Are binge drinking disparities by sexual identity lower in U.S. states with nondiscrimination statutes that include sexual orientation?

Purpose Studies examining binge drinking disparities by sexual identity focus on intra- and inter-personal minority stressors experienced by lesbian, gay, and bisexual (LGB) populations. State-level statutes are powerful tools that can reduce health disparities. We examined how state-level nondiscrimination statutes that include sexual orientation as a protected ground (i.e., inclusive statutes) are associated with binge drinking disparities between LGB and straight adults. Methods We combined data from the 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS), the Movement Advancement Project (MAP), and administrative data sources for information on binge drinking, sexual identity, nondiscrimination statutes, and individual and state-level factors. We included an interaction term in the logistic regression models to test whether inclusive nondiscrimination statutes modify the association between sexual identity and binge drinking. Results Inclusive statutes modified the association between sexual identity and binge drinking among women, but not men. In states without inclusive statutes, the odds of binge drinking among lesbian [1.71 (95%CI: 1.27–2.31)] and bisexual [1.83 (95% CI: 1.54–2.17)] women were significantly higher compared with straight women. In states with inclusive statutes, the odds of binge drinking comparing lesbian and straight women were not significantly different [1.19 (95% CI: 0.92–1.53)]. The odds ratio for binge drinking comparing bisexual and straight women was 26.8% lower in states with [1.34 (95% CI: 1.13–1.60)] versus states without inclusive statutes. Conclusions The enactment of nondiscrimination statutes inclusive of sexual orientation at the state-level are associated with narrower binge drinking disparities between lesbian, bisexual, and straight women

Country tobacco laws and article 11 of the WHO Framework Convention on Tobacco Control: a review of tobacco packaging and labeling regulations of 25 countries

Background Urgent, evidence-based tobacco control efforts have been advocated by the WHO through the Framework Convention on Tobacco Control (FCTC) articles and guidelines. The level of implementation of these guidelines varies by country and region. This paper identifies areas of alignment and non-alignment of country tobacco laws with respect to the FCTC’s article 11 requirements, which lists guidelines for regulating tobacco packaging and labeling. Methods Countries from each of the six WHO regions were ranked by number of smokers and 25 countries were selected, representing countries from all WHO regions with the highest number of smokers. A scoring guide based on the FCTC article 11 requirements was created and used to rank country tobacco laws and assess levels of alignment as well as identify common areas of weakness and strength. Results Across the countries examined, laws were generally strong in mandating the display of health warning messages on the front and back of cigarette packs and cartons. However, they were deficient in prohibiting the display of emission yields, and placing warnings at the top of the principal display area, as well as requiring health messages on tobacco’s negative social and economic outcomes. Conclusions Country tobacco packaging and labeling laws can be strengthened by greater compliance with the FCTC article 11 guidelines

\u27Menthol-Plus’: a Major Category of Cigarette Found Among ‘Concept’ Descriptor Cigarettes from Mexico

Background Tobacco companies are offering cigarettes with ‘concept’ descriptor names that suggest sensation and/or flavour properties (eg, Marlboro ‘Velvet Fusion’). Little has been known about the identities and levels of flavour chemicals in such cigarettes. Methods Thirty-three filter cigarette variants from 27 packs (including two sampler packs with four variations each) from Canada and Mexico were analysed (rod + filter) for 177 flavour chemicals plus triacetin, a filter plasticiser and possible flavourant. Five brands of US mentholated filter cigarettes were also analysed. Results Twenty-seven of the 33 cigarettes (all were Mexican variants) were categorised as ‘menthol-plus’: significant menthol (3.0–11.9 mg/cigarette), plus varying amounts (0.32–3.4 mg/cigarette) of total other flavour chemicals (TOFCs) (excludes triacetin). For 10 of the 27, TOFCs \u3e1.0 mg/cigarette. For 7 of the 27, the TOFCs profile was categorised as containing total fruit flavour compounds (TFFCs) \u3e1.0 mg/cigarette. One Mexican variant was categorised as ‘menthol-only’ (TOFCs ≤0.15 mg/cigarette). All menthol-plus and menthol-only cigarettes contained one or two optional-crush capsules in their filters (crushed prior to analysis). All five Canadian brand variants were ‘non-flavoured’. All five US brand variants were ‘menthol-only’. Conclusions All but one of the ‘concept’ descriptor cigarettes from Mexico were ‘menthol-plus’. While the Canadian cigarettes complied with Canada’s flavour chemical ban, concept descriptors on the packs may increase appeal. Given the scale of the problem posed by menthol alone, health officials seeking to decrease the appeal of smoked tobacco should examine the extent to which ‘concept descriptor’ cigarettes using ‘menthol-plus’ flavour profiling together with artful descriptors are furthering the problem of smoked tobacco

The role of theory-driven graphic warning labels in motivation to quit: a qualitative study on perceptions from low-income, urban smokers

