or not), influenced their stigmatizing attitudes.
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Affiliation(s)
- Camille Auriol
- Laboratoire CERPPS, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Patrick Raynal
- Laboratoire CERPPS, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Nicole Cantisano
- Laboratoire CERPPS, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
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Matsuyama Y, Tabuchi T. Does Tobacco Smoking Increase Social Isolation? A Mendelian Randomization Study. Am J Epidemiol 2024; 193:626-635. [PMID: 37981720 PMCID: PMC10999643 DOI: 10.1093/aje/kwad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
In this study, we aimed to investigate the causal effect of smoking on social isolation among older adults in England. Data from older adults of European ancestry who participated in 1 or more waves of the English Longitudinal Study of Ageing, from wave 1 (2002/2003) to wave 9 (2018/2019), were analyzed (n = 43,687 observations from 7,008 individuals; mean age = 68.50 years). The effect of current smoking on social isolation (ranging from 0 to 5) was estimated by 2-stage least squares regression using a polygenic score (PGS) for smoking cessation as the instrument. A low PGS for smoking cessation predicted current smoking (per 1-standard-deviation lower PGS, coefficient = 0.023, 95% confidence interval (CI): 0.015, 0.030; F = 36.420). The second-stage regression showed that current smoking increased social isolation by 1.205 points (95% CI: 0.308, 2.101). The association was larger for persons with higher socioeconomic backgrounds: 2.501 (95% CI: -0.024, 5.026) and 0.696 (95% CI: -0.294, 1.686) for those with higher and lower educational levels, respectively. This study showed that current smoking instrumented by a PGS for smoking cessation was associated with social isolation. Assuming that the PGS served as a valid instrument in this study, the findings support an effect of smoking on social isolation.
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Affiliation(s)
- Yusuke Matsuyama
- Correspondence to Dr. Yusuke Matsuyama, Department of Oral Health Promotion, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, Japan (e-mail: )
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Warner ET, Revette A, Restrepo E, Lathan CS. Women's Information Needs and Educational Preferences Regarding Lung Cancer Screening. J Womens Health (Larchmt) 2024; 33:318-327. [PMID: 38061051 PMCID: PMC10924114 DOI: 10.1089/jwh.2023.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
Background: Physicians are less likely to discuss lung cancer screening (LCS) with women, and women have lower awareness of LCS availability. The objective of this qualitative study was to determine information needs, patient-provider communication barriers, and preferences for LCS education among women. Materials and Methods: Eight semistructured qualitative focus groups were conducted with 28 self-identified women meeting LCS eligibility criteria. Participants were recruited through a large health system, from a community-based LCS program, and through a national online database between October 2020 and March 2021. Focus groups were led by a trained moderator via Zoom. Audio recordings were transcribed and analyzed using thematic analysis by investigators. Results: LCS decision-making influences included: (1) Health care provider recommendation; (2) Self-advocacy; (3) Insurance coverage and cost; (4) Family; and (5) Interest in early detection. Participants preferred video and print materials, available at physician's office or shared by physician, without scare tactics or shaming about smoking, use clear language, with diverse participants and images. Preferred content focused on: (1) Benefits of early detection; (2) Lung cancer definition, statistics, and risk factors; (3) Benefits of quitting smoking; (4) Demonstration or explanation of how LCS is done; and (5) Availability of other tests and potential harms of screening. Conclusion: Women in our study had limited awareness of LCS and their eligibility and wanted recommendation and support for LCS from their health care providers. We identified addressable information needs about lung cancer and the screening process that can be used to improve LCS uptake in women and shared decision-making processes.
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Affiliation(s)
- Erica T. Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna Revette
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily Restrepo
- Clinical Translational Epidemiology Unit, Department of Medicine, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher S. Lathan
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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David JC, Rascle N, Auriacombe M, Serre F, Sutter-Dallay AL, Loyal D. A video-based intervention to overcome pregnancy smoking stigma among healthcare students: a randomised controlled trial. Psychol Health 2024:1-20. [PMID: 38372141 DOI: 10.1080/08870446.2024.2316677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES This study tests a video intervention to reduce pregnancy smoking stigma among French healthcare students. DESIGN The participants were randomly selected to watch online either an experimental video (presenting educational content regarding stigma and contact with pregnant smokers) or a control video (presenting standard educational content about the risks of smoking). The students completed scales assessing stigma, intention to address smoking cessation and self-efficacy to do so, before the intervention (T0, n = 252), one week after the intervention (T1, n = 187), and one month after the intervention (T2, n = 131). RESULTS Compared to the medical students, especially men, the midwifery students reported lower derogative cognitions (η2p = .18), negative behaviours (η2p = .07) and personal distress (η2p = .06). However, the midwifery students also reported lower levels of intention to address smoking (η2p = .02) than the medical students. The experimental video decreased derogative cognitions to a greater extent than the control video (η2p = .23) in both the short and medium term. This study is the first intervention designed to reduce the stigmatisation of pregnant smokers by healthcare students. We recommend that the issue of stigma should receive more attention in the medical curriculum.
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Affiliation(s)
- J-C David
- Université Paris Cité, CRPMS, Paris, France
| | - N Rascle
- Univ. Bordeaux, Inserm U1219 Bordeaux Population Health, Bordeaux, France
| | - M Auriacombe
- Hôpital Charles Perrens, Bordeaux, France
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - F Serre
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - A-L Sutter-Dallay
- Univ. Bordeaux, Inserm U1219 Bordeaux Population Health, Bordeaux, France
- Hôpital Charles Perrens, Bordeaux, France
| | - D Loyal
- Université Paris Cité, CRPMS, Paris, France
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Rogova A, Leal IM, Britton M, Chen TA, Lowenstein LM, Kyburz B, Casey K, Skeene K, Williams T, Reitzel LR. Implementing a tobacco-free workplace program at a substance use treatment center: a case study. BMC Health Serv Res 2024; 24:201. [PMID: 38355470 PMCID: PMC10865640 DOI: 10.1186/s12913-024-10629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center. METHODS This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice. RESULTS Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center. CONCLUSIONS Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
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Affiliation(s)
- Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America.
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America.
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Tzuan A Chen
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Lisa M Lowenstein
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kathleen Casey
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kim Skeene
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Teresa Williams
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Lorraine R Reitzel
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
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Lund KE, Saebo G. Challenges in legitimizing further measures against smoking in jurisdictions with robust infrastructure for tobacco control: how far can the authorities allow themselves to go? Harm Reduct J 2024; 21:33. [PMID: 38321438 PMCID: PMC10848560 DOI: 10.1186/s12954-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND According to a recently published study, approximately half of those who currently smoke in Norway have little or no desire to quit despite a hostile regulatory and socio-cultural climate for smoking. On this background, we discuss some challenges that regulators will face in a further tightening of structural measures to curb smoking. MAIN BODY Central to our discussion is the research literature concerned with the concept of state-paternalism in tobacco control-the line between an ethically justified interference with the freedom of those who smoke and an exaggerated infringement disproportionate to the same people's right to live as they choose. In countries with an already advanced infrastructure for tobacco control, this dilemma might become quite intrusive for regulators. We ask that if people, who smoke are aware of and have accepted the risks, are willing to pay the price, smoke exclusively in designated areas, and make decisions uninfluenced by persuasive messages from manufacturers-is a further tightening of anti-smoking measures still legitimate? Strengthening of the infrastructure for tobacco control can be seen as a "help" to people who-due to some sort of "decision failure"-continue to smoke against their own will. However, for those who want to continue smoking for reasons that for them appear rational, such measures may appear unwanted, punitive, and coercive. Is it within the rights of regulators to ignore peoples' self-determination for the sake of their own good? We problematize the "help" argument and discuss the authorities' right to elevate the zero-vision of smoking as universally applicable while at the same time setting up barriers to switching to alternative nicotine products with reduced risk. CONCLUSION We recommend that a further intensification of smoking control in countries that already have a well-developed policy in this area requires that regulators start to exploit the opportunity that lies in the ongoing diversification of the recreational nicotine market.
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Affiliation(s)
- Karl Erik Lund
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway.
| | - Gunnar Saebo
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway
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Abstract
Research on the effects of stigmatizing on smokers shows that it is stressful to be reminded of one's devalued status and stigmatization might help or hinder quitting intentions. In this study, we asked smokers (N=277) to play an online ball-tossing Cyberball game, ostensibly with non-smoking strangers. Participants were randomly assigned to an ostracism (included or excluded) and concealment (smoking status concealed or revealed) manipulation. We found that exclusion led smokers (directly or via threat appraisals) to be more stressed, cognitively depleted, rejection sensitive, have fewer positive cognitions, see themselves at greater health risk, feel more internalized stigma, and be more interested in quitting, with stronger effects when their smoking status was revealed instead of concealed. These results suggest that concealment is imperfect in protecting against stigma and that exclusion (although stressful and cognitively taxing) can lead to cognitions, attitudes, and intentions helping smokers quit and thus leave their devalued identity. The results do not imply that one ought to stigmatize; stigmatizing smokers might be unethical or create barriers to health-seeking behaviors which could counteract structural efforts to help smokers quit. Future research should examine the role of self-affirmation to increase the effectiveness of health messages perceived as stigmatizing or identity threatening.
