Sociocultural Risk Factors for Elevated Perceived Stress among African American Smokers

Introduction: African Americans experience unique stressors that may inhibit smoking cessation and enhance relapse rates. Few studies, however, have focused on risk factors for perceived stress among treatment seekers. Because African Americans are less likely to quit compared to the larger community, understanding factors associated with perceived stress among smokers has the potential to improve intervention outcomes. This study examined psychosocial and cultural correlates of stress in a sample of African American participants in a randomized controlled trial. Methods: At baseline, participants reported demographic factors and completed assessments of smoking history, alcohol use, friend and household smoking, weight concerns, acculturation, depressive symptoms, and perceived stress (N = 325). Bivariate associations were examined, followed by multiple regression analyses to test independent relationships. The sample was comprised of mostly middle-aged males, with at least a high school education, who were single, and reported low household income. Participants were moderately nicotine dependent and smoked 18 cigarettes per day for 26 years. Results: Perceived stress was inversely associated with age (r = -.16, p = .004), education (r = -.11, p = .04), household income (r = -.11, p = .047), and positively associated with being male (r = .13, p = .02). Stress perceptions were positively related to cigarettes per day (r = .11, p = .049), nicotine dependence (r = .20, p = .001), drinking frequency (r = .15, p = .008), drinking intensity (r = .14, p=.02), and inversely related to smoking duration (r = -.12, p = .03). We found positive associations between perceived stress and household smokers (r = .18, p = .004), and friends who smoke (r = .15, p = .01). Perceived stress was also positively associated with post-cessation weight concern (r = .14, p = .01), a traditional African American cultural orientation; r = .12, p = .04), and depressive symptoms (r = .65, p Conclusion: These findings have important intervention implications. Many of the risk factors for distress among African American smokers are modifiable. Interventions should prioritize addressing depression, household smoking environment, and stress among younger smokers, in addition to managing other stress-enhancing concerns like alcohol use

Changes in Youth Cigarette Use Following the Dismantling of an Antitobacco Media Campaign in Florida

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n ~1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking

Trends in smokeless tobacco use in the us workforce: 1987-2005

The primary aim was to examine whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers. Smokeless tobacco exposure increases the risk of oral cavity, esophageal, and pancreatic cancers, and stroke. The prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44. While smokeless tobacco use has declined in the general population, it may be that the prevalence of smokeless tobacco use has increased among workers due to workplace smoking restrictions, which have been shown to have increased over the years. Using the most current nationally representative National Health Interview Survey (NHIS) data, we examined whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers (n = 125,838). There were no significant changes in smokeless tobacco use prevalence from 1987-2005 (pooled prevalence = 3.53%); rates also were lower in smoke free workplaces. Worker groups with high rates of smokeless tobacco use included farm workers (10.51%) and blue collar workers (7.26%). Results indicate that smokeless tobacco prevention strategies targeting particular worker groups are warranted

Effect of childhood victimization on occupational prestige and income trajectories

Background Violence toward children (childhood victimization) is a major public health problem, with long-term consequences on economic well-being. The purpose of this study was to determine whether childhood victimization affects occupational prestige and income in young adulthood. We hypothesized that young adults who experienced more childhood victimizations would have less prestigious jobs and lower incomes relative to those with no victimization history. We also explored the pathways in which childhood victimization mediates the relationships between background variables, such as parent’s educational impact on the socioeconomic transition into adulthood. Methods A nationally representative sample of 8,901 young adults aged 18–28 surveyed between 1999–2009 from the National Longitudinal Survey of Youth 1997 (NLSY) were analyzed. Covariate-adjusted multivariate linear regression and path models were used to estimate the effects of victimization and covariates on income and prestige levels and on income and prestige trajectories. After each participant turned 18, their annual 2002 Census job code was assigned a yearly prestige score based on the 1989 General Social Survey, and their annual income was calculated via self-reports. Occupational prestige and annual income are time-varying variables measured from 1999–2009. Victimization effects were tested for moderation by sex, race, and ethnicity in the multivariate models. Results Approximately half of our sample reported at least one instance of childhood victimization before the age of 18. Major findings include 1) childhood victimization resulted in slower income and prestige growth over time, and 2) mediation analyses suggested that this slower prestige and earnings arose because victims did not get the same amount of education as non-victims. Conclusions Results indicated that the consequences of victimization negatively affected economic success throughout young adulthood, primarily by slowing the growth in prosperity due to lower education levels