Background: Use of communication theories in the development of pictorial health warning labels (graphic warning labels) for cigarette packaging might enhance labels’ impact on motivation to quit, but research has been limited, particularly among low socioeconomic status (SES) populations in the U.S. This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers. Methods: A cross-sectional qualitative study was conducted with 25 low-income adult smokers in Baltimore, Maryland, who were purposively sampled from a community-based source population. Semi-structured, in-depth interviews were conducted from January to February 2014. Participants were asked about the motivational impact of 12 labels falling into four content categories: negative depictions of the health effects of smoking to smokers and others, and positive depictions of the benefits of quitting to smokers and others. Data were coded using a combined inductive/deductive approach and analyzed thematically through framework analysis. Results: Labels depicting negative health effects to smokers were identified as most motivational, followed by labels depicting negative health effects to others. Reasons included perceived severity of and susceptibility to the effects, negative emotional reactions (such as fear), and concern for children. Labels about the benefits of quitting were described as motivational because of their hopefulness, characters as role models, and desire to improve family health. Reasons why labels were described as not motivational included lack of impact on perceived severity/susceptibility, low credibility, and fatalistic attitudes regarding the inevitability of disease. Conclusions: Labels designed to increase risk perceptions from smoking might be significant sources of motivation for low SES smokers. Findings suggest innovative theory-driven approaches for the design of labels, such as using former smokers as role models, contrasting healthy and unhealthy characters, and socially-oriented labels, might motivate low SES smokers to quit.The data collection was supported by the National Institute on Drug Abuse at the National Institutes of Health and the Food and Drug Administration Center for Tobacco Products (grant numbers R01DA032217-04 and R01DA032217-04S); and by the National Institute of Allergy And Infectious Diseases at the National Institutes of Health, The Johns Hopkins Center for AIDS Research (grant number 1P30 AI094189). The agencies were not involved in any technical aspect of the study. Funding for Open Access provided by the UMD Libraries Open Access Publishing Fund.https://doi.org/10.1186/s12889-015-1438-

Recommended core items to assess e-cigarette use in population-based surveys

A consistent approach using standardised items to assess e-cigarette use in both youth and adult populations will aid cross-survey and cross-national comparisons of the effect of e-cigarette (and tobacco) policies and improve our understanding of the population health impact of e-cigarette use. Focusing on adult behaviour, we propose a set of e-cigarette use items, discuss their utility and potential adaptation, and highlight e-cigarette constructs that researchers should avoid without further item development. Reliable and valid items will strengthen the emerging science and inform knowledge synthesis for policy-making. Building on informal discussions at a series of international meetings of 65 experts from 15 countries, the authors provide recommendations for assessing e-cigarette use behaviour, relative perceived harm, device type, presence of nicotine, flavours and reasons for use. We recommend items assessing eight core constructs: e-cigarette ever use, frequency of use and former daily use; relative perceived harm; device type; primary flavour preference; presence of nicotine; and primary reason for use. These items should be standardised or minimally adapted for the policy context and target population. Researchers should be prepared to update items as e-cigarette device characteristics change. A minimum set of e-cigarette items is proposed to encourage consensus around items to allow for cross-survey and cross-jurisdictional comparisons of e-cigarette use behaviour. These proposed items are a starting point. We recognise room for continued improvement, and welcome input from e-cigarette users and scientific colleagues

Prior Daily Menthol Smokers More Likely to Quit 2 Years After a Menthol Ban Than Non-menthol Smokers: A Population Cohort Study

BACKGROUND AND AIMS: The province of Ontario, Canada, banned the use of menthol-flavored tobacco products as of January 1, 2017. This study aims to assess the longer-term impact of a menthol ban on smoking behavior at 2 years, which is unknown. METHODS: Population cohort study with baseline survey (n = 1821) conducted September–December 2016 and follow-up survey January–August 2019 among current smokers in Ontario (16+) prior to the menthol ban. Poisson regression was used to assess the probability of quitting smoking by pre-ban menthol status, controlling for differences in smoking and demographic characteristics, with multiple imputations used to address missing data. FINDINGS: Menthol smokers were more likely to report having quit smoking (12% [daily menthol] and 10% [occasional menthol] vs. 3% [non-menthol]; p < .001) than non-menthol smokers in the 2 years after a menthol ban. After adjustment for smoking and demographic characteristics, daily menthol smokers had higher likelihood of quitting smoking (adjusted relative risk [ARR] 2.08; 95% confidence interval [CI] 1.20–3.61) and reported more quit attempts (ARR 1.45; 95% CI 1.15–1.82). Among those who attempted to quit, menthol smoking was not associated with relapse (daily ARR = 0.96; 95% CI: 0.86, 1.07; occasional ARR = 0.99; 95% CI: 0.90, 1.08). However, there was a statistically significant interaction among menthol users who reported using other flavored tobacco products 1 year after the ban (ARR = 0.26 [95% CI: 0.08, 0.90]) CONCLUSIONS: The study found increased probability of quitting among daily menthol smokers and more quit attempts among daily and occasional menthol smokers compared with non-menthol smokers in Ontario 2 years after the implementation of a menthol ban. IMPLICATIONS: This study examines quitting behavior 2 years after a menthol ban in Ontario, Canada. Those who were daily menthol smokers prior to the ban were more likely to quit smoking and make more quit attempts in the 2 years after the ban. While there was no difference in the likelihood of relapse between menthol and non-menthol smokers among those who attempt to quit, there were indications that pre-ban daily menthol smokers who used other tobacco products after the ban were likely to quit