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Sæbø G, Lund M. Is the perceived public stigma of smokers associated with value opposites? An exploratory cross-sectional analysis of Norwegian data 2011-2013. FRONTIERS IN SOCIOLOGY 2024; 8:1051189. [PMID: 38274842 PMCID: PMC10808314 DOI: 10.3389/fsoc.2023.1051189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Smoker stigma is a likely unintended consequence of tobacco polices aiming to denormalise smoking. Little is known about the dissemination of stigmatising attitudes toward smokers at the population level, including their associations with personal values. Applying a theoretical approach that conceptualises stigma as a cultural (moral and intersubjective) issue, we analyse the spread of perceived public stigma of smokers in Norway and factors predicting agreement with such a perception. Using merged data from the biennial national survey Norwegian Monitor 2011 and 2013 (N = 7,792), we tested whether the tendency to agree with a perceived public stigma of smokers differs by four indexes of value opposites ('puritanism/emancipation,' 'conformity/individuality,' 'tolerance/intolerance,' 'status/anti-status'), controlling for smoking status, SES, and demographics. Descriptive statistics and block-wise logistic regression models were applied. In the total sample, 59.1% agree with the statement that 'most people think less of a person who smokes.' Two of the four indexes of value opposites tested were associated with tendencies to agree with the perceived public stigma of smokers ('puritanism/emancipation' and 'status/anti-status'). Smokers with current plans to quit expressed the highest perceived public stigma, while ex-smokers expressed a higher perceived public stigma than never-smokers. Women, young people and respondents with high SES agree with a public stigma of smokers more than men, older people and respondents with low SES do. The perceived public stigma of smokers is high in Norway and varies to some extent with personal values, but also with socio-demographics and especially smoking status.
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Affiliation(s)
- Gunnar Sæbø
- Norwegian Institute of Public Health, Oslo, Norway
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Kjeld SG, Thygesen LC, Danielsen D, Jensen MP, Krølner RF, Pisinger C, Andersen S. Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial. BMJ Open 2024; 14:e070176. [PMID: 38191253 PMCID: PMC10806711 DOI: 10.1136/bmjopen-2022-070176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting. DESIGN Cluster randomised controlled trial stratified by school type with 5 months follow-up. SETTING AND PARTICIPANTS Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491). INTERVENTIONS The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support. OUTCOMES Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers. RESULTS We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40). CONCLUSIONS Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers. TRIAL REGISTRATION NUMBER ISRCTN16455577.
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Affiliation(s)
- Simone G Kjeld
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Lau C Thygesen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Dina Danielsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Marie P Jensen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Rikke F Krølner
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Charlotta Pisinger
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital, Frederiksberg, Denmark
- Tryg Foundation, Virum, Denmark
| | - Susan Andersen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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11
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David JC, Fonte D, Sutter-Dallay AL, Auriacombe M, Serre F, Rascle N, Loyal D. The stigma of smoking among women: A systematic review. Soc Sci Med 2024; 340:116491. [PMID: 38096599 DOI: 10.1016/j.socscimed.2023.116491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/04/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences. METHODS In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies. RESULTS The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation. CONCLUSIONS These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.
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Affiliation(s)
| | | | - Anne-Laure Sutter-Dallay
- Inserm U1219 Bordeaux Population Health, Bordeaux, France; Hôpital Charles Perrens, Bordeaux, France
| | - Marc Auriacombe
- Hôpital Charles Perrens, Bordeaux, France; CNRS UMR 6033, SANPSY, Bordeaux, France
| | | | - Nicole Rascle
- Inserm U1219 Bordeaux Population Health, Bordeaux, France
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12
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Abufarsakh B, Scarduzio J, Okoli C. Smoking Cessation Barriers among Individuals with Mental Illnesses: A Qualitative Study of Patients' and Healthcare Providers' Perspectives. Issues Ment Health Nurs 2023; 44:1159-1166. [PMID: 37819773 DOI: 10.1080/01612840.2023.2255261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
In this paper we aimed to explore: (1) challenges that people with mental illnesses (MIs) describe in engaging in smoking cessation, (2) challenges that mental health providers (MHPs) perceive that people living with MIs face, and (3) how the perceived challenges are similar and/or different from both perspectives. Semi-structured interviews were used to obtain narrative data from 16 MHPs and 13 psychiatric inpatients with MIs. We identified themes purport societal, group, and individual factors may influence smoking cessation treatment engagement. The scope of the perceived challenges appeared varied in the narratives of MHPs as compared to those with MI.
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Affiliation(s)
| | | | - Chizimuzo Okoli
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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13
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Olson RE, Wen EX, Staines Z, Goh F, Marshall HM. Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening. Health (London) 2023; 27:1115-1134. [PMID: 35668696 DOI: 10.1177/13634593221099108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.
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14
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Kava CM, Strait M, Treend K, Vu T, Hannon PA, Harris JR. Opportunities to Improve Tobacco Control for State Agency Employees. J Occup Environ Med 2023; 65:e710-e716. [PMID: 37641188 PMCID: PMC10840754 DOI: 10.1097/jom.0000000000002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The aim of the study is to explore tobacco-related knowledge and perceptions at Washington State (WA) agencies. METHODS The study used a cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data. RESULTS Of employees, only 18% with a history of tobacco use had used their agency's cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts. CONCLUSIONS State agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.
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Affiliation(s)
- Christine M Kava
- From the Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington (C.M.K., M.S., T.V., P.A.H., J.R.H.); and Washington State Department of Health, Tumwater, Washington (K.T.)
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15
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McGarity-Shipley EC, Lee EY, Pyke KE. A pilot cross-sectional investigation of chronic shame as a mediator of the relationship between subjective social status and self-rated health among middle-aged adults. Health Psychol Behav Med 2023; 11:2268697. [PMID: 37842010 PMCID: PMC10569351 DOI: 10.1080/21642850.2023.2268697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
Subjective social status (SSS) is an important independent predictor of health outcomes, however, the pathways through which it affects health are poorly understood. Chronic shame has previously been suggested as a potential mechanism but this has never been investigated and the relationship between chronic shame and health is under-researched. The purpose of this pilot study was to explore whether chronic shame explains a significant portion of the association between SSS and self rated health (SRH). Two-hundred American adults aged 30-55 years were recruited via a crowd-sourcing platform and were asked to provide information on their SSS, level of chronic shame, and SRH. Chronic shame significantly mediated the relationship between SSS and SRH. This pilot study provides initial evidence that shame explains a significant portion of the relationship between subjective social status and self-rated health. These findings support the initiation of larger, longitudinal investigations into chronic shame as a mediator of the subjective social status and self-rated health relationship.
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Affiliation(s)
- Ellen C. McGarity-Shipley
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
| | - Eun-Young Lee
- In Situ Population Health Research Group, School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
| | - Kyra E. Pyke
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
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16
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Pope I, Suresh C, Ward E, Belderson P, Notley C. Biochemical Verification of Tobacco-Use as an Inclusion Criterion in Smoking Cessation Trials- Lessons From the Cessation of Smoking Trial in the Emergency Department. Tob Use Insights 2023; 16:1179173X231193898. [PMID: 37588031 PMCID: PMC10426292 DOI: 10.1177/1179173x231193898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Biochemical verification of smoking status prior to recruitment into smoking cessation trials is widely used to confirm smoking status, most commonly using exhaled carbon monoxide (CO). There is variation in the level of CO used as a biochemical inclusion criterion, and thus the possibility for people reporting to be current smokers to be incorrectly excluded from trials. METHODS As part of the Cessation of Smoking Trial in the Emergency Department, people attending the Emergency Department (ED) who reported being current daily smokers underwent CO testing to confirm eligibility. Elective semi-structured interviews were undertaken with the researchers who recruited participants. As part of the interviews, researchers were asked their views and experiences with CO testing. RESULTS Of the 1320 participants who reported being current daily smokers and underwent CO testing, 300 (22.7%) blew a CO reading of 7 ppm or less and were excluded from taking part. Possible explanations offered by researchers for participants blowing low CO readings were (1) long wait times in the ED, therefore a long period having elapsed since people had last smoked and (2) patients having reduced smoking for the period before the ED attendance due to ill health. CONCLUSIONS Biochemical verification has the potential to improve internal validity of smoking cessation for inclusion in trials, but at the cost of reduced generalisability through exclusion of participants who would receive the intervention if it were implemented in practice. We would recommend researchers carefully consider whether it is appropriate and necessary to include biochemical verification as an inclusion criterion.
