E-Cigarette Use Among persons With Diagnosed HIV in the U.S.

Introduction: E-cigarettes emerged in the U.S. market in the late 2000s. In 2017, E-cigarette use among U.S. adults was 2.8%, with higher use among some population groups. Limited studies have assessed E-cigarette use among persons with diagnosed HIV. The purpose of this study is to describe the national prevalence estimates of E-cigarette use among persons with diagnosed HIV by selected sociodemographic, behavioral, and clinical characteristics. Methods: Data were collected between June 2018 and May 2019 as part of the Medical Monitoring Project, an annual cross-sectional survey that produces nationally representative estimates of behavioral and clinical characteristics of persons with diagnosed HIV in the U.S. Statistically significant differences (p<0.05) were determined using chi-square tests. Data were analyzed in 2021. Results: Among persons with diagnosed HIV, 5.9% reported currently using E-cigarettes, 27.1% had ever used them but were not using them currently, and 72.9% had never used them. Current use of E-cigarettes was highest among persons with diagnosed HIV who currently smoke conventional cigarettes (11.1%), those with major depression (10.8%), those aged 25-34 years (10.5%), those who reported injectable and noninjectable drug use in the past 12 months (9.7%), those diagnosed <5 years ago (9.5%), those who self-reported sexual orientation as other (9.2%), and non-Hispanic White people (8.4%). Conclusions: Overall, findings suggest that a greater proportion of persons with diagnosed HIV used E-cigarettes than the overall U.S. adult population and that higher rates were observed among certain subgroups, including those who currently smoke cigarettes. E-cigarette use among persons with diagnosed HIV warrants continued attention because of its potential impact on HIV-related morbidity and mortality.

CDC Deployments to State, Tribal, Local, and Territorial Health Departments for COVID-19 Emergency Public Health Response - United States, January 21-July 25, 2020.

Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by SARS-CoV-2. During January 21-July 25, 2020, in response to official requests for assistance with COVID-19 emergency public health response activities, CDC deployed 208 teams to assist 55 state, tribal, local, and territorial health departments. CDC deployment data were analyzed to summarize activities by deployed CDC teams in assisting state, tribal, local, and territorial health departments to identify and implement measures to contain SARS-CoV-2 transmission (1). Deployed teams assisted with the investigation of transmission in high-risk congregate settings, such as long-term care facilities (53 deployments; 26% of total), food processing facilities (24; 12%), correctional facilities (12; 6%), and settings that provide services to persons experiencing homelessness (10; 5%). Among the 208 deployed teams, 178 (85%) provided assistance to state health departments, 12 (6%) to tribal health departments, 10 (5%) to local health departments, and eight (4%) to territorial health departments. CDC collaborations with health departments have strengthened local capacity and provided outbreak response support. Collaborations focused attention on health equity issues among disproportionately affected populations (e.g., racial and ethnic minority populations, essential frontline workers, and persons experiencing homelessness) and through a place-based focus (e.g., persons living in rural or frontier areas). These collaborations also facilitated enhanced characterization of COVID-19 epidemiology, directly contributing to CDC data-informed guidance, including guidance for serial testing as a containment strategy in high-risk congregate settings, targeted interventions and prevention efforts among workers at food processing facilities, and social distancing.

Community Members' Pre-exposure Prophylaxis Awareness, Attitudes, and Trusted Sources for PrEP Information and Provision, Context Matters Survey, 2015-2016.

Men and women of color have had low pre-exposure prophylaxis (PrEP) uptake. How one's preferred source of health information shapes attitudes toward PrEP is unclear. We conducted cross-sectional surveys to assess changes in PrEP awareness, knowledge, and attitudes, trusted sources for PrEP information, and associations between trusted source of information and PrEP knowledge and attitudes. Participants were recruited from six areas served by community health centers in Chicago, IL (two health centers); Jackson, MS; Newark, NJ; Philadelphia, PA; and Washington, D.C. during June-September 2015 (n = 160) and June-September 2016 (n = 200). Participants were Black (74%), heterosexual (81%), and largely unaware of PrEP (72%). Participants who trusted health experts and community organizations for PrEP information had lower percentages of agreeing with statements indicative of negative PrEP attitudes. Interventions that increase PrEP awareness as well as knowledge and favorable attitudes might help increase PrEP use in communities with high HIV prevalence.

