Faculty Bibliography

INTRODUCTION/BACKGROUND:Little is known about the relationship between smoke-free laws and persistent disparities in secondhand smoke (SHS) exposure among nonsmoking adults in the U.S. METHODS:We constructed time-varying smoke-free law measures representing whether or not at least 50% of each U.S. county's population was covered by smoke-free laws in workplaces and hospitality venues (restaurants/bars). We merged this data with restricted data on cotinine-derived SHS exposure among nonsmokers from the National Health and Nutrition Examination Survey, 1999-2014 (N=25,444). Using logistic regression, we estimated associations between smoke-free law coverage and SHS exposure among all nonsmokers, and within age strata (25-39, 40-59, 60+). We explored differential associations by gender, race/ethnicity, education, and poverty income ratio (PIR) by testing the significance of interactions terms for the full sample and within age strata. RESULTS:In adjusted models, hospitality coverage was associated with lower odds of SHS exposure in the full sample (odds ratio/OR=0.62; 95% confidence interval/CI=0.51-0.76), and within each age group, with ORs ranging from 0.58 (ages 25-39) to 0.67 (ages 60+). Workplace coverage was associated with lower SHS exposure only among younger adults (OR=0.81; 95% CI=0.65-0.99). Within the full sample and among adults ages 40-59, hospitality laws were associated with narrowing SHS exposure differentials between males and females. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females, but worsening exposure disparities by PIR. CONCLUSIONS:Smoke-free laws may reduce SHS exposure among adult nonsmokers, but may be insufficient to improve disparities in SHS exposure.

BACKGROUND:Little is known regarding long-term impacts of anti-tobacco media campaigns on youth smoking and related disparities in the United States. METHODS:We examined longitudinal cohort data from Monitoring the Future (MTF) between 2000 and 2017 in modified Poisson regression models to understand the long-term impacts of televised Truth and state-sponsored ad campaign exposure at baseline (age 18) on first cigarette and daily smoking initiation 1 to 2 years later (at modal ages 19/20). We also used additive interactions to test for potential effect modification between campaign exposure and smoking outcomes by sex, race/ethnicity, and parental educational attainment. RESULTS:We found no evidence for baseline media campaign exposure to be associated with first cigarette or daily smoking initiation at modal age 19/20. Further, results showed no evidence for effect modification between campaign exposure and first cigarette or daily smoking initiation. CONCLUSIONS:We found no evidence that baseline Truth and state-sponsored ad exposure was associated with first cigarette or daily smoking initiation at follow up, nor did we find any evidence for effect modification by sex, race/ethnicity, or parental education. We hypothesize that anti-tobacco media campaigns might have had a short-term impact on smoking behaviors, though these effects were not sustained long term.

BACKGROUND:Exposure to structural stigma (i.e., societal norms and policies that constrain access to resources) may help explain poor health outcomes among sexual minority (SM) individuals in the USA. PURPOSE/OBJECTIVE:We examined the relationship between structural stigma and smoking prevalence among U.S. SM and heterosexual adults. METHODS:We adapted an index to capture multiple state-level structural stigma indicators, including attitudes toward same-sex marriage; the geographical density of same-sex couples; and state-level policies toward SMs. The outcome variable was current smoking, derived from the National Adult Tobacco Survey (2012-2014). Poisson regression models stratified by SM status were used to assess the relationship between structural stigma and the prevalence ratio (PR) of current smoking. We included a squared term for stigma to explore nonlinear relationships between stigma and smoking. Interaction terms were used to examine effect modification by sex. RESULTS:Adjusted models suggested a curvilinear PR relationship between stigma and smoking for both SM (linear PR = 1.03 [0.97-1.08]; quadratic PR = 0.98 [0.97-1.00]) and heterosexual (linear PR = 1.00 [0.99-1.02]; quadratic PR = 0.99 [0.988-0.995]) adults. The quadratic term was significant (p < .05) for both SM and heterosexual respondents, however, the change in probability of smoking associated with structural stigma was more pronounced among SM individuals. Specifically, the highest and lowest exposures to stigma were associated with the lowest probabilities of smoking. There was no apparent effect modification by sex. CONCLUSIONS:Findings lend support to addressing SM structural stigma as a driver of smoking, particularly among SM adults.