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Affiliation(s)
- Ian Pope
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Emma Ward
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
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17
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Al-Zalabani AH, Monshi SS, Al-Ahmadi AF, Ali AKA, Mirdad GA, Alanazi MM, Alsaedi MQ, Alanazi AM. Dissuasive cigarettes as a tobacco control measure: a scoping review. Tob Control 2023:tc-2023-057974. [PMID: 37414527 DOI: 10.1136/tc-2023-057974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim was to identify and review the research literature on dissuasive cigarettes, including key concepts, types, sources of evidence and research gaps. DATA SOURCES PubMed, Scopus and Web of Science databases were searched up to January 2023 with no language or date restrictions. All study designs were included. Reference lists of the identified studies were manually searched. Studies on tobacco products other than cigarettes or on external cigarette packaging alone were excluded. STUDY SELECTION Two reviewers screened titles and abstracts independently using eligibility criteria. The full text of the selected articles was subsequently screened independently by two reviewers to confirm eligibility. DATA EXTRACTION Two reviewers independently extracted data from all studies using data abstraction forms. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS We identified 24 original studies, 3 review articles and 4 commentary articles. Research on dissuasive cigarettes was reported from Australia, New Zealand, Europe and North America. We presented results in four themes: the concept of dissuasive cigarettes; approaches and types; potential benefits, barriers and concerns; and current research gaps. CONCLUSIONS Dissuasive cigarettes represent a promising strategy that could be used in tobacco control. Parallel implementation with plain packaging would be feasible and synergistic.
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Affiliation(s)
| | - Sarah S Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Ahmed Khalid A Ali
- Model of Care, Al-Madinah Health Cluster, Al-Madinah Al-Munawarah, Saudi Arabia
| | | | - Manal Muteb Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mawada Qabl Alsaedi
- Saudi Board Preventive Medicine Program, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Abdullah M Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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18
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Jung AR, Lee G. The changes in smoking stigmatization during the COVID-19 pandemic. PUBLIC HEALTH IN PRACTICE 2023; 5:100383. [PMID: 37056634 PMCID: PMC10076244 DOI: 10.1016/j.puhip.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
Objectives This study aimed to analyze the changes in smoking stigmatization in relation to an individual's smoking status after the COVID-19 outbreak. Study design A 2 (before vs. after COVID-19) X 2 (smoking status: smoker vs. non-smoker) factorial design was developed. Methods Two national surveys were conducted, one each before (between January 7th and 15th, 2020) and after (between January 26th and February 18th, 2021) the COVID-19 outbreak in South Korea. A total of 7296 representative adult responses were finalized. Respondents were categorized into two groups: non-smokers and smokers. Smoking stigma was measured in two ways: social and personal. Results In general, smoking stigmatization intensified after the COVID-19 outbreak. However, there was a discrepancy in responses based on smoking status-non-smokers exhibited a heightened negative stigma toward smokers, whereas smokers had generous perspectives about themselves. Conclusions The health-oriented environment generated by the response to COVID-19 is leading to increased stigmatization of smokers who pose a risk to public health. However, the discrepancy between smokers and non-smokers shows that social efforts are required to alter smokers' generous views about themselves and to persuade them to cease smoking.
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Affiliation(s)
- A-Reum Jung
- Department of Media & Communication, Sejong University, Neungdong-ro, Gwangjin-gu, Seoul, 05006, South Korea
| | - Guiohk Lee
- Department of Media & Communication, Sejong University, Neungdong-ro, Gwangjin-gu, Seoul, 05006, South Korea
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19
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Woo S, Veliz P, Saint Arnault DM, Struble LM, Earl A, Larson JL. Development and preliminary psychometric evaluation of the COPD-related Stigma Scale. Heart Lung 2023; 61:22-28. [PMID: 37084465 DOI: 10.1016/j.hrtlng.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Stigma experiences contribute to psychological distress and negatively affect healthcare-seeking behavior in people with chronic obstructive pulmonary disease (COPD). Most evidence comes from qualitative research, and no well-established measure of COPD-related stigma exists. Prior research yielded a preliminary measure of COPD-related stigma, but it required item reduction and validation. OBJECTIVES The purpose of this study was to revise the preliminary measure, reduce the number of items, identify underlying constructs, and evaluate the reliability and validity of the shortened version. METHODS A descriptive, cross-sectional study was conducted. Participants (N = 148; mean = 64 ± 7.27 years) completed the 51-item preliminary COPD-related Stigma Scale (COPDSS). Item-level analysis was conducted before running exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Convergent validity and known-groups validity were evaluated. RESULTS In the item-level analysis, eight items were deleted, leaving 43 items for factor analysis. A four-factor model with 24 items (α = 0.93) was derived from EFA: social stigma (α = 0.95), felt stigma (α = 0.95), anticipated stigma-oxygen (α = 0.80), and smoking-related stigma (α = 0.81). The 24-item COPDSS was significantly correlated with the 8-item Stigma Scale for Chronic Illness (r = 0.83), the Hospital Anxiety and Depression Scale (r = 0.57), and the PROMIS Physical Function (r = -0.48). The 24-item COPDSS discriminated between known groups based on age (p = .03), use of inhalers (p = .002) and use of supplemental oxygen (p < .001), and psychological distress levels (ps < .001). CONCLUSION Findings support the reliability and validity of the 24-item COPDSS. This instrument can be used to understand underlying stigma processes in people with COPD.
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Affiliation(s)
- Seoyoon Woo
- School of Nursing, University of Michigan, Ann Arbor, MI, United States.
| | - Philip Veliz
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Laura M Struble
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Allison Earl
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Janet L Larson
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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20
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Gilbert E, Ewald A. "You get past the packaging": young women smokers' resistance to standardized cigarette packaging. Women Health 2023; 63:186-193. [PMID: 36650637 DOI: 10.1080/03630242.2022.2164397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We examined how young women construct and experience plain tobacco packaging. Forty-one Australian young women who are current smokers took part in this qualitative interview research. Data was analyzed using constructivist grounded theory, with the core category about the strategic ways young women resist plain tobacco packaging. The majority of women reported that plain packaging was unappealing and that the larger health warnings were shocking and offensive. However, almost all reported being desensitized to the graphic health warnings. The graphic warnings were seen as "fake" or lacking in credibility, and irrelevant to the women's life stage. Importantly, the majority of women engaged in practices to strategically resist and avoid health warnings on the packs as a way to continue smoking. Our findings point to the need to develop health warnings on tobacco products that are gender specific and focus on proximal social consequences to increase salience for young women smokers.
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Affiliation(s)
- E Gilbert
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - A Ewald
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
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21
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Hefler M, Durkin SJ, Cohen JE, Henriksen L, O'Connor R, Barnoya J, Hill SE, Malone RE. New policy of people-first language to replace 'smoker', 'vaper' 'tobacco user' and other behaviour-based labels. Tob Control 2023; 32:133-134. [PMID: 36806099 PMCID: PMC9985717 DOI: 10.1136/tc-2023-057950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia .,NHMRC Centre of Research Excellence in Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Joaquin Barnoya
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala, Guatemala.,Integra Cancer Institute, Guatemala, Guatemala
| | - Sarah E Hill
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Ruth E Malone
- Social and Behavioral Sciences, University of California, San Francisco, California, USA
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22
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Welberry HJ, Chau T, Heffernan M, San Jose JC, Jorm LR, Singh MF, Sachdev PS, Anstey KJ, Lautenschlager NT, Valenzuela M, McNeil J, Brodaty H. Factors Associated with Participation in a Multidomain Web-Based Dementia Prevention Trial: Evidence from Maintain Your Brain (MYB). J Alzheimers Dis 2023; 92:959-974. [PMID: 36806506 DOI: 10.3233/jad-220990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The Maintain Your Brain (MYB) trial aims to prevent cognitive decline and dementia through multidomain, web-based risk-reduction. To facilitate translation, it is important to understand drivers of participation. OBJECTIVE To describe characteristics associated with participation in MYB. METHODS This was an observational ancillary study of MYB, a randomized controlled trial nested within the 45 and Up Study in New South Wales, Australia. We linked 45 and Up Study survey and MYB participation data. The study cohort comprised 45 and Up Study participants, aged 55-77 years at 1 January 2018, who were invited to participate in MYB. 45 and Up Study participant characteristics and subsequent MYB consent and participation were examined. RESULTS Of 98,836 invited, 13,882 (14%) consented to participate and 6,190 participated (6%). Adjusting for age and sex, a wide range of factors were related to participation. Higher educational attainment had the strongest relationship with increased MYB participation (university versus school non-completion; AdjOR = 5.15; 95% CI:4.70-5.64) and lower self-rated quality of life with reduced participation (Poor versus Excellent: AdjOR = 0.19; 95% CI:0.11-0.32). A family history of Alzheimer's disease was related to increased participation but most other dementia risk factors such as diabetes, obesity, stroke, high blood pressure, and current smoking were associated with reduced participation. CONCLUSION Higher socio-economic status, particularly educational attainment, is strongly associated with engagement in online dementia prevention research. Increasing population awareness of dementia risk factors, and better understanding the participation barriers in at-risk groups, is necessary to ensure online interventions are optimally designed to promote maximum participation.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Juan Carlo San Jose
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Fiaratone Singh
- School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Valenzuela
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
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23
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Madawala S, Osadnik CR, Warren N, Kasiviswanathan K, Barton C. Healthcare experiences of adults with COPD across community care settings: a meta-ethnography. ERJ Open Res 2023; 9:00581-2022. [PMID: 36755964 PMCID: PMC9900446 DOI: 10.1183/23120541.00581-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Studies investigating lived experiences of patients with COPD raise important concerns about interactions with healthcare professionals. Patients often describe feelings of guilt and shame associated with their COPD and may experience stigma and poor patient experience of care. The aims and objectives of the present study were to systematically scope and synthesise findings from peer-reviewed qualitative studies describing healthcare experiences of patients living with COPD across community care settings. Methods A meta-ethnography was undertaken. Database searches were performed in Ovid MEDLINE, PsychINFO, Ovid Emcare, CINAHL Plus and Sociological Abstracts. Eligible qualitative studies were included. Study screening and data extraction was performed by two independent reviewers. A "line-of-argument" synthesis and deductive and inductive analysis was used to identify key themes, where the deductive element aligned to Wong and Haggerty's six key dimensions of patient experiences. Results Data from 23 studies were included. Experiences and their meaning to patients were explored within the context of six domains of patient experience including access, interpersonal communication, continuity and coordination, comprehensiveness and trust. Inductive coding revealed emotion, stigma, identity and vulnerability shaped healthcare experiences of adults with COPD. Implications Experiences often fell short of what was expected and needed in community settings. Adopting strategies to improve experiences of care in the community can be expected to improve self-management and contribute to improved health outcomes and quality of life. These strategies should take account of vulnerability, stigma and emotions such as guilt and blame that are potent affective drivers of the experience of care for patients with COPD.