Smoking Urges During Treatment and Long-Term Cessation among Low-Income African Americans

The urge to smoke is a predictor of smoking relapse. Little research has focused on the impact of acute urges during treatment among African Americans. This study examined the relationship between smoking urges and long-term abstinence among treatment seekers. Longitudinal prospective investigation. Urges to smoke were assessed at the initial (session 1) and final (session 8) sessions among adult smokers (N=308) enrolled in a 4-week group intervention trial. Nicotine patch use was assessed over 30 days. Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention, and at 3-, 6-, and 12-month follow-ups. Hierarchical logistic regressions tested associations between session 1 and session 8 urges and 7-day ppa at each smoking status assessment. There was a significant overall decrease in smoking urges (M=29, SD=15 at session 1; M=17, SD=11 at session 8). After controlling for covariates, urges to smoke at session 1 were unrelated to 7-day ppa at any of the assessment points. However, session 8 urges were inversely associated with 7-day ppa post-intervention (AOR=.94, CI:.92-.97), at 3-months (AOR=.93, CI: .89-.97), 6-months (AOR=.93, CI: .90-.97), and 12-months (AOR=.96, CI: .96-.99). Nicotine patch use was positively associated with 7-day ppa at each assessment. The most robust predictors of abstinence through 12-months post-intervention were decreased urges over the 4-week, 8-session group intervention and the frequency of nicotine patch use. Interventions aimed at addressing the needs of African American smokers should address urges and encourage nicotine replacement adherence to increase abstinence rates

The reach of a youth-oriented anti-tobacco media campaign on adult smokers

It remains unclear whether youth-targeted anti-tobacco media campaigns reach adults. We examined the reach of the youth-oriented Florida “truth” campaign to (a) determine the extent to which adult smokers were aware of the campaign and (b) test if that awareness was associated with an intention to quit smoking in the next 30 days. Data included 781 adult smokers who in 2001 participated in a 20-min telephone survey designed to examine the effects of the “truth” campaign in Florida. Participants were asked numerous questions aimed at measuring their awareness of the campaign and about their tobacco use. Awareness of the campaign was mixed with 21% confirming the “truth” campaign theme, 45% the “truth” logo, 62% “truth” advertising events, and 68% the “truth” advertising theme. Awareness of industry manipulation was the only variable significantly associated with smokers’ intentions to quit (OR = 1.66; 95% CI = 1.34–2.05) in the multivariate model. The “truth” anti-tobacco campaign targeted 12–17 year olds in an effort to prevent them from starting to smoke. Despite the awareness, the campaign did not have the “unintended consequence” of influencing adults’ intentions to smoke. To change the behavior of adults it is not sufficient to have a youth-focused program

Culturally specific versus standard group cognitive behavioral therapy for smoking cessation among African Americans: an RCT protocol

Abstract Background African American smokers experience disproportionately higher rates of tobacco-related illnesses compared to Caucasians. It has been suggested that interventions targeted to specific racial/ethnic groups (i.e., culturally specific) are needed; however, the literature examining the efficacy of culturally specific interventions is equivocal. Moreover, there are few descriptions of methods used to create these interventions. The main aim of this study is to test the efficacy of a culturally specific smoking cessation intervention among African Americans. Methods/Design A 2-arm randomized controlled trial (RCT) will be conducted to assess the efficacy of a culturally specific group cognitive behavioral therapy (CBT), compared to standard group CBT among treatment-seeking smokers from the community. Participants in both conditions receive the transdermal nicotine patch (TNP) for 8-weeks. We intend to randomize at least 247 adult smokers who self-identify as African American into the trial. Enrolled participants are block randomized into one of two groups: Standard group CBT (control) or a culturally specific group CBT (CS-CBT). Groups are matched for time and attention, and consist of eight sessions. The primary outcome variable is 7-day point prevalence abstinence (7-day ppa). Smoking status is assessed at the end-of-counseling (EOC), and 3, 6, and 12-month follow-ups, with self-reported abstinence verified by saliva cotinine. We hypothesize that the CS-CBT condition will produce significantly greater smoking cessation rates compared to the control condition. We also expect that this effect will be moderated by acculturation and ethnic identity, such that the CS-CBT will show the greatest effect on cessation among participants who are less acculturated and have greater ethnic identity. Discussion Answering the fundamental question of whether culturally specific interventions lead to incremental efficacy over established, evidence-based approaches is of utmost importance. This study will have implications for the development and implementation of smoking cessation interventions among African Americans and other racial/ethnic minority groups. Trial registration NCT01811758http://deepblue.lib.umich.edu/bitstream/2027.42/112926/1/40359_2013_Article_14.pd

