How Is Exposure to Tobacco Outlets Within Activity Spaces Associated With Daily Tobacco Use Among Youth? A Mediation Analysis

INTRODUCTION: We investigated associations between exposure to tobacco outlets within activity spaces and daily tobacco use, and whether exposure to adults or peers using tobacco mediate these relationships. METHODS: We used Geographic Ecological Momentary Assessment data over 14 days from 85 youth aged 16-20 years in eight mid-sized California city areas. Tobacco outlet addresses and global positioning systems locations were geocoded and activity spaces were constructed by joining sequential points. We assessed daily number of tobacco outlets within 50 or 100 m of activity space polylines and number of minutes participants were within 50 or 100 m of tobacco outlets each day; daily use of tobacco; and whether participants saw (1) adults and (2) people their age (peers) using tobacco each day. RESULTS: Controlling for demographics, results of multilevel structural equation models showed no association between number of tobacco outlets within 50 m of polylines and tobacco use (probit regression coefficient: 0.01, p = .82). However, we found evidence of an indirect effect (p = .001) through daily exposure to peers using tobacco. Specifically, greater number of tobacco outlets within 50 m of polylines was positively associated with seeing peers use tobacco (probit regression coefficient: 0.10, p < .001). In turn, seeing peers use tobacco was positively associated with tobacco use on that day (probit regression coefficient: 2.23, p < .001). Similar results were found for number of tobacco outlets within 100 m of polylines. CONCLUSIONS: Exposure to tobacco outlets within activity spaces affects youth tobacco use through daily exposure to peers who use tobacco. IMPLICATIONS: Using real-time-ordered data, this article examines whether exposure to adults and peers using tobacco mediate associations between exposure to tobacco outlets within activity spaces and daily tobacco use among youth. Results suggest that exposure to tobacco outlets within activity spaces affects daily tobacco use through exposure to peers who use tobacco. These findings provide additional significant support for policy makers who are considering regulating the number and density of tobacco retailers and point to the importance of interventions focused on peer tobacco use and youths' daily environments to reduce tobacco use

Mental Health in China: Stigma, Family Obligations, and the Potential of Peer Support

Some people with mental illness in China do not receive treatment. We explored how stigma and familial obligation influenced accessibility of social support for patients with depression in China and the potential acceptability of peer support programs. Semi-structured qualitative interviews were conducted with five psychiatrists and 16 patients receiving care for depression from a large psychiatric hospital in Jining, Shandong Province of China. Patients with mental illness reported barriers that prevented them from (a) receiving treatment and (b) relying on informal social support from family members, including stigma, somatization, and community norms. Circumventing these barriers, peer support (i.e., support from others with depression) was viewed by patients as an acceptable means of exchanging information and relying on others for support. Formative research on peer support programs to examine programming and activities may help reduce the burden of unmet mental health care needs in China

Vaping industry-funded academic scholarships

While the benefits versus the risks of increased e-cigarette use among adults remains unsettled, the fact that 21% of high school students in 2018 have used e-cigarettes in the last month is concerning to almost all policymakers and clinicians. A recent e-cigarette marketing technique involves the promotion of scholarships for students. Given the novelty of these promotions, we undertook an analysis to understand how widespread this practice is in the USA, along with characteristics of such scholarships

Attitudes towards potential new tobacco control regulations among U.S. adults

Favorable attitudes towards tobacco control policies can facilitate their implementation and success. We examined attitudes toward four potential U.S. Federal tobacco regulations (banning menthol from cigarettes, reducing nicotine levels in cigarettes, banning candy and fruit flavored electronic cigarettes, and banning candy and fruit flavored little cigars and cigarillos) and associations with individual and state variables. A nationally representative phone survey of 4337 adults assessed attitudes toward potential policies. Weighted logistic regression was used to assess relationships between attitudes and demographic factors, smoking behavior, beliefs about the government (knowledge, trust, and credibility), exposure to tobacco control campaigns, and state variables from the US Centers for Disease Control and Prevention (CDC) State Tobacco Activities Tracking and Evaluation (STATE) System. Most respondents supported three out of four policies. Respondents that were female, non-white, Latino, living below the poverty line, had less than high school education, were of older age, did not smoke, had higher trust in government, and were exposed to national tobacco control campaigns had higher odds of expressing favorable attitudes toward potential new tobacco regulations than did their counterparts. No state-level effects were found. While differences in attitudes were observed by individual demographic characteristics, behaviors, and beliefs, a majority of participants supported most of the potential new tobacco regulations surveyed

Should the legal age for tobacco be raised? Results from a national sample of adolescents

Raising the minimum age of legal access to tobacco products may reduce smoking initiation and save lives. In a national telephone survey (2014-2015), US adolescents aged 13 to 17 years (N = 1,125; response rate, 66%) were asked about raising the age of legal access to tobacco products and randomized to hear one of 3 ages (19, 20, or 21 y). Most adolescents, across all US regions, favored raising the minimum age of legal access to 19 (75.7%), 20 (80.6%), or 21 (76.4%). These supportive attitudes may be useful to tobacco prevention and control practitioners who seek to reduce tobacco use among adolescents