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Affiliation(s)
- Sanduni Madawala
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia,Corresponding author: Sanduni Madawala ()
| | - Christian Robert Osadnik
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Narelle Warren
- Department of Sociology, School of Social Sciences, Faculty of Arts, Monash University, Victoria, Australia
| | - Karthika Kasiviswanathan
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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24
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Getz V, Munkhaugen J, Lie HC, Dammen T. Barriers and facilitators for smoking cessation in chronic smokers with atherosclerotic cardiovascular disease enrolled in a randomized intervention trial: A qualitative study. Front Psychol 2023; 14:1060701. [PMID: 37034951 PMCID: PMC10074255 DOI: 10.3389/fpsyg.2023.1060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives Smoking is common in patients with cardiovascular disease. Despite strong recommendations for cessation and the existence of efficacious pharmacological and behavioral interventions, cessation rates remain low. Therefore, in this study, we explore perceived facilitators and barriers to smoking cessation in patients with atherosclerotic cardiovascular disease who have participated in a cessation intervention study. Methods Participants (N = 10) from the intervention arm of a randomized controlled study with access to free cessation support and pharmacological aids completed a semi-structured, in-depth telephone interview after a 6-monthfollow-up between October 2021 and July 2022. The interviews were audio recorded, transcribed, and analyzed according to principles of thematic analysis. Results The mean age was 65.7 (range: 55-79) years, and three of the 10 participants were women. Among the participants, five had quit smoking, three had relapsed, and two were persistent smokers. The themes identified encompassed barriers and facilitators to cessation, both including individual and contextual factors. Barriers included the upsides of smoking, difficult life situations, addiction to smoking, smoking in social circles, perceived lack of support and understanding from health professionals. Facilitators included intrinsic motivation, concerns about the health condition, financial implications, specific behavioral strategies, positive influence from the social environment, and helpful components of the cessation intervention. Conclusion Smokers with cardiovascular disease who have attended a cessation intervention study report several facilitators weighted against barriers, interacting with the intention to cease smoking. The most important potentially modifiable factors of significance for cessation identified may be addressed through motivational interviews and focus groups with other smokers.
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Affiliation(s)
- Vilde Getz
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Hanne C. Lie
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- *Correspondence: Toril Dammen
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25
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Alanazi AM, Monshi SS, Alfahadi NA, Alsayari SS, Alkhonain FS, Alsulami NM, Alotaibi TF, Algarni SS, Abunurah HY, Al-Zalabani AH, Ismaeil TT. The associations between the credibility of the tobacco control regulatory body and smoking behavior change among Saudi smokers. Tob Induc Dis 2022; 20:107. [PMID: 36514796 PMCID: PMC9717579 DOI: 10.18332/tid/155814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Recently, Saudi Arabia has extensively reformed its tobacco control policies and extended its smoking cessation services. A public outrage on social media among smokers was witnessed, especially after the implementation of plain cigarette packaging, which might have discredited the significant efforts of tobacco treatment services and tobacco control policies. However, it is not known how the credibility of the tobacco control regulatory body among Saudi smokers might affect their smoking behavior. METHODS Saudi tobacco smokers (n=511) were recruited using a convenience sampling technique. A cross-sectional survey was conducted comprising questions related to the credibility of the tobacco control regulatory body (modified Food and Drug Administration Tobacco Credibility Scale), quit attempts, use of nicotine replacement therapy (NRT), and motivation to change smoking behavior in the future. Logistic and linear regression models were used for the analysis. RESULTS The public interest subscale of the credibility of the tobacco control regulatory body, was positively associated with confidence in changing smoking behavior (β=0.204; 95% CI: 0.078-0.713; t=2.449, p=0.015) and readiness to change smoking behavior (β=0.237; 95% CI: 0.127-0.727; t=2.802, p=0.005). Moreover, the subscale of expertise was positively associated with confidence in changing smoking behavior (β=0.190; 95% CI: 0.006-0.697; t=1.999, p=0.046) and readiness to change smoking behavior (β=0.225; 95% CI: 0.063-0.710; t=2.352, p=0.019). However, public interest in the credibility of the tobacco control regulatory body was negatively associated with NRT use among smokers who tried to quit (adjusted odds ratio, AOR=0.691; 95% CI: 0.526-0.909). The credibility of the tobacco control regulatory body, however, was not associated with the last month's or ever quit attempts. CONCLUSIONS The credibility of the tobacco control regulatory body was positively associated with motivation to change smoking behavior but negatively associated with NRT use. Optimizing communication tools with the public is a potential avenue for improving smoking treatment and prevention in Saudi Arabia.
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Affiliation(s)
- Abdullah M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sarah S. Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Nada A. Alfahadi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sadeem S. Alsayari
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Foton S. Alkhonain
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Norah M. Alsulami
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tareq F. Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh S. Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hassan Y. Abunurah
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Taha T. Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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26
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Barasinski C, Zaros C, Bercherie J, Bernard JY, Boisseau N, Camier A, Chanal C, Doray B, Dugravier R, Evrard A, Ficheux AS, Garlantézec R, Kadawathagedara M, Laurent-Vannier A, Lecorguillé M, Marie C, Molénat F, Pelé F, de Villepin BP, Rigourd V, Rousseau M, Storme L, Weiss S, Salinier C, Béranger R. Intervention during the Perinatal Period: Synthesis of the Clinical Practice Guidelines from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S2-S16. [PMID: 36480672 DOI: 10.1111/jmwh.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
These clinical practice guidelines from the French National College of Midwives (CNSF) are intended to define the messages and the preventive interventions to be provided to women and co-parents by the different professionals providing care to women or their children during the perinatal period. These guidelines are divided into 10 sections, corresponding to 4 themes: 1/ the adaptation of maternal behaviors (physical activity, psychoactive agents); 2/ dietary behaviors; 3/ household exposure to toxic substances (household uses, cosmetics); 4/ promotion of child health (breastfeeding, attachment and bonding, screen use, sudden unexplained infant death, and shaken baby syndrome). We suggest a ranking to prioritize the different preventive messages for each period, to take into account professionals' time constraints.