Disparities in Smoking-Related Mortality Among American Indians/Alaska Natives.

INTRODUCTION: Smoking-related disparities continue to be a public health problem among American Indian/Alaska Native (AI/AN) population groups and data documenting the health burden of smoking in this population are sparse. The purpose of this study was to assess mortality attributable to cigarette smoking among AI/AN adults relative to non-Hispanic white adults (whites) by calculating and comparing smoking-attributable fractions and mortality. METHODS: Smoking-attributable fractions and mortality among AI/ANs (n=1.63 million AI/ANs) and whites were calculated for people living in 637 Indian Health Service Contract Health Service Delivery Area counties in the U.S., from mortality data collected during 2001-2009. Differences in smoking-attributable mortality between AI/ANs and whites for five major causes of smoking-related deaths were examined. All data analyses were carried out in 2013-2014. RESULTS: Overall, from 2001 to 2009, age-adjusted death rates, smoking-attributable fractions, and smoking-attributable mortality for all-cause mortality were higher among AI/ANs than among whites for adult men and women aged ≥35 years. Smoking caused 21% of ischemic heart disease, 15% of other heart disease, and 17% of stroke deaths in AI/AN men, compared with 15%, 10%, and 9%, respectively, for white men. Among AI/AN women, smoking caused 18% of ischemic heart disease deaths, 13% of other heart diseases deaths, and 20% of stroke deaths, compared with 9%, 7%, and 10%, respectively, among white women. CONCLUSIONS: These findings underscore the need for comprehensive tobacco control and prevention efforts that can effectively reach and impact the AI/AN population to prevent and reduce smoking.

Smoke-free policies in U.S. Prisons and jails: A review of the literature.

INTRODUCTION: Despite progress in limiting exposure to secondhand smoke (SHS) in the United States, little is known about the impact of smoke-free polices in prisons and jails. SHS exposure in this setting may be great, as smoking prevalence among inmates is more than three times higher than among non-incarcerated adults. To inform the implementation of smoke-free policies, this article reviews the literature on the extent, nature, and impact of smoke-free policies in U.S. prisons and jails. METHODS: We systematically searched PubMed, Embase, EconLit, and Social Services Abstracts databases. We examined studies published prior to January 2014 that described policies prohibiting smoking tobacco in adult U.S. correctional facilities. RESULTS: Twenty-seven studies met inclusion criteria. Smoke-free policies in prisons were rare in the 1980s but, by 2007, 87% prohibited smoking indoors. Policies reduced SHS exposure and a small body of evidence suggests they are associated with health benefits. We did not identify any studies documenting economic outcomes. Non-compliance with policies was documented in a small number of prisons and jails, with 20%-76% of inmates reporting smoking in violation of a policy. Despite barriers, policies were implemented successfully when access to contraband tobacco was limited and penalties were enforced. CONCLUSION: Smoke-free policies have become increasingly common in prisons and jails, but evidence suggests they are not consistently implemented. Future studies should examine the health and economic outcomes of smoke-free policies in prisons and jails. By implementing smoke-free policies, prisons and jails have an opportunity to improve the health of staff and inmates.

Tobacco use, cessation, and home smoking rules in a Hispanic community.

OBJECTIVE: To determine prevalence of smoking, quit ratios, and home smoking rules among Hispanics residing in colonias in El Paso, Texas. METHODS: Face-to-face interviews with 1485 Hispanic adults. GeoFrame™ field enumeration methods were used to develop a sampling frame from households in randomly selected colonias. RESULTS: The overall percent of current cigarette smoking was 14.6% (95% CI 12.4 to 16.8); Over 55% of smokers reported a serious quit attempt. Participants overwhelmingly reported that smoking was not allowed in their homes. CONCLUSIONS: Prevalence estimates for current smoking and restriction in the home were similar to those reported for recent national surveys.

Menthol cigarette use among racial and ethnic groups in the United States, 2004-2008.