Randomized Controlled Trial of Group-Based Culturally Specific Cognitive Behavioral Therapy Among African American Smokers

This study tested the efficacy of group-based culturally specific cognitive behavioral therapy (CBT) for smoking cessation among low-income African Americans. Participants (N = 342; 63.8% male; M = 49.5 years old; M cigarettes per day = 18) were randomly assigned to eight sessions of group-based culturally specific or standard CBT, plus 8 weeks of transdermal nicotine patches. Biochemically verified 7-day point prevalence abstinence (ppa) was assessed at the end-of-therapy (ie, CBT) (EOT), and 3-, 6-, and 12-month follow-ups. Primary outcomes were the longitudinal intervention effect over the 12-month follow-up period, and 7-day ppa at the 6-month follow-up. Secondary outcomes included 7-day ppa at the EOT and 12-month follow-up, and intervention ratings. Generalized linear mixed modeling tested the longitudinal effect and logistic regression tested effects at specific timepoints. Generalized linear mixed modeling demonstrated a longitudinal effect of intervention condition. Specifically, 7-day ppa was two times (P = .02) greater following culturally specific CBT versus standard CBT when tested across all timepoints. Analyses by timepoint found no significant difference at 6 or 12 months, yet culturally specific CBT was efficacious at the EOT (62.5% vs. 51.5% abstinence, P = .05) and the 3-month follow-up (36.4% vs. 22.9% abstinence, P = .007). Finally, intervention ratings in both conditions were high, with no significant differences. Culturally specific CBT had a positive longitudinal effect on smoking cessation compared to a standard approach; however, the effects were driven by short-term successes. We recommend the use of group-based culturally specific CBT in this population when possible, and future research on methods to prevent long-term relapse. Culturally specific interventions are one approach to address smoking-related health disparities; however, evidence for their efficacy in African Americans is equivocal. Moreover, the methodological limitations of the existing literature preclude an answer to this fundamental question. We found a positive longitudinal effect of culturally specific CBT versus standard CBT for smoking cessation across the follow-up period. Analyses by assessment point revealed that the overall effect was driven by early successes. Best practices for treating tobacco use in this population should attend to ethnocultural factors, but when this is not possible, standard CBT is an alternative approach for facilitating long-term abstinence

Correlates of smoking among young adults: The role of lifestyle, attitudes/beliefs, demographics, and exposure to anti-tobacco media messaging

Young adults (18-24 years) have the highest smoking rate of any age group. Unlike youth/adult populations where there is one primary message targeting behavior, anti-tobacco campaigns targeting young adults should contain messages of prevention and cessation. The objective was to identify factors influencing young adult cigarette use, employing the Centers for Disease Control and Prevention logic model, with an emphasis on the role of lifestyle, tobacco use tolerance, and attitudes/beliefs. Cross-sectional data were collected from 4401 young adults using telephone interviews in 2010 as part of the evaluation for the Tobacco Free Florida Campaign. Multivariate logistic regression was used to examine the relationship between current smoking status and lifestyles, tolerance of tobacco use, and attitude/belief variables. The young adult cigarette prevalence rate is 20.3%, with males more likely to be smokers (25.1%) than females (15.6%) and non-Hispanic Whites more likely to be smokers than other racial/ethnic groups (23.8%). Significant associations were found between lifestyle variables (frequent bar/club, drinks per month, and number of friends who smoke), tolerance of tobacco use (allow smoke in house/car and moderate tobacco use), and four attitude/belief indices and current smoking behavior. Results suggest lifestyles and attitudes/beliefs should be key behavioral targets of prevention programs aimed at young adults. Data strongly suggest that as young adults reject negative labels attached to smokers, they are more likely to smoke. Prevention (and cessation) programs may need to reduce barriers that result in segregating nonsmokers/smokers so smokers can have an increased chance of adopting attitudes/beliefs of nonsmokers