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Affiliation(s)
- Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Axe TGI-DecisipH, Clermont-Ferrand, F-63000, France
| | - Cécile Zaros
- French Institute for Demographic Studies (Ined), French Institute for Medical Research and Health (Inserm), French Blood Agency, ELFE Joint Unit, Aubervilliers, F-93320, France
| | | | - Jonathan Y Bernard
- Centre de Recherche en Épidémiologie et StatistiqueS (CRESS), Inserm, INRAE, Université de Paris, Paris, F-75004, France
| | - Nathalie Boisseau
- Université Clermont Auvergne, laboratoire AME2P, Clermont-Ferrand, F-63000, France
| | - Aurore Camier
- Centre de Recherche en Épidémiologie et StatistiqueS (CRESS), Inserm, INRAE, Université de Paris, Paris, F-75004, France
| | - Corinne Chanal
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier cedex 5, F-34295, France.,Réseau de Périnatalité Occitanie Espace Henri BERTIN SANS, Montpellier, F-34080, France
| | - Bérénice Doray
- Service de génétique, CHU de La Réunion, cedex, Saint-Denis, 97405, France.,Centre Ressource Troubles du Spectre de l'Alcoolisation Fœtale (TSAF) - Fondation Père Favron, Saint-Pierre, 97410, France
| | - Romain Dugravier
- Centre de psychopathologie Périnatale Boulevard Brune - GHU Paris Psychiatrie et Neurosciences, Paris, 75014, France
| | - Anne Evrard
- Association Bien Naître, Lyon, 69003, France.,Association Ciane (Collectif interassociatif autour de la naissance), Paris, 75011, France
| | | | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, F-35000, France
| | - Manik Kadawathagedara
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, F-35000, France
| | - Anne Laurent-Vannier
- Hôpitaux de Saint Maurice, Service de rééducation des enfants après atteinte cérébrale acquise, Centre de suivi et d'insertion après lésions cérébrales acquises, Saint, F-94410, Maurice
| | - Marion Lecorguillé
- Centre de Recherche en Épidémiologie et StatistiqueS (CRESS), Inserm, INRAE, Université de Paris, Paris, F-75004, France
| | - Cécile Marie
- Agence régionale de Santé Auvergne-Rhône-Alpes, 241 rue Garibaldi CS 93383, Lyon, 69418 cedex 03
| | - Françoise Molénat
- Association de Formation et de Recherche sur l'Enfant et son Environnement (AFREE), Montpellier, 34000, France.,Société francophone de psychologie périnatale, Montpellier, 34090, France
| | - Fabienne Pelé
- Département de médecine générale, Université de Rennes 1, Rennes, France.,Université de Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, F-35000, France
| | - Brune Pommeret de Villepin
- Service gynécologie-obstétrique, Centre hospitalier de Tourcoing, 155 rue du Président-René-Coty, Tourcoing, 59200, France
| | - Virginie Rigourd
- Lactarium Ile de France, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, 75015, France
| | - Mélie Rousseau
- Association pour la Prévention de la Pollution Atmosphérique (APPA), Loos, France
| | - Laurent Storme
- Univ. Lille, ULR 2694 METRICS, Department of Neonatology, CHU Lille, Lille, F-59000, France
| | | | | | - Rémi Béranger
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, F-35000, France
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Clawson AH, Cole AB, Kurien CS, Blair AL. Racial and ethnic differences in distress, discrimination, substance use coping, and nicotine use among parents during COVID-19. J Ethn Subst Abuse 2022:1-24. [PMID: 36227608 PMCID: PMC10097833 DOI: 10.1080/15332640.2022.2128960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study identified contributing factors for tobacco-related inequities among parents (N = 331) during COVID-19. Compared to non-Hispanic White parents, Asian, Black, and multiracial parents experienced greater discrimination. Parents with a nicotine use history experienced greater discrimination and substance use coping relative to tobacco abstainers. Among parents who used nicotine during the pandemic (n = 45), experiencing financial loss, having COVID-19, and greater worries were positively associated with nicotine reductions during COVID-19. Being female, increased family members with COVID-19, discrimination, and substance use coping were negatively associated with nicotine reductions. Tobacco interventions that reduce substance use coping and increase alternative coping are needed.
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Affiliation(s)
- Ashley H. Clawson
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
| | - Ashley B. Cole
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
| | | | - Alexandra L. Blair
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, Oklahoma, 74078
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28
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Harwood A, Carter D, Eliott J. A public health framework for reducing stigma: the example of weight stigma. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:511-520. [PMID: 35857213 PMCID: PMC9463314 DOI: 10.1007/s11673-022-10199-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/01/2022] [Indexed: 05/15/2023]
Abstract
We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma (self-stigma).
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Affiliation(s)
- Alison Harwood
- The Office of Research Ethics, Compliance and Integrity, The University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Drew Carter
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Jaklin Eliott
- Associate Professor, School of Public Health, The University of Adelaide, Adelaide, South Australia 5005 Australia
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29
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Al Dharman S, Safar K, Al Enezi F, Al Bahar H, Ali A, Al Qallaf Z, Al Shaya A, Alenezi M, Al Otaibi S, Al Nassar M, Mohammad Z, Alzayani S. An experimental vignette study to assess stigmatized attitudes
towards tobacco smokers in Kuwait. Tob Prev Cessat 2022; 8:32. [PMID: 36118613 PMCID: PMC9414082 DOI: 10.18332/tpc/152254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Shouq Al Dharman
- Department of Preventive Medicine, Farwaniya Hospital, Ministry of Health, State of Kuwait
| | - Kawthar Safar
- Department of Otorhinolaryngology Head and Neck Surgery, Zain Hospital, Ministry of Health, State of Kuwait
| | | | | | - Alaa Ali
- Farwaniya Hospital, Ministry of Health, State of Kuwait
| | | | | | | | | | | | | | - Salman Alzayani
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Kingdom of Bahrain
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30
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Benny A, McLay M, Callaghan RC, Bates A, Olson R. Population-based comparison of cancer survival outcomes in patients with and without psychiatric disorders. BMC Psychiatry 2022; 22:543. [PMID: 35953787 PMCID: PMC9373539 DOI: 10.1186/s12888-022-04191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Patients with PD also potentially receive substandard care in comparison to the general population. Previous research has shown that individuals with PD have a decreased risk of receiving a tobacco related (TR) cancer diagnosis. To further assess this trend, this study assesses the survival of patients with a TR cancer with or without a PD. MATERIALS AND METHODS Our study utilized multiple databases, with methods described elsewhere,6 to identify people in British Columbia that have been diagnosed with psychiatric disorders and appendicitis (our control group). From these groups, we selected individuals who also had a TR cancer. We subsequently extracted information pertaining to these patients from these databases. RESULTS Thirty-nine thousand eight hundred forty-one patients with cancer were included in our study. Analyses of these patients were controlled for by age, gender, cancer type and diagnosis year. This analysis displayed shorter survival time among patients who were diagnosed with depression (HR = 1.16; p = 0.01; 95% CI: 1.04-1.29), schizophrenia (HR = 1.62; p < 0.01; 95% CI: 1.43-1.84), or bipolar disorder (HR = 1.35; p < 0.01; 95% CI: 1.12-1.64) compared to the cancer patients without a PD, all of which were statistically significant. People that were diagnosed with anxiety disorders did not have a survival time that was significantly different from our control population (HR = 1.07; p = 0.22; 95% CI: 0.96-1.19). CONCLUSIONS Individuals with PD, except for those with anxiety, were found to have a shorter survival time following diagnosis with a TR cancer as compared to our control group. We hypothesize several factors, which may account for this statistically significant difference: (1) delayed diagnosis, (2) poor access to care, (3) poor assessment or follow-up, or (4) physician beliefs of poor treatment adherence.
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Affiliation(s)
- Alexander Benny
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mary McLay
- grid.17091.3e0000 0001 2288 9830Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Russell C. Callaghan
- grid.266876.b0000 0001 2156 9982Division of Medical Sciences, University of Northern British Columbia, Prince George, Canada
| | - Alan Bates
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, BC Cancer, University of British Columbia, Vancouver, Canada
| | - Robert Olson
- Department of Surgery, BC Cancer, University of British Columbia, 1215 Lethbridge Street, Prince George, BC V2M7E9, Canada.
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31
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Wu Y. Tobacco Control Measures' Role in Improving Employees' Health Under the Impact of Health Education and Media Campaign. Front Public Health 2022; 10:904894. [PMID: 35874977 PMCID: PMC9301119 DOI: 10.3389/fpubh.2022.904894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Abstract
The overarching purpose of this study was to investigate the impact of health education, media campaigns, and peer counselor training on employees' health. This study also attempted to evaluate the function of tobacco control as a mediator in the relationship between employees' health and health education, media campaigns, and peer counselor training. Data were collected from 440 tobacco industry workers in China using a questionnaire technique. Smart-PLS software and a structural equation modeling (SEM) technique were used to evaluate the data. Employees' health was found to be significantly improved by health education, media campaigns, and peer counselor training. Furthermore, tobacco control was discovered to moderate the association between employee health and health education, media campaigns, and peer counselor training. By analyzing the impact of health education, media campaigns, and peer counselor training on employees' health, this research provided an important theoretical contribution. In terms of practical applications, this study would help employees consuming tobacco to maintain a healthy and safe atmosphere that encourages them to be engaged and perform well. Furthermore, this study could prove effective in resolving difficulties linked to controlling employee tobacco addiction and improving their performance. The tiny sample size of this study, which included solely employees working in the Chinese tobacco sector, was one of its limitations. In addition, future studies can incorporate other constructs to acquire a deeper knowledge of the factors that influence employees' health.