INTRODUCTION: Understanding the patterns of menthol cigarette use can be useful in developing and justifying policies designed to prevent and reduce cigarette use and exposure to tobacco smoke. This report provides an update and summary of the demographic distribution and trends of menthol cigarette use in the United States. METHODS: Data from the 2004-2008 National Survey on Drug Use and Health were analyzed to estimate menthol cigarette use among current smokers by race/ethnicity, sex, and age (12 years and older). A t-test was used to compare estimates for menthol and nonmenthol use by demographic group. Trend analyses were conducted to examine differences in menthol cigarette use by race/ethnicity and age from 2004 to 2008. RESULTS: Over half of menthol cigarette smokers were female (52.2%), and approximately 29.4% of all menthol smokers were Black, which was almost 10 times the percentage of nonmenthol smokers who were Black (3.0%, p < .01). Prevalence of past month menthol cigarette use was highest among current smokers aged 12-17 years (44.7%) and decreased as age group increased. From 2004 to 2008, menthol cigarette use increased significantly among White smokers aged 12-17 years (from 40.3% in 2004 to 46.0% in 2008, p < .01). Menthol cigarette use among young adult smokers aged 18-25 years increased for Hispanics (from 33.9% in 2004 to 42.4% in 2008, p < .01) and Whites (from 26.7% to 32.5%, p < .01). CONCLUSIONS: Demographic disparities in menthol cigarette use persist in the United States. Continued monitoring and improvement of existing surveillance systems to identify patterns and trends in menthol cigarette use are needed.

Adult tobacco survey - 19 States, 2003-2007.

PROBLEM/CONDITION: Tobacco use is the leading cause of preventable death in the United States. REPORTING PERIOD: This report includes data collected during February 2003-November 2007. DESCRIPTION OF THE SYSTEM: The Adult Tobacco Survey (ATS) is a state-administered, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >or=18 years. ATS collects data on tobacco use, smoking cessation, secondhand smoke exposure, risk perception and social influences, health influences, and tobacco-related policy issues in the United States. ATS was developed primarily for evaluation of state tobacco control programs rather than for surveillance and offers states a great deal of flexibility in terms of when and how often the surveys can be conducted. During 2003-2007, a total of 33 state ATSs were conducted by 19 states, with sample sizes ranging from 1,301 to 12,734 completed and partially completed interviews. RESULTS: ATS data indicate that during 2003-2007, 13.3%-25.4% of adults smoked cigarettes (median: 19.2%); fewer adults smoked cigars (median: 6.4%) or used smokeless tobacco (median: 3.5%). The majority of tobacco users used one tobacco product (median: 82.5%). In most states, approximately half of cigarette smokers reported that they would try to quit in the next 6 months (median: 58.4%), and approximately half made an attempt to quit in the preceding year (median: 46.8%). The majority of adults (i.e., smokers and nonsmokers combined) reported that smoking should not be allowed at all in workplaces (median: 77.6%), restaurants (median: 65.5%), public buildings (median: 72.5%), or indoor sporting events/concerts (median: 72.1%). One third of adults reported smoking should not be allowed at all in cocktail lounges or bars (median: 33.1%). The percentage of adults who reported having smoke-free policies at work or home ranged from 51.2% to 75.2% (median: 61.7%). INTERPRETATION: These data indicate that respondents support certain state tobacco control measures; for example, the majority of adults in participating states were supportive of smoke-free policies as well as of an increase in tobacco excise tax. However, one of every five tobacco users in the participating states used multiple tobacco products, a behavior that was more common among young adults. Therefore, these data also underscore a continued need for monitoring and evaluating evidence-based, comprehensive U.S. tobacco control programs and policies. PUBLIC HEALTH ACTIONS: State ATSs can be used by states to monitor and evaluate comprehensive statewide tobacco control programs. Continued surveillance of tobacco use and tobacco control outcome indicators are needed to monitor, evaluate, and improve state programs that address tobacco use, cessation, and secondhand smoke exposure.

Customizing survey instruments and data collection to reach Hispanic/Latino adults in border communities in Texas.

OBJECTIVES: We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007-April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas-Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas. RESULTS: The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%. CONCLUSIONS: Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods.

Abnormal mammogram follow-up: do community lay health advocates make a difference?

This pilot study evaluates a community lay health advocate (CLHA) intervention in promoting follow-up for abnormal mammograms among African American women. A controlled trial was implemented at an urban hospital in Atlanta, with 48 women in a CLHA intervention group and 35 in a usual care group. Participants were 25 or older and had an abnormal mammogram between March 25, 2002, and May 2, 2003. Intervention group women received CLHA support including encouragement of timely