Enhancing Community-Based Participatory Research Through Human-Centered Design Strategies

Introduction. The purpose of this review is to compare and contrast the values, purpose, processes, and outcomes of human-centered design (HCD) and community-based participatory research (CBPR) approaches to address public health issues and to provide recommendations for how HCD can be incorporated into CBPR partnerships and projects. Review Process. By consulting published literature, source materials, and experts on both approaches, a team of researchers completed a three-phased process of synthesizing key similarities and differences between HCD and CBPR and generating recommendations for ways to integrate HCD strategies in CBPR projects. Results. There are five HCD strategies that can be readily incorporated into CBPR projects to improve outcomes: (1) form transdisciplinary teams, (2) center empathy, (3) recruit and work with “extreme users,” (4) rapidly prototype, and (5) create tangible products or services. Conclusions. Integrating HCD in CBPR projects may lead to solutions that potentially have greater reach, are more readily adopted, are more effective, and add innovation to public health services, products, and policies

Associations among neighborhood poverty, perceived neighborhood environment, and depressed mood are mediated by physical activity, perceived individual control, and loneliness

Few studies have documented the pathways through which individual level variables mediate the effects of neighborhoods on health. This study used structural equation modeling to examine if neighborhood characteristics are associated with depressive symptoms, and if so, what factors mediated these relationships. Cross-sectional data came from a sample of mostly rural, older adults in North Carolina (n = 1,558). Mediation analysis indicated that associations among neighborhood characteristics and depressive symptoms were mediated by loneliness (standardized indirect effect = −0.19, p < 0.001), physical activity (standardized indirect effect = −0.01, p = 0.003), and perceived individual control (standardized indirect effect = −0.07, p = 0.02) with loneliness emerging as the strongest mediator. Monitoring such individual mediators in formative and process evaluations may increase the precision of neighborhood-based interventions and policies

Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review

Objectives Given the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults. Design PubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018. Eligibility criteria Quantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation. Data extraction and synthesis Three authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure. Results The review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies). Conclusion This review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults

An eye tracking study of anti-smoking messages on toxic chemicals in cigarettes

The US Food and Drug Administration is tasked with communicating information to the public about the harmful chemicals in cigarette smoke. Our study used eye tracking method to test the effectiveness of messages about the harmful chemicals in cigarettes smoke among adult smokers. A sample size of 211 current cigarette smokers viewed four communication messages that included: Health effects of a chemical in cigarette smoke and an image depicting the health effect. The messages focused on arsenic, formaldehyde, uranium, and general health. Eye tracking recorded the length of time participants viewed the text and the image. After each message, the participants were asked about the messages’ effectiveness in changing attitudes towards smoking. We analyzed the data using multilevel modeling, and of the 211 smokers, 59.7% were female, 36.5% were Black, and 21.3% had a high school degree or less. Compared to the general message, the messages about formaldehyde and uranium were more discouraging to smoking (p < 0.05). Messages about formaldehyde were more believable and made participants want to quit more than the general messages. Increasing message dose was significantly associated with discouraging participants from smoking and made participants want to quit (p < 0.05). Our findings suggest that anti-smoking messages, containing chemical information, can successfully increase negative attitudes toward smoking cigarettes and potentially encourage quitting

Risk factors for multiple tobacco product use among high school youth

Purpose: To examine how youth multiple tobacco product (MTP) users differ relative to non-users and to single-product users on risk factors at multiple levels of influence. Methods: We analyzed data on high school students from the North Carolina Youth Tobacco Survey, 2015 (n = 2922). Single- and MTP use were defined as use of one, or two or more tobacco products in the past month, respectively. Multinomial regressions estimated the association between risk factors and MTP use compared to single-product use and non-use of tobacco. Risk factors included intra-personal (e.g., harm perceptions), and interpersonal (e.g., household, peer tobacco use, secondhand smoke or vapor, and advertising) factors. Results: Of students, 12% and 13% were single product and MTP users, respectively. Many differences emerged between MTP users and non-tobacco users, with MTP users showing lower harm perceptions, higher perceived social benefits of smoking, significantly higher relative risk of having friends who use tobacco (RRR = 4.79, 95% CI 3.42, 6.70), of exposure to secondhand e-cigarette vapor (RRR = 1.35, 95% CI 1.23, 1.48), and of being receptive to tobacco marketing (RRR = 4.01, 95% CI 2.87, 5.61). Fewer differences emerged between MTP and single product users with MTP users having significantly higher relative risk of having friends who use tobacco (RRR = 2.31 95% CI 1.73, 3.07), of exposure to secondhand vapor (RRR = 1.10, 95% CI 1.02, 1.18), and of being receptive to tobacco marketing (RRR = 1.71, 95% CI 1.17, 2.50). Conclusions: Efforts that target multiple tobacco product use should increase youth tobacco-related harm perceptions, and protect youth from social, peer, and industry influences