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Affiliation(s)
- Yu Wu
- Media and Communication College, Weifang University, Weifang, China
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32
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Lee HS, Su SJ, Yen ST, Tan AK. Cigarette smoking and quitting by individuals in Malaysia. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Helen S.H. Lee
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | - Shew-Jiuan Su
- Department of Geography, National Taiwan Normal University, Taipei, Taiwan
| | - Steven T. Yen
- Department of Agricultural Economics, National Taiwan University, Taipei, Taiwan
| | - Andrew K.G. Tan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
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33
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Pierce JP, Kealey S, Leas EC, Pulvers K, Stone MD, Oratowski J, Brighton E, Villaseñor A, Strong DR. Effect of Graphic Warning Labels on Cigarette Pack-Hiding Behavior Among Smokers: The CASA Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2214242. [PMID: 35653155 PMCID: PMC9164006 DOI: 10.1001/jamanetworkopen.2022.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The inclusion of graphic warning labels (GWLs) on cigarette packs is recommended for tobacco control but has not yet been implemented in the US. It is unknown whether and to what extent the inclusion of GWLs on cigarette packs affects smokers' willingness to display the packs in public. OBJECTIVE To determine whether the inclusion of GWLs on cigarette packs affects pack-hiding behavior among smokers in social settings. DESIGN, SETTING, AND PARTICIPANTS This community-based randomized clinical trial assessed smokers' real-world experience of using cigarettes repackaged to include GWLs (GWL packs) compared with standard US packs and blank packs over a 3-month intervention period with 12 months of follow-up between September 6, 2016, and December 3, 2019. The study included 357 participants aged 21 to 65 years from San Diego County, California, who smoked 5 or more cigarettes per day, were not actively planning to quit smoking, were not pregnant, and had no unstable medical conditions. Participants purchased and received cigarette packs through the study website. INTERVENTIONS During the 1-month run-in period, participants received their usual US cigarette packs. During the 3-month intervention period, participants were randomized to receive GWL packs (study-manufactured packs with 3 rotating images under license from the Commonwealth of Australia; GWL pack group), blank packs (study-manufactured packs devoid of industry marketing imagery; blank pack group), or standard US packs (US pack group). MAIN OUTCOMES AND MEASURES Pack hiding was queried daily (with participants reporting behavior within the last 4 hours) and weekly via interactive text messages during the 1-month run-in and intervention periods. Self-reported smoking behavior was biochemically validated. RESULTS Among 357 enrolled participants, the mean (SD) age was 39.3 (11.8) years; 195 participants (54.6%) were female, 40 (11.2%) were Hispanic, 243 (68.1%) were non-Hispanic White, and 74 (20.7%) were of other non-Hispanic races (including American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, or multiracial). A total of 18 987 cigarette packs were purchased and delivered during the run-in and intervention periods. Daily querying showed that the inclusion of GWLs on cigarette packs increased the percentage of smokers who hid their packs at least some of the time from 41.3% (95% CI, 39.6%-43.0%) during the run-in period to 57.1% (95% CI, 55.9%-58.1%) by the end of the intervention period. In the postintervention period, returning to standard US packs reduced pack-hiding behavior to the levels observed during the run-in period. Pack hiding remained at run-in levels for both the blank pack group (35.2%; 95% CI, 33.6%-36.8%) and the US pack group (41.4%; 95% CI, 39.7%-43.1%]) throughout the study. Although even participants in the GWL group with the lowest prestudy tendency to conceal score (ie, 1) had a mean (SE) probability of pack hiding during the intervention of 0.84 (0.02), this group's probability of pack hiding decreased to a mean (SE) of 0.43 (0.03) after intervention. When social reactions to packs were queried at the end of the study, the modal response from participants in the GWL pack group was observers' aversive reactions to the packs, whereas the modal response from participants in the blank pack group was observers' positive interest in the study. Neither smoking prevalence nor consumption differed by group at any point in the study. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, receiving cigarettes in GWL packs vs blank packs increased pack-hiding behavior in social settings, which may be associated with aversive reactions from observers. However, 12-month smoking behavior did not change. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02676193.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Kim Pulvers
- Department of Psychology, California State University, San Marcos
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Jesica Oratowski
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Elizabeth Brighton
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Adriana Villaseñor
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
- Department of Epidemiology, Public Health Services, San Diego County, San Diego, California
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
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McGarity-Shipley EC, Lew LA, Bonafiglia JT, Pyke KE. The acute effect of a laboratory shame induction protocol on endothelial function in young, healthy adults. Exp Physiol 2022; 107:978-993. [PMID: 35584040 DOI: 10.1113/ep090396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Shame is a form of social stress which involves internalizing social devaluations imposed by others. The aim of this study was to determine, for the first time, how acutely experiencing shame impacts endothelial function. What is the main finding and its importance? Brachial artery flow-mediated dilation, an index of endothelial function, was impaired following an intervention that acutely increased self reported shame. This occurred without increases in cortisol or tumor necrosis factor alpha receptor binding. Frequent or prolonged shame induced endothelial dysfunction could have important cardiovascular consequences. ABSTRACT Objective The objective of this study was to examine the impact of a shame induction protocol on endothelial function. Methods Fifteen participants (n = 7 men, n = 8 women) completed both a written shame induction and control protocol on two different experimental days. Pre- and post-protocol we assessed: 1) Endothelial function and arterial shear rate via a standard brachial artery reactive hyperemia flow-mediated dilation (FMD) test across two post-intervention time points (15 and 35-min post); 2) Perceived shame via the Experiential Shame Scale (ESS), and; 3) Cortisol and sTNFαRII (soluble tumor necrosis factor alpha receptor) through oral fluid analysis. Results Shame increased after the shame induction protocol (pre: 2.9±.6 vs. post: 3.7±.5, p<.001) but not the control protocol (pre: 3.0±.5 vs. post: 2.8±.5, p = .15) (protocol by time interaction: p<.001). When all three time points were included in the analysis, %FMD did not change over time. Considering only the lowest point, %FMD significantly decreased in response to the shame protocol (pre: 4.8±1.9 vs. post: 3.2±1.6, p<.001) but not the control protocol (4.2±1.8 vs. post: 3.8±1.5, p = .45) (protocol by time interaction: p = .035). Covariation of the shear rate stimulus for FMD did not alter the FMD results. When including both the control and shame protocol, but not the shame protocol alone, increased shame was significantly associated with decreased FMD (r = -.37, p<.046). There were no significant time by protocol interaction effects for cortisol or sTNFαRII. Conclusions Temporary increases in shame may cause transient endothelial dysfunction which, if chronically repeated, could manifest as reduced vasoprotection against atherosclerosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ellen C McGarity-Shipley
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Lindsay A Lew
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Jacob T Bonafiglia
- Muscle Physiology Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Kyra E Pyke
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
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Castaldelli-Maia JM, Nesoff ED, Lima DR, Sanchez ZM, Martins SS. The first day of smoking abstinence is more challenging for women than men: A meta-analysis and meta-regression across 12 low- and middle-income countries. Addict Behav 2022; 128:107234. [PMID: 35007914 DOI: 10.1016/j.addbeh.2021.107234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/24/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Maintained abstinence during the first 24 h of a quit attempt is a critical predictor of long-term smoking cessation. Little is known about sex differences in the very early abstinence period, particularly in the context of low- and middle-income countries (LMICs) with varying anti-smoking policies and female smoking prevalences. We examined female sex effects on one-day relapse in a cross-national sample from 12 LMICs. METHODS Data from the Global Adult Tobacco Survey (2008-2012) included nationally representative samples from 12 LMICs restricted to smokers with ≥ 1 quit attempt in the past 12 months (n = 16,576). We ran adjusted logistic regression models for female sex effects on one-day relapse, adjusting for nine individual-level demographics (e.g., age, education, age at smoking initiation) and smoking cessation variables (e.g., exposure to health warnings, receipt of counseling). We then conducted a meta-analysis adjusted for national-level and policy measures through meta-regression (e.g., cigarette consumption per capita, percent of cigarette box covered with warning labels). RESULTS One-day relapse prevalence varied across countries (2.7-13.6%). The odds of one-day relapse were significantly higher for women than for men in six countries (adjusted for nine individual-level sociodemographic variables), and there were no significant sex differences in the remaining six countries. Result remained significant after meta-regressions for national-level tobacco consumption and policy measures. Sensitivity analyses showed that the odds of one-day relapse for women remained significant when excluding countries with both higher and lower relative rates of female smoking. Larger warning labels on cigarette packs were associated with reduced odds of one-day relapse among women. CONCLUSION The first day of a quit attempt is more challenging for women than men in LMICs. Tailored interventions incorporating national policies, in addition to counseling and pharmacotherapy, could play an essential role in supporting women during the initial abstinence phase of smoking cessation in LMICs.