PURPOSE:To evaluate sociodemographic differences in the relationship between state and national anti-smoking media campaigns and cessation behaviors among adult smokers in the U.S. DESIGN:Repeated cross-sectional analysis. SETTING:U.S. nationally representative survey of adults ages 18 and older, 2001-2015. SUBJECTS:76,278 year-ago smokers from the 2001-2015 Tobacco Use Supplement to the Current Population Survey. MEASURES:Area-level exposure to State-sponsored and "Tips from former smokers" anti-tobacco media campaigns was the primary predictor of this study. Outcome variables included: quit attempt in the past 12 months, past 30-day smoking cessation, and past 90-day smoking cessation among year-ago smokers. ANALYSIS:We conducted modified Poisson regression models to examine the association between media campaign exposure and cessation behaviors. We also examined effect modification on the additive scale by sex, race/ethnicity, income, and education using average marginal effects. RESULTS:Year-ago smokers with greater exposure to media campaigns were more likely to report 30-day (Prevalence Ratio [PR]: 1.18, CI: 1.03, 1.36) and 90-day cessation (PR: 1.18, CI: 1.00, 1.41) compared to respondents with less campaign exposure. We found no evidence of effect modification by sociodemographic variables. CONCLUSION:Exposure to anti-smoking media campaigns were associated with year-ago smokers' cessation behaviors. However, there were no differences in the association by sex, race/ethnicity, income, or education, indicating that broadly focused media campaigns may be insufficient to reduce smoking cessation among priority populations, and thus health disparities generally.

INTRODUCTION:The goal of the paper is to characterize the geographic and sociodemographic patterns of policies prohibiting tobacco sales to people aged <21 years (i.e., Tobacco 21) at the local, county, and state levels in the U.S. before the national law. METHODS:This study assessed area-level markers for region, race/ethnicity, education, poverty status, and smoke-free law coverage as predictors of Tobacco 21 passage as of December 20, 2019, using modified Poisson and negative binomial regression models with robust SEs. Data were analyzed in 2020. RESULTS:Before the passage of the national policy, 191 million people were covered by Tobacco 21 laws. Counties with higher percentages of non-Hispanic Blacks and individuals living below the poverty line had a lower probability of coverage, whereas counties with higher percentages of Hispanics/Latinxs and individuals with a college degree had a higher probability of coverage. Tobacco 21 coverage also varied by region, with far greater coverage in the Northeast than in the Midwest and South. CONCLUSIONS:The national Tobacco 21 law may address disparities in coverage by SES, race/ethnicity, and region that could have lasting implications with regard to health equity.

Increasing cigarette taxes has been the cornerstone of tobacco control policy. Recent work has argued that raising cigarette taxes alone may no longer be an effective strategy for lowering smoking rates. We largely confirm these findings but also find that increases in price continue to predict lower smoking participation in most model specifications. We argue that raising cigarette prices via taxation remains an effective public health policy. We discuss the advantages of homogeneous tax environments and minimum price laws for eliminating opportunities for consumers to offset tax increases by searching for lowest taxes.

INTRODUCTION:This study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers. METHODS:The effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic regression and data from the 2010-2011 and 2014-2015 waves of the Tobacco Use Supplement to the Current Population Survey. Using boosted logistic regression, the Tobacco Use Supplement was restricted to an analytic sample composed of childless adults with high probability of being <138% of the federal poverty level. Propensity score weighting was used to compare changes in smoking cessation among a sample of current and past smokers in states that expanded Medicaid with a control sample of current and past smokers in states that did not expand Medicaid with similar sociodemographic characteristics and smoking histories. This study additionally controlled for state socioeconomic trends, welfare policies, and tobacco control policies. Analysis was conducted between January 2018 and June 2019. RESULTS:After weighting by propensity score and adjusting for state socioeconomic trends, welfare policies, and tobacco control policies, the Medicaid expansion was not associated with increases in smoking quit attempts or smoking cessation. CONCLUSIONS:The Medicaid expansion did not appear to improve smoking cessation, despite extending health insurance eligibility to 2.3 million low-income smokers. Greater commitments to reducing barriers to cessation benefits and increasing smoking cessation in state Medicaid programs are needed to reduce smoking in low-income populations.

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003-2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression models to assess the impact of each smoke-free measure on 90-day cessation. Effect modification by gender, education, family income, and race/ethnicity was examined using interaction terms. (3) Results: Coverage by workplace smoke-free laws and self-reported workplace smoke-free policies was associated with higher odds of cessation among respondents ages 40-54. Family income modified the association between smoke-free workplace laws and cessation for women ages 25-39 (the change in the probability of cessation associated with coverage was most pronounced among lower-income women). (4) Conclusions: Heterogeneous associations between policies and cessation suggest that smoke-free policies may have important implications for health equity.

Background/UNASSIGNED:Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions. Methods/UNASSIGNED:(ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH). Results/UNASSIGNED:ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption. Conclusions/UNASSIGNED:Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions.