LGBTQ Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behavior, 2010-2022

INTRODUCTION

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals use tobacco at disproportionately high rates but are as likely as straight tobacco users to want to quit and to use quitlines. Little is known about the demographics and geographic distribution of LGBTQ quitline participants, their engagement with services, or their long-term outcomes.

AIMS AND METHODS

Californians (N = 333 429) who enrolled in a statewide quitline 2010-2022 were asked about their sexual and gender minority (SGM) status and other baseline characteristics. All were offered telephone counseling. A subset (n = 19 431) was followed up at seven months. Data were analyzed in 2023 by SGM status (LGBTQ vs. straight) and county type (rural vs. urban).

RESULTS

Overall, 7.0% of participants were LGBTQ, including 7.4% and 5.4% of urban and rural participants, respectively. LGBTQ participants were younger than straight participants but had similar cigarette consumption. Fewer LGBTQ participants reported a physical health condition (42.1% vs. 48.4%) but more reported a behavioral health condition (71.1% vs. 54.5%; both p's < .001). Among both LGBTQ and straight participants, nearly 9 in 10 chose counseling and both groups completed nearly three sessions on average. The groups had equivalent 30-day abstinence rates (24.5% vs. 23.2%; p = .263). Similar patterns were seen in urban and rural subgroups.

CONCLUSIONS

LGBTQ tobacco users engaged with and appeared to benefit from a statewide quitline even though it was not LGBTQ community-based. A quitline with staff trained in LGBTQ cultural competence can help address the high prevalence of tobacco use in the LGBTQ community and reach members wherever they live.

IMPLICATIONS

This study describes how participants of a statewide tobacco quitline broke down by sexual orientation and gender. It compares participants both by SGM status and by type of county to provide a more complete picture of quitline participation both in urban areas where LGBTQ community-based cessation programs may exist and in rural areas where they generally do not. To our knowledge, it is the first study to compare LGBTQ and straight participants on their use of quitline services and quitting aids, satisfaction with services received, and rates of attempting quitting and achieving prolonged abstinence from smoking.

California School Staff Reports of Seeing Students Vaping at School and Disciplinary Actions

Youth vaping is a concern and schools may use many approaches to discipline students caught vaping at school. This study identified the prevalence of school staff seeing vaping in schools and the measures used to discipline students. A state-wide sample of 7,938 staff from 255 middle and high schools reported whether they saw any students vaping at school in the last 30 days, whether they have caught any students vaping during class in the last semester, and what happened after catching a student vaping in class. Open-text responses were coded and themes were identified related to disciplinary approaches. 31.9% of staff reported seeing students vaping at school, and 11.9% of teachers reported catching a student vaping during class. Teachers described four categories of disciplinary approaches after catching students vaping in class: no consequences, punitive approaches, restorative approaches, and mixed approaches. Additional support is necessary to help schools address student vaping.

American Indian/Alaska Native Smokers' Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behaviors From 2008 to 2018

INTRODUCTION

The objective of this study was to examine access, engagement, and quitting behaviors of American Indian/Alaska Native (AIAN) callers to the California Smokers' Helpline. Telephone counseling is the primary function of the quitline. The overarching theoretical framework for California's quitline is social cognitive theory, although it also utilizes motivational interviewing and cognitive-behavioral strategies.

AIMS AND METHODS

AIAN (n = 16 089) and White (n = 173 425) California quitline callers from 2009 to 2018 were compared on their characteristics, engagement, and quitting behaviors. Quitline callers responded to a telephone survey at intake. A random selection was called for evaluation 7 months later (White n = 8194, AIAN n = 764). Data from the 2009 to 2017 California Health Interview Survey (CHIS) were used as a reference point for AIANs (AIAN n = 1373).

RESULTS

The quitline and CHIS had similar proportions of AIANs (4.6% vs. 4.3%, respectively). AIAN smokers were more likely than White smokers to report physical (53.6% vs. 44.9%) and mental (65.7% vs. 57.8%) health conditions at intake. AIANs were more likely to participate in counseling than White callers (67.1% vs. 65.7%). Among those who received counseling, AIANs had greater odds than White smokers of making a quit attempt (adjusted odds ratio = 1.39 [1.06, 1.81]) and similar odds of quitting for 180 days (adjusted odds ratio = 0.95 [0.69, 1.31]).

CONCLUSIONS

Rates of access, engagement, and quitting suggest that individualized quitline counseling was as effective with AIANs as it was with White smokers. Increasing efforts to refer AIANs to existing state quitlines can help more smokers quit.