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Affiliation(s)
- João M Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, Brazil; Department of Neuroscience, Medical School, ABC Health University Center, Brazil; Department of Epidemiology, Mailman School of Public Health, Columbia University, US.
| | - Elizabeth D Nesoff
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Danielle R Lima
- Department of Psychiatry, Medical School, University of São Paulo, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Medical School, Universidade Federal de São Paulo, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, US
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The impact of digital interventions on help-seeking behaviour for mental health problems: a systematic literature review. Curr Opin Psychiatry 2022; 35:207-218. [PMID: 35579875 DOI: 10.1097/yco.0000000000000788] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Interventions that facilitate help-seeking could help individuals to get care earlier on which could also help avert some mental health crises. Delivering interventions via a digital format could mitigate some key barriers to mental healthcare. We reviewed the literature for digital interventions which facilitate formal or informal help-seeking for mental health problems. We examined the impact of identified interventions on actual and intended help-seeking and attitudes towards help-seeking. RECENT FINDINGS We identified 35 interventions. About half (51%) of studies showed an improvement in at least one help-seeking outcome with the greatest number showing an improvement in help-seeking intentions and the fewest studies showing an improvement in actual behaviour (29%). Findings suggest that interventions that promote active participation and personal involvement through sharing one's own narrative seem to be promising practices to facilitate help-seeking. SUMMARY Our findings suggest digital interventions can improve help-seeking for mental health problems among a range of populations. Given speciality mental health resources are scarce, further research needs to consider how these interventions could best target the most vulnerable groups to link them with mental healthcare and how these interventions might facilitate earlier intervention in a way that might reduce need for crisis care and support.
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Diaz D, Quisenberry AJ, Fix BV, Sheffer CE, O'Connor RJ. Stigmatizing attitudes about lung cancer among individuals
who smoke cigarettes. Tob Induc Dis 2022; 20:38. [PMID: 35529324 PMCID: PMC9006129 DOI: 10.18332/tid/146907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many individuals with lung cancer report experiencing stigma associated with their diagnosis. The objective of this study was to explore how different factors, including smoking status, lung cancer concern, and thoughts on smoking behaviors, were associated with increased stigmatizing attitudes towards people with lung cancer. METHODS In 2015, a Web-based survey was completed by people who currently smoked. Participants (n=1419) aged 18–65 years were randomly assigned to one of three scenarios in which the character who was diagnosed with lung cancer currently, formerly, or never smoked cigarettes. Two aspects of stigma were assessed: blaming the victim and negative attributions about people with lung cancer. RESULTS For blaming the victim and negative attributions, lung cancer stigma differed by scenario (described smoking status, p<0.0001), when adjusting for race, sex, education level, age, income, nicotine dependence, quit intentions, and quit attempts. Higher levels of lung cancer concern were associated with greater blaming the victim (p=0.001), when adjusting for scenario and other significant correlates. CONCLUSIONS The findings suggest that stigmatizing attitudes from people who smoke towards people with lung cancer may be reflective of how they feel about their own smoking habits. We suggest that specific messaging guidelines that avoid an over emphasis on an individual’s smoking status, cessation interventions that address stigma, and screening messages tailored to smoking status, may help to lessen the burden of lung cancer stigma.
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Affiliation(s)
- Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Brian V. Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Christine E. Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Richard J. O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
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Philip KEJ, Bu F, Polkey MI, Brown J, Steptoe A, Hopkinson NS, Fancourt D. Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100302. [PMID: 35036984 PMCID: PMC8743222 DOI: 10.1016/j.lanepe.2021.100302] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Smoking is often colloquially considered "social". However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up. METHODS In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models. FINDINGS At baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 - 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 - 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 - 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 - 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 - 0·356, to 0·297, 95%CI 0·140 - 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 - 0·270, to coef.=0·197, 95%CI 0·087 - 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 - 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses. INTERPRETATION Smoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception. FUNDING UK Economic and Social Research Council & Imperial College London.
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Affiliation(s)
- Keir EJ Philip
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- NIHR Imperial Biomedical Research Centre, London, United Kingdom
- Respiratory Medicine, Royal Brompton Business Group, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Feifei Bu
- Tobacco and Alcohol Research Group, University College London, United Kingdom
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Respiratory Medicine, Royal Brompton Business Group, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jamie Brown
- Tobacco and Alcohol Research Group, University College London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- NIHR Imperial Biomedical Research Centre, London, United Kingdom
- Respiratory Medicine, Royal Brompton Business Group, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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Hoek J, Edwards R, Waa A. From social accessory to societal disapproval: smoking, social norms and tobacco endgames. Tob Control 2022; 31:358-364. [PMID: 35241613 DOI: 10.1136/tobaccocontrol-2021-056574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
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Loyal D, Sutter AL, Auriacombe M, Serre F, Rascle N. The Pregnant Smoker Stigma Scale – Public Stigma (P3S-PS): development and validation in general French population. Women Health 2022; 62:157-167. [DOI: 10.1080/03630242.2022.2030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Deborah Loyal
- INSERM U1219, Bordeaux University, Bordeaux, France
- CRPMS EA 3522, Paris University, Paris, France
| | - Anne-Laure Sutter
- INSERM U1219, Bordeaux University, Bordeaux, France
- Perinatal Psychiatry Unit, Charles Perrens Hospital, Bordeaux, France
| | - Marc Auriacombe
- CNRS USR 3413, SANPSY, Bordeaux University, Bordeaux, France
- Addictology Unit, Charles Perrens Hospital, Bordeaux, France
| | - Fuschia Serre
- CNRS USR 3413, SANPSY, Bordeaux University, Bordeaux, France
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Kaplan DM, Hamann HA, Price SN, Williamson TJ, Ver Hoeve ES, Mcconnell MH, Duchschere JE, Garland LL, Ostroff JS. Developing an ACT-based intervention to address lung cancer stigma: Stakeholder recommendations and feasibility testing in two NCI-designated cancer centers. J Psychosoc Oncol 2022; 41:59-75. [PMID: 35129091 PMCID: PMC9356115 DOI: 10.1080/07347332.2022.2033377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Few psychosocial interventions have been tailored to meet the unique needs of patients diagnosed with lung cancer. This pilot study developed and tested a six-week intervention for reducing lung cancer stigma.Design and Subjects: Guided by qualitative interviews conducted with 9 lung cancer patients and 5 thoracic oncology care providers, Acceptance and Commitment Therapy was adapted for treatment of lung cancer stigma (ACT-LCS). In a subsequent single arm pilot study, 22 lung cancer patients reporting high levels of stigma completed the intervention.Setting: NCI-designated cancer centers in the Southwestern and Eastern United States.Results: Of 46 eligible patients, 22 provided consent, with 20 completing the intervention (10 in-person, 10 telehealth). Overall stigma decreased across timepoints, largely driven by reductions in internalized stigma. There were also significant reductions in social isolation, sleep disturbance, and fatigue.Conclusions: The ACT-LCS protocol demonstrates preliminary feasibility and acceptability. This intervention may be particularly suited for helping patients navigate feelings associated with internalized stigma.
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Affiliation(s)
- Deanna M. Kaplan
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Sarah N. Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Timothy J. Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Soffer M. Cancer-related stigma in the USA and Israeli mass media: an exploratory study of structural stigma. J Cancer Surviv 2022; 16:213-222. [PMID: 35107795 PMCID: PMC8809241 DOI: 10.1007/s11764-021-01145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Cancer is considered a stigmatized condition in many cultures. One key cultural site that produces illness-related structural stigma is mass media. This study explored the social construction of cancer-related stigma in mass media during the time of COVID-19. Specifically, we compared how cancer-related stigma is constructed in two contexts: American and Israeli mass media. METHODS Two samples were drawn: all articles that mentioned cancer and published in a 4-month period in USA Today (N = 117) and Israel Today (N = 108). Inductive Thematic Analysis was used to analyze the articles. RESULTS Three similar themes were identified in the samples: "the trivialization of cancer," "cancer as metaphor," and the "the war against cancer." In both samples, people with cancer were depicted as heroic. Despite the similarities in themes, how each theme was constructed reflected sociocultural differences between the two samples. CONCLUSIONS There appear to be presented universal mechanisms of cancer-related stigma in the media, alongside cultural differences in how they are employed and constructed. IMPLICATIONS FOR CANCER SURVIVORS The results stress the importance of debunking cancer-related stigma in the media and elsewhere. Cancer survivors and their families, reporters, researchers, and other stakeholders in the two studied countries should collaborate to devise culturally informed guidelines for reporting and writing about cancer.
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Affiliation(s)
- Michal Soffer
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 349883, Haifa, Israel.
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Gao M, Lee C, Park S. Gender, Tobacco Control Policies, and Persistent Smoking Among Older Adults: A Longitudinal Analysis of 11 European Countries. Nicotine Tob Res 2022; 24:1247-1256. [PMID: 35092442 PMCID: PMC9278835 DOI: 10.1093/ntr/ntac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/15/2021] [Accepted: 01/25/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Little is known about sociodemographic and macro-level predictors of persistent smoking when one has developed a health condition that is likely caused by smoking. AIMS AND METHODS We investigate the impact of gender, education, and tobacco control policies (TCPs) on persistent smoking among older Europeans. Respondents (aged 50 +) with a smoking history and at least one smoking-related health condition were pooled from the Survey of Health, Aging and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) from four waves from 2004 to 2013. We fitted gender-specific logistic regression models with two-way fixed effects (country and year) and tested interaction terms between gender, education, and TCPs. RESULTS Although women are less likely to smoke than men, they were more likely to smoke persistently. The effects of education and general TCPs on persistent smoking were significant for women only. Compared to women with low levels of education, those with moderate education (odds ratio [OR] = .63; .49-.82) and high education (OR = .57; .34-.98) are less likely to be persistent smokers. TCPs are associated with a reduced risk of women's persistent smoking (OR = .70; .51-.95) and the association is stronger for those having less education. CONCLUSIONS Older women, particularly those with low levels of education, are vulnerable to persistent smoking. TCPs might be effective in reducing persistent smoking for older women, with greater effects for less-educated women. Future studies are needed to understand mechanisms that explain gender differences in responsiveness to TCPs. IMPLICATIONS Persistent smoking is a particularly harmful smoking behavior as it is associated with greater risks of comorbidity and mortality. By employing the framework of the multilevel social determinants of health, this study examined the behavior of persistent smoking among older adults in European countries. Women, especially women with low levels of education are vulnerable to persistent smoking. Moreover, TCPs, in general, are significantly related to a reduction in persistent smoking among older women only and the negative association is stronger for those having less education, indicating gender and socioeconomic differences in responsiveness to TCPs.
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Affiliation(s)
- Manjing Gao
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Chioun Lee
- Corresponding Author: Chioun Lee, PhD, 1207 Watkins, 900 University Ave., Riverside, CA 92521, USA. Telephone: +1 952-827-4411; E-mail:
| | - Soojin Park
- Graduate School of Education, University of California-Riverside, Riverside, CA, USA
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Kim SS, DeMarco RF. The Intersectionality of HIV-Related Stigma and Tobacco Smoking Stigma With Depressive and Anxiety Symptoms Among Women Living With HIV in the United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:523-533. [PMID: 34999667 DOI: 10.1097/jnc.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study examined the intersectionality of HIV-related stigma, tobacco smoking stigma, and mental health among women living with HIV who were daily smokers. This secondary analysis used baseline data from 2 pilot smoking cessation studies. Participants received either an HIV-tailored or an attention-control intervention focused on smoking cessation as an outcome. There were significant positive relationships between HIV-related stigma and depressive and anxiety symptoms. In contrast, tobacco smoking stigma had no significant relationship with either of the symptoms when HIV-related stigma was controlled. However, there was a significant interaction effect (β = 1.37, p = .02) of tobacco smoking stigma with internalized HIV-related stigma on anxiety symptoms. Tobacco smoking stigma worsened anxiety symptoms for women who had high internalized HIV-related stigma. Health care providers should understand the effect of HIV-related stigma on mental health and address the intersectionality of HIV-related stigma with other socially disapproved behaviors, such as tobacco smoking.
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Affiliation(s)
- Sun S Kim
- Sun S. Kim, PhD, APRN-BC, is an Associate Professor, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Massachusetts, USA. Rosanna F. DeMarco, PhD, RN, FAAN, is a Professor and Associate Dean for Academic Affairs, College of Nursing and Health Sciences, University of Massachusetts Boston, Massachusetts, USA
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Leone FT, Evers-Casey S. Tobacco Use Disorder. Med Clin North Am 2022; 106:99-112. [PMID: 34823737 PMCID: PMC8630801 DOI: 10.1016/j.mcna.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tobacco use disorder is highly prevalent; more than a billion individuals use tobacco worldwide. Popular views on the addictive potential of tobacco often underestimate the complex neural adaptations that underpin continued use. Although sometimes trivialized as a minor substance, effects of nicotine on behavior lead to profound morbidity over a lifetime of exposure. Innovations in processing have led to potent forms of tobacco and delivery devices. Proactive treatment strategies focus on pharmacotherapeutic interventions. Innovations on the horizon hold promise to help clinicians address this problem in a phenotypically tailored manner. Efforts are needed to prevent tobacco use for future generations.
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Affiliation(s)
- Frank T Leone
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Sarah Evers-Casey
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA
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Blum K, Bowirrat A, Baron D, Badgaiyan RD, Thanos PK, Elman I, Braverman ER, Gold MS. Understanding that Addiction Is a Brain Disorder Offers Help and Hope. Health (London) 2022. [DOI: 10.4236/health.2022.146050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Plage S, Olson RE. Surprise Reveals the Affective-Moral Economies in Cancer Illness Narratives. QUALITATIVE HEALTH RESEARCH 2021; 31:2730-2742. [PMID: 34632868 DOI: 10.1177/10497323211044468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Emotions, like joy and sorrow, feature in illness narratives, dramatizing stories of becoming: sick, well, controlled, in control. However, brief emotions, such as surprise, have received limited analytic attention in cancer illness narratives. Drawing on 20 interviews with 11 participants with diverse cancer diagnoses, along with the 455 photographs they produced for this study, we address the complex interactions between discourse, societal expectations, and perceptions in moral-affective economies. Tracing the emergence, deployment, and silencing of surprise provided an avenue to explore connections between affect, morality, advocacy, and philanthropy. We show how surprise works to deny uncertainties couched in individual risk, and situate cancer causation within the logics of anticipation, (re)producing socio-cultural etiology narratives. Attending to surprise reveals how some cancers are situated as individual responsibilities, with restricted access to compassion and collective resources. Thus, we interrogate the affective-moral economy underpinning cancer illness narratives, and surprise's pivotal role in its analysis.
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Affiliation(s)
- Stefanie Plage
- The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca E Olson
- The University of Queensland, Brisbane, Queensland, Australia
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Social Norms Change and Tobacco Use: A Protocol for a Systematic Review and Meta-Analysis of Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212186. [PMID: 34831942 PMCID: PMC8618876 DOI: 10.3390/ijerph182212186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Tobacco use kills more than eight million individuals each year, and results in substantial economic and human capital loss across nations. While effective supply-side solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers, and less feasible to implement in countries with weaker tobacco control policy environments. Thus, effective demand-side solutions are needed. Shifting social norms around tobacco use is one such promising approach. To this end, a systematic review and meta-analysis of social norms intervention studies to influence tobacco use will be conducted following PRISMA 2020 guidance. Tobacco intervention studies with at least two time points that explicitly mention social norms or social influence as part of an intervention or set of measured variables will be included. Literature sources will comprise PubMed, Scopus, PsycInfo, and the Cochrane Trial Registry, as well as several grey literature sources. Two reviewers will independently screen studies, and risk of bias will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools. The primary outcomes will be change in tobacco use and change in social norms. A random-effects meta-analysis will be conducted for both outcomes. Sources of heterogeneity will be explored using meta-regression with key covariates. Non-reporting biases will be explored using funnel plots. PROSPERO: CRD42021251535.
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Warner ET, Park ER, Luberto CM, Rabin J, Perez GK, Ostroff JS. Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress. Psychooncology 2021; 31:753-760. [PMID: 34797953 DOI: 10.1002/pon.5859] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress. METHODS This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups. RESULTS Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers. CONCLUSIONS Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.
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Affiliation(s)
- Erica T Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Christina M Luberto
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Rabin
- Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jamie S Ostroff
- Memorial Sloan-Kettering Cancer Center, Behavioral Sciences, New York, New York, USA
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Evans-Polce RJ, Smith DM, Veliz P, Boyd CJ, McCabe SE. Sexual identity differences in biomarkers of tobacco exposure among women in a national sample. Cancer Epidemiol 2021; 74:101980. [PMID: 34247064 PMCID: PMC8455424 DOI: 10.1016/j.canep.2021.101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sexual minority women are consistently at increased risk for tobacco use compared to heterosexual women. Neither biomarkers of nicotine exposure nor biomarkers of tobacco toxicant exposure have been examined by sexual identity. METHODS This study used interview and biomarker data from women in the biomarker core sample of Wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013-2014; n = 4930). We examined associations of sexual identity with nicotine exposure (measured with urinary cotinine and TNE-2) and with tobacco-specific nitrosamines (measured with urinary NNAL). Multivariable regression modeling was used to examine these associations among the full biomarker core sample, among past 30-day tobacco users, and among exclusive established cigarette users before and after controlling for tobacco use quantity and intensity. RESULTS In the full biomarker sample of women, prior to adjusting for tobacco use quantity and intensity, bisexual women had significantly higher cotinine, TNE-2, and NNAL levels compared to heterosexual women. Among exclusive established cigarette users, gay/lesbian women had significantly higher NNAL compared to heterosexual women prior to adjusting for tobacco quantity and intensity. No differences by sexual identity were found after adjusting for tobacco use quantity and intensity. CONCLUSIONS This is the first study to demonstrate differences in biological markers of tobacco exposure by sexual identity among women in the U.S. This has important public health implications as greater exposure to both nicotine and to tobacco-specific nitrosamines are strongly linked to cancer risk.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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