Cultural representations of dementia

In a Perspective, Alexandra Hillman and Joanna Latimer discuss cultural representations of dementia in the media, film, and literature

Metal Concentrations in e-Cigarette Liquid and Aerosol Samples:The Contribution of Metallic Coils

Supplemental Material is available online (https://doi.org/10.1289/EHP2175)Electronic cigarettes (e-cigarettes) generate an aerosol by heating a solution (e-liquid) with a metallic coil. Whether metals are transferred from the coil to the aerosol is unknown. Objective: Our goal was to investigate the transfer of metals from the heating coil to the e-liquid in the e-cigarette tank and the generated aerosol. Methods: We sampled 56 e-cigarette devices from daily e-cigarette users and obtained samples from the refilling dispenser, aerosol, and remaining e-liquid in the tank. Aerosol liquid was collected via deposition of aerosol droplets in a series of conical pipette tips. Metals were reported as mass fractions (μg/kg) in liquids and converted to mass concentrations (mg/m3) for aerosols. Results: Median metal concentrations (μg/kg) were higher in samples from the aerosol and tank vs. the dispenser (all p<0.001): 16.3 and 31.2 vs. 10.9 for Al; 8.38 and 55.4 vs. <0.5 for Cr; 68.4 and 233 vs. 2.03 for Ni; 14.8 and 40.2 vs. 0.476 for Pb; and 515 and 426 vs. 13.1 for Zn. Mn, Fe, Cu, Sb, and Sn were detectable in most samples. Cd was detected in 0.0, 30.4, and 55.1% of the dispenser, aerosol, and tank samples respectively. Arsenic was detected in 10.7% of dispenser samples (median 26.7 μg/kg) and these concentrations were similar in aerosol and tank samples. Aerosol mass concentrations (mg/m3) for the detected metals spanned several orders of magnitude and exceeded current health-based limits in close to 50% or more of the samples for Cr, Mn, Ni, and Pb. Conclusions: Our findings indicate that e-cigarettes are a potential source of exposure to toxic metals (Cr, Ni, and Pb), and to metals that are toxic when inhaled (Mn and Zn). Markedly higher concentrations in the aerosol and tank samples versus the dispenser demonstrate that coil contact induced e-liquid contamination.This study is supported by the Cigarette Restitution Fund (State of Maryland; grant PHPA-G2034). P.O. was supported by the Alfonso Martín Escudero Foundation (postdoctoral fellowship 2014). A.A. was supported by the American Heart Association Tobacco Regulation and Addiction Center (grant 1P50HL120163). A.N.A., M.H., and P.O. are supported by the National Institute of Environmental Health Sciences/National Institutes of Health (grant 5P30ES009089)

Influence of religious organisations’ statements on compliance with a smoke-free law in Bogor, Indonesia: a qualitative study

ObjectiveTo explore the Bogor public's perspective on Muslim organisations’ pronouncements against smoking and the effect of these pronouncements on compliance with a new smoke-free law in the context of a prosmoking social norm.DesignSemistructured focus group discussions were conducted, transcribed, coded using ATLAS.ti software, and analysed using thematic content analysis. Photo elicitation was also used during the focus groups.SettingBogor, Indonesia.Participants11 focus groups (n=89), stratified by age, gender and smoking status, with members of the public (46 male, 43 female, ages 18–50).ResultsThere was limited knowledge of and compliance with both the smoke-free law and the religious pronouncements. In most of the focus groups, smoking was described as a discouraged, but not forbidden, behaviour for Muslims. Participants described the decision of whether to follow the religious pronouncements in the context of individual choice. Some participants felt religious organisations lacked credibility to speak against smoking because many religious leaders themselves smoke. However, some non-smokers said their religion reinforced their non-smoking behaviour and some participants stated it would be useful for religious leaders to speak more about the smoke-free law.ConclusionsReligious organisations’ pronouncements appear to have had a small effect, primarily in supporting the position of non-smokers not to smoke. Participants, including smokers, said their religious leaders should be involved in supporting the smoke-free law. These findings suggest there is potential for the tobacco control community to partner with sympathetic local Muslim leaders to promote common goals of reducing smoking and public smoke exposure. Muslim leaders’ views on smoking would be perceived as more credible if they themselves followed the smoke-free law. Additionally, public health messaging that includes religious themes could be piloted and tested for effectiveness. These findings may also inform similar efforts in other Muslim cities implementing smoke-free laws