IMPLICATIONS

This study showed that AIAN smokers were well represented among California quitline callers, even without a targeted campaign. It also found that AIAN smokers engaged in quitline services and were as able to quit as their White counterparts were, even after adjusting for other baseline characteristics. One implication is that public health programs can promote quitlines using broad-based campaigns knowing that they will still motivate AIAN smokers to seek help. Another implication is that a standard, individualized counseling protocol delivered by culturally competent quitline staff can effectively help AIAN smokers to quit.

The Association of Trail Features With Self-Report Trail Use by Neighborhood Residents

BACKGROUND

Urban trails are a useful resource to promote physical activity. This study identified features of urban trails that correlated with trail use.

METHODS

Multiuse urban trails were selected in Chicago, Dallas, and Los Angeles. An audit of each trail was completed using the Systematic Pedestrian and Cyclist Environmental Scan for Trails instrument, identifying built environmental features. A self-report of trail use was obtained from trailside residents (N = 331) living within 1 mile of each trail. Univariate and multivariate Poisson regressions controlled for trail time from home and motivation for physical activity.

RESULTS

Positive associations with the past month's hours on the trail were observed for the presence of distance signs, vegetation height, vegetation maintenance, and trail crowding, and a negative association was observed for the presence of crossings on the trail. Positive associations with dichotomous trail use were observed for the presence of distance signs, vegetation height, and vegetation maintenance, and a negative association was observed for the presence of crossings on the trail.

CONCLUSIONS

These correlates should be confirmed in other studies and, if supported, should be considered in the promotion and design of urban trails.

Tobacco Advertisement Liking, Vulnerability Factors, and Tobacco Use Among Young Adults

INTRODUCTION

Young adulthood (aged 18-24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined whether vulnerability factors moderated the association between tobacco advertisement liking and tobacco use in the United States.

METHODS

Analyses were conducted among 9109 US young adults in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013-14). Participants viewed 20 randomly selected sets of tobacco advertisements (five each for cigarettes, e-cigarettes, cigars, and smokeless tobacco) and indicated whether they liked each ad. The outcome variables were past 30-day cigarette, e-cigarette, cigar, and smokeless tobacco use. Covariates included tobacco advertisement liking, age, sex, race or ethnicity, sexual orientation, education, poverty level, military service, and internalizing and externalizing mental health symptoms.

RESULTS

Liking tobacco advertisements was associated with tobacco use, and this association was particularly strong among those with lower educational attainment (cigarettes, cigars) and living below the poverty level (e-cigarettes, smokeless tobacco).

CONCLUSIONS

The association between tobacco advertisement liking and tobacco use was stronger among young adults with lower educational attainment and those living below the poverty level. Policies that restrict advertising exposure and promote counter-marketing messages in this population could reduce their risk.

IMPLICATIONS

This study shows that liking tobacco advertisements is associated with current tobacco use among young adults, with stronger associations for vulnerable young adults (ie, lower education levels and living below the poverty level). Findings suggest a need for counter-marketing messages, policies that restrict advertising exposure, and educational interventions such as health and media literacy interventions to address the negative influences of tobacco advertisements, especially among young adults with a high school education or less and those living below the poverty level.

A Mixed Methods Approach to Creating Depression Public Service Announcements by Collaborating with People with Depressive Symptomatology

Depression is a treatable condition; unfortunately, many do not seek help. Depression public service announcements (D-PSAs) are one means of increasing help-seeking behavior. However, as Beck's cognitive theory of depression indicates, it can be challenging to persuade people with depression. Although there have been successful D-PSAs, some have been ineffective or led to boomerang effects. With the goal of providing guidance for future messages, we use a mixed-methods approach to assess how people with heightened depressive symptomatology perceive motivations and barriers regarding help-seeking. Study 1 participants (N = 186), with and without depressive symptomatology, provided motivations and barriers to seeking help for depression. Study 1's qualitative analysis determined 112 motivations and 124 barriers to help-seeking. Study 2 participants (N= 214), all with heightened depressive symptomatology, rated the motivations and barriers from Study 1 on their attitude function, importance, awareness, and argument strength. This insight guided successful D-PSA creation in a follow-up study, reported elsewhere. The methodological approach utilized, and the specific motivations and barriers revealed, will ideally assist scholars and practitioners seeking to develop future D-PSAs.

