Session
Tobacco Oral #1 - Health Equity: Tobacco Use and Cessation in Historically Marginalized Populations
APHA 2022 Annual Meeting and Expo
Abstract
Examining Current Tobacco Use Prevalence and Preference in Drug Treatment Court Clients
APHA 2022 Annual Meeting and Expo
Background: Drug treatment courts (DTCs) were established as an alternative to incarceration for people accused of a non-violent, drug-related offense. DTCs link clients to substance use treatment providers and behavioral health resources through judicial case processing. Understanding the prevalence and specific types of tobacco use and dual-use among DTC clients could inform tobacco cessation intervention strategies consistent with the transtheoretical model, given that DTC clients may already be in a state of readiness for behavior change.
Method: Preliminary data were drawn from the HEROIC (Health Evaluation of the Results of Opioid Intervention Court) study, an ongoing longitudinal survey-based study of DTC clients that is currently in the recruitment phase (n = 62). Descriptive statistics were used to examine current tobacco use in the form of cigarettes, cigars, smokeless tobacco, dual-use (i.e., e-cigarettes & traditional cigarettes), and overall tobacco use at the baseline survey.
Results: Overall, 74% of the DTC clients reported currently using a tobacco product at baseline. Prevalence of current use varied widely by tobacco product with cigarettes being the most prevalent (73%), followed by e-cigarettes (58%), smokeless tobacco (6%), and cigars (5%). Notably, almost half of the sample reported current dual-use of cigarettes and e-cigarettes (45%).
Conclusion: There is a dearth of literature examining tobacco use prevalence and preference in DTC clients. We observed that tobacco use was highly prevalent in our sample, particularly cigarette smoking, e-cigarette use, and dual-use. These findings are of concern given that cigarette smoking may be associated with lower rates of substance use disorder treatment success. DTCs should integrate tobacco cessation programs into their systems to positively affect client outcomes.
Abstract
Minority Stress among LGBTQ Smokers in the Deep South: A Mixed Methods Study
APHA 2022 Annual Meeting and Expo
Introduction: Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face higher levels of stress than the general population in the form of minority stress, which are discriminatory, stigmatizing, and victimizing experiences. Minority stress has been suggested to be a factor that contributes to poorer smoking outcomes in LGBTQ populations, especially for those living in the Deep South states of Louisiana, Mississippi, Alabama, Georgia, and South Carolina. The objective of this study was to elucidate how minority stress influences smoking among LGBTQ smokers in the Deep South, using a mixed methods approach.
Methods: A one-time, cross-sectional online survey was administered to 1,296 LGBTQ smokers in the Deep South. Survey measurements included previously validated measures of minority stress (prejudice events, perceived stigma, and internalized queerphobia), mental health, social support, smoking, quitting, LGBTQ and non-LGBTQ norms, self-efficacy, and smoking outcome variables (stage of change and nicotine dependence level). Multiple linear regression was used to assess the relationship between minority stress variables and smoking outcome variables. To expound on how minority stress affects mental health and subsequent stage of change, we conducted 15 individual, semi-structured online interviews with LGBTQ smokers in the Deep South. Interview topics spanned across 5 domains: LGBTQ identity, smoking/quitting, minority stress, mental health, and social support.
Results: Survey findings showed that after adjusting for covariates, increased levels of internalized queerphobia were significantly associated with increased nicotine dependence level, and decreased levels of perceived stigma were associated with further stage of change. Themes that emerged throughout interviews included: struggles with LGBTQ identity, coping with minority stress, reasons for smoking, and barriers to quitting smoking.
Conclusion: This research elucidates how increased levels of minority stress is associated with poorer smoking outcomes among LGBTQ individuals in the Deep South. Findings will help guide future smoking prevention and cessation programs for this population.
Abstract
Risk and Protective Factors for E-Cigarette Use among Hispanic Young People: Why Acculturation Level Matters
APHA 2022 Annual Meeting and Expo
Background: The 2021 NYTS showed that 36.6% of Hispanic youth ages 12-17 are susceptible to e-cigarettes and 41.8% are curious about them. Hispanic youth are more likely to be curious about and/or initiate tobacco use with e-cigarettes compared to non-Hispanic peers. Understanding the heterogeneity of the Hispanic population is critical to addressing this disparity. Prior research has found that Hispanic youth may be at higher or lower risk of tobacco use based on level of acculturation—the complex process of blending into the mainstream culture while navigating one’s heritage culture. This study further unpacks the role of acculturation in e-cigarette use among Hispanic youth and young adults.
Methods: We conducted 20 virtual focus groups with Hispanic youth/young adults (13-24-years-old) segmented by age cohort, e-cigarette use, and acculturation level (measured by language preference and birth country). Sixteen groups were in English and four in Spanish. Discussion topics included Hispanic identity; e-cigarette knowledge, attitudes, and beliefs; and reasons for use/curiosity. We developed a codebook and coded transcripts in their original language, enabling thematic analysis and exploration of differences by segment. The intercoder reliability Kappa was .89. Participants also completed an online survey about tobacco use behaviors which was analyzed quantitatively.
Results: We found variations in risk and protective factors for e-cigarette use by acculturation level. More acculturated participants had greater knowledge and familiarity with tobacco and nicotine and higher rates of tobacco-marijuana poly-use compared to lower acculturated participants. Bicultural participants more commonly mentioned curiosity and direct peer pressure as drivers for e-cigarette use. While bicultural participants noted the negative impacts of e-cigarette use on family relationships, this was not a deterrent to use. Less acculturated participants were most concerned with stigma related to vaping and the negative impacts on family, as well as disapproval from the broader Hispanic community, compared to more acculturated participants.
Discussion/Conclusions: Bicultural teens face unique stressors, feeling “pulled from the middle, toggling between Hispanic roots and efforts to assimilate. This includes in-group discrimination related to not adhering to cultural norms or not speaking Spanish fluently and out-group discrimination related to physical appearance (including skin color), Hispanicity, and speaking Spanish. Public health efforts must recognize the heterogeneity of the Hispanic population and the role acculturation plays in susceptibility to e-cigarettes. Nuanced understanding can inform the design of more targeted and impactful communication strategies and messages to reduce disparate e-cigarette risk among this population.
Abstract
Reducing Tobacco Disparities in LGBTQ+ Communities: Creating Affirming Ways to Quit
APHA 2022 Annual Meeting and Expo
Background: Tobacco use is disproportionately high among lesbian, gay, bisexual, transgender and gender diverse populations (LGBTQ+). Community-engaged and culturally targeted cessation programs show promise for increasing quitting among minoritized populations, including LGBTQ+ people. Our goal was to evaluate the acceptability and preliminary effectiveness of a culturally targeted healthcare provider-focused intervention to decrease tobacco use among LGBTQ+ people living in Ohio.
Methods: The Equitas Health Institute partnered with Ohio State University College of Public Health researchers to evaluate a training program to improve brief tobacco screening using the “Ask, Advise, Refer method and a culturally-targeted LGBTQ+ Tobacco Cessation Conversation Guide designed to facilitate cessation conversations between providers and LGBTQ+ tobacco users. First, we measured provider attitudes toward brief cessation counseling and knowledge of LGBTQ+ tobacco use pre- and post-training. We then conducted semi-structured key informant interviews and focus groups with LGBTQ+ community members to discuss tobacco use and their opinions of the materials.
Results. Post-training more providers correctly identified LGBTQ+ tobacco prevalence (14.3% vs. 35.1%) and the relative effectiveness of brief cessation counseling (42.9% vs. 71.4%). Post-training, more providers agreed that they could help smokers who want to quit (30.8% vs. 53.8%). Key Informants recommended developing age-specific cessation materials targeting adolescents, young adults, and older smokers. They stressed the importance of addressing vaping and tobacco smoking and integrating culturally-specific drivers of nicotine and tobacco use (e.g., minority stress coping, gender-affirmative behavior). Including images of diverse LGBTQ+ people was considered critical to increase acceptability. Key Informants were interested in co-branding materials for dissemination across settings.
Conclusions. This study highlights the value of a community-engaged research partnership to address LGBTQ+ tobacco disparities via provider training and culturally-targeted communications development.
Abstract
“Why Another Policy that Targets Us?”: African American Perspectives on Increased Regulation of Mentholated Tobacco Products
APHA 2022 Annual Meeting and Expo
Historically, Black and African American communities have been targeted by tobacco companies, especially with tobacco products that contain menthol. This study seeks to explore the perceptions of new and proposed tobacco and menthol regulations among Black/African Americans throughout Los Angeles County, California. In-depth qualitative interviews were conducted with 69 community members that were identified through community leaders, community-based organizations, and through snowball sampling. Using a grounded theory approach, four themes emerged: (1) opposition to new menthol regulations due to potential implications with law enforcement, (2) generational tobacco and menthol product use, (3) interest in quitting resources and community specific information, and (4) other health related issues and concerns in the Black/African American community (i.e., COVID-19 and poverty). The necessity of accurate, reliable, and culturally relevant information on menthol tobacco products is clear. Findings will help us understand how to meet the Black/African American communities where they are and determine culturally appropriate ways to promote tobacco related policies and regulations.