Tobacco Industry Marketing Exposure and Commercial Tobacco Product Use Disparities among American Indians and Alaska Natives

Background: Non-Hispanic American Indians and Alaska Natives (NH AI/AN) have the highest commercial tobacco use (CTU) among U.S. racial/ethnic groups. Tobacco marketing is a risk factor, however few studies examine it among NH AI/AN. Objective: We identified prevalence of tobacco industry marketing exposure and correlates of CTU among NH AI/AN compared to other racial/ethnic groups. Methods: Data were from wave 1 (2013-2014; N = 32,320) of the Population Assessment of Tobacco and Health Study, analyzing self-reported exposure to tobacco ads from stores, tobacco package displays, direct mail and email marketing. Correlates of CTU were identified and interactions between racial/ethnic groups and tobacco marketing were assessed. Results: NH AI/AN (n = 955) had a higher prevalence of exposure to retail tobacco ads (64.5% vs 59.3%; p < 0.05), mail (20.2% vs.14.3%; p < 0.001) and email (17.0% vs.10.6%; p < 0.001) marketing than NH Whites (n = 19,297). Adjusting for tobacco use and related risk factors, exposure to email marketing remained higher among NH AI/AN than NH Whites. Interactions between racial/ethnic groups and marketing exposures on CTU were nonsignificant. CTU was higher among NH AI/AN than NH Whites and among adults who reported exposure to tobacco ads, mail, and email marketing. Conclusions/importance: There is higher tobacco marketing exposure in stores and via mail for NH AI/AN. Email marketing exposure was higher, even after controlling for tobacco-related risk factors. The tobacco industry may be targeting NH AI/AN through emails, which include coupons and other marketing promotions. Culturally relevant strategies that counter-act tobacco industry direct marketing tactics are needed to reduce disparities in this population.

Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature

INTRODUCTION

We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups.

METHODS

Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group.

RESULTS

There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results.

CONCLUSIONS

We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.

Tobacco regulatory compliance with STAKE Act age-of-sale signage among licensed tobacco retailers across diverse neighborhoods in Southern California

INTRODUCTION

The California Stop Tobacco Access to Kids Enforcement (STAKE) Act requires licensed tobacco retailers to post minimum age-of-sale signage at the point of sale. This study investigated STAKE Act compliance in licensed tobacco retailers across four racial/ethnic communities in Southern California.

METHODS

The sample consisted of 675 licensed tobacco retailers (excluding chain store supermarkets and pharmacies) randomly selected based on zip codes from predominantly non-Hispanic White (n=196), African American (n=193), Hispanic/Latino (n=186), and Korean American (n=100) communities. A protocol for assessing signage was completed at each store by community health workers (promotoras de salud). The law changed from a minimum age of 18 to 21 years (Tobacco 21) during data collection, as of 9 June 2016. Differences in signage compliance were evaluated before and after changes in the State law.

RESULTS

Overall, 45% of the stores were compliant with posting the required age-of-sale signage (which varied in minimum age by date of collection); 14% of stores did not have any store interior age-of-sale signs, and 41% of stores had some type of age-of-sale sign but were not compliant with the STAKE Act (e.g. 29.5% of the stores had non-compliant tobacco industry We Card signs but not STAKE Act signs). Stores observed after the 2016 implementation of Tobacco 21 had significantly lower STAKE Act signage compliance rates (38.6%) compared to stores observed before the change in the State law (70.9%) (z=6.8623, p<0.001). The difference in STAKE Act sign compliance between stores located in AA communities (16.9%) and stores located in NHW communities (41.5%) observed within the first three months after the change in law was statistically significant (χ²(1)=20.098, p<0.001).

CONCLUSIONS

Findings suggest the need for prompt, educational outreach to licensed tobacco retailers on age-of-sale signage changes, multiple compliance checks, and enforcement.

Adolescent tobacco coupon receipt, vulnerability characteristics and subsequent tobacco use: analysis of PATH Study, Waves 1 and 2

OBJECTIVES

We examine adolescent receipt of tobacco coupons and subsequent tobacco use.

METHODS

Data were from the Population Assessment of Tobacco and Health (PATH) Study (2013-2015). We identified correlates of coupon receipt at Wave 1 (youth sample age 12-17 ; n = 13 651) including demographics, additional vulnerability factors that may place youth at risk of tobacco use and correlates of coupon receipt by channel. We examined associations of Wave 1 coupon receipt with Wave 2 tobacco use using weighted multivariable models.

RESULTS

Overall, 7.6% of US youth received tobacco coupons in the 6 months before Wave 1. Coupon recipients were more likely to be women, living outside urban areas, living with a tobacco user, current and former (vs never) tobacco users, having high internalising mental health symptoms and having a favourite tobacco advertisement. Coupons were received primarily through direct mail (56%), product packs (28%) and online (25%). Never tobacco users at Wave 1 who received coupons were more likely to be ever users at Wave 2 (adjusted OR (aOR)=1.42; 95% CI 1.06 to 1.91). Coupon recipients were more likely to use a new tobacco product between waves (aOR=1.67; 95% CI 1.18 to 2.36) and report past 30-day tobacco use at Wave 2 (aOR=1.81; 95% CI 1.31 to 2.49).

CONCLUSIONS

One in 13 US youth (7.6%) received coupons. Vulnerable youth had the greatest odds of coupon receipt. Coupon recipients had greater odds of tobacco use among never users, trying a new tobacco product and current use. Coupon bans, limits on youth coupon exposure, stronger age verification, pack inserts or restricting coupon redemption may help reduce tobacco use among adolescents, particularly for those at greatest risk.

Increasing Help-Seeking Outcomes among People with Elevated Depressive Symptomatology with Public Service Announcements: An Examination of Functional Matching and Message Sidedness

The current experimental study assessed the utility, and potential harm, of depression public service announcements (D-PSAs) that were matched, moderately matched, or mismatched based on attitude function (i.e., social-adjustive or object-appraisal) and either one-sided or refutational two-sided. US adults (N = 567) with mild to severe depressive symptomatology were randomly assigned to view control messages or one set of D-PSAs. Results indicate that functionally matched D-PSAs, regardless of message sidedness, caused more favorable help-seeking outcome expectations, attitudes, and intentions compared to the control messages. Exposure to the mismatched D-PSAs, particularly refutational, led to less-favorable help-seeking outcome expectations, attitudes, and intentions compared with the control condition. Help-seeking outcomes among those exposed to the moderately matched messages were not significantly different from those exposed to the control messages, with the exception of those exposed to the one-sided moderately matched messages. The one-sided moderately matched messages resulted in lower help-seeking intentions than the control messages. Overall, results indicate that if messages can be tailored to match the recipients' attitude functions, help-seeking outcomes among people with heightened depressive symptomatology can be increased. However, the results also indicate that some D-PSAs can have negative effects.

Implementation of HPV vaccination guidelines in a diverse population in Los Angeles: Results from an environmental scan of local HPV resources and needs

Research shows that vaccination against human papillomavirus (HPV) infection is one of the most effective methods for reducing risk for cervical cancer; it also protects against other HPV-related cancers. Controversies exist regarding HPV vaccination in several communities; which may in part explain why although rates of HPV vaccination are increasing nationwide, Los Angeles County (LAC) data show that many adolescents are still not vaccinated. These adolescents remain at high-risk for infection. Using community-based participatory principles, we conducted an environmental scan that included a literature review, the development of a community advisory board, community feedback from HPV community meetings, and interviews with stakeholders to understand attitudes toward HPV vaccination and their impact in follow through with HPV vaccines. Twenty-eight key stakeholders participated in our coalition comprised of community organizations and clinics with strong ties to the local community. This is the only coalition dedicated exclusively to improving HPV vaccine uptake in LAC. Of these, twenty-one participated in an environmental scan via qualitative interviews about HPV vaccination programs, service delivery priorities, and proposed steps to increase HPV vaccination uptake in LAC. The environmental scan revealed targets for future efforts, barriers to HPV uptake, and next steps for improving local HPV vaccination uptake rates. The environmental scan also identified local HPV vaccination interventions and resources. Although LAC has developed important efforts for vaccination, some interventions are no longer being implemented due to lack of funds; others have not been evaluated with sufficient outcome data. The risk for cervical and other HPV-related cancers could be greatly reduced in LAC if a multilevel, multicultural, and multilingual approach is taken to better understand rates of HPV vaccination uptake, particularly among racial/ethnic minorities and LGBTQ youth. Our environmental scan provides guidance on attitudes toward vaccination, and how best to address the needs of LAC families and providers.

Methods for Coding Tobacco-Related Twitter Data: A Systematic Review

Background

As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research.

Objective

The objective of this systematic review was to assess the methodological approaches of categorically coded tobacco Twitter data and make recommendations for future studies.

Methods

Data sources included PsycINFO, Web of Science, PubMed, ABI/INFORM, Communication Source, and Tobacco Regulatory Science. Searches were limited to peer-reviewed journals and conference proceedings in English from January 2006 to July 2016. The initial search identified 274 articles using a Twitter keyword and a tobacco keyword. One coder reviewed all abstracts and identified 27 articles that met the following inclusion criteria: (1) original research, (2) focused on tobacco or a tobacco product, (3) analyzed Twitter data, and (4) coded Twitter data categorically. One coder extracted data collection and coding methods.

Results

E-cigarettes were the most common type of Twitter data analyzed, followed by specific tobacco campaigns. The most prevalent data sources were Gnip and Twitter’s Streaming application programming interface (API). The primary methods of coding were hand-coding and machine learning. The studies predominantly coded for relevance, sentiment, theme, user or account, and location of user.

Conclusions

Standards for data collection and coding should be developed to be able to more easily compare and replicate tobacco-related Twitter results. Additional recommendations include the following: sample Twitter’s databases multiple times, make a distinction between message attitude and emotional tone for sentiment, code images and URLs, and analyze user profiles. Being relatively novel and widely used among adolescents and black and Hispanic individuals, Twitter could provide a rich source of tobacco surveillance data among vulnerable populations.

State Psychological Reactance to Depression Public Service Announcements Among People With Varying Levels of Depressive Symptomatology

Campaigns seeking to help people with depression can be effective, but they can also backfire. Psychological reactance is proposed as a partial explanation. Two experimental studies examined the effect of two depression messages (i.e., autonomy-supportive language, controlling language) for participants (n = 2027, n = 777) with varying levels of depressive symptomatology. For Study 1, two versions of a print public service announcement about seeking help for depression served as the experimental stimulus. Study 2 used an existing video public service announcement about seeking help for depression, but the text was altered to create the two conditions. In both studies, increased depressive symptomatology was associated with reduced help-seeking attitudes and intentions, as well as greater state reactance to a public service announcement about depression. Increased state reactance mediated the relationship between increased depressive symptomology and unfavorable help-seeking outcomes. Further, across the two studies, participants with high levels of depressive symptomatology who were exposed to the autonomy-supportive language ad reported either as much, or more, state reactance than participants with high levels of depressive symptomatology who were in the control condition. These results warn that language perceived as autonomy-supportive by people without depression might be perceived as controlling among people with depression.

Heavy episodic drinking in college females: an exploration of expectancies, consequences, and self-efficacy

Differences on expectancies and self-efficacy between college females who engage in heavy episodic drinking (HED) and non-HED were examined. Students (N = 95) from Southern California filled out the Comprehensive Effects of Alcohol, Cognitive Appraisal of Risky Events, and Drinking Context Convivial Drinking scales as well as self-efficacy, alcohol use, and demographic items in the fall semester of 2008. Logistic and linear regression showed that greater positive expectancies and lower self-efficacy were predictive of categorization as HED and greater convivial drinking. Implications, limitations, and directions for future research are discussed.

Persuading people with depression to seek help: respect the boomerang

People with depression are likely to process information with a negative bias when confronted with self-relevant information. Accordingly, we feared exposing depressed people to a public service announcement (PSA) addressing the stigma of depression would possibly boomerang and result in less intention to seek help and in increased self-stigma. College students (N = 271; Mage  = 22.51, SD = 4.71; 63.1% female; 37.3% White, 31.9% Hispanic, 12.9% Asian, 6.8% multiethnic, 3.4% Black, 7.6% other) were randomly assigned to receive a print ad focused on depression or a nonrelevant comparison ad. A paper-and-pencil survey consisting of the Beck Depression Inventory-II, Self-Stigma of Seeking Help scale, help-seeking intentions, and demographics followed. Regression analysis indicated that viewing a depression ad caused people with greater depressive symptoms to experience greater levels of self-stigma than depressed people exposed to a nonrelevant comparison ad. Bootstrap mediation analysis showed that for individuals who viewed a depression PSA, self-stigma mediated the relationship between depressive symptoms and professional help-seeking intentions. While this current study offers no direct evidence in regard to the utility of current and past depression campaigns, results indicate a definite need for caution when developing materials targeting people with depression to seek help.

Increasing social support for depressed individuals: a cross-cultural assessment of an affect-expectancy approach

Depression is a mental illness affecting 121 million people. The Substance Abuse and Mental Health Services Administration recently launched a national, bilingual (English and Spanish) campaign to motivate young adults to support friends with mental illness. This article highlights and assesses the usefulness of two theoretically derived variables for increasing the social support received by all depressed individuals: (a) affect and (b) social support outcome expectations. In accord with the Substance Abuse and Mental Health Services Administration's bilingual campaign, the authors conducted two studies using intercepts at 2 swap meets in the U.S. Southwest. One study sample consisted of Spanish-dominant Hispanics, the other non-Hispanics. For both samples, results indicate that affect, social support outcome expectations, and their interaction accounted for more than 50% of the variance of social support intentions (67% in the Hispanic sample when familism was considered). Affect is commonplace in the helping behavior literature; results indicate social support outcome expectations deserve equal consideration. Moreover, an unexpected finding emerged: Perceiving a lack of willpower, need for attention, and lack of moral character to be the cause of depression resulted in increased sympathy among the Hispanic sample but increased anger among non-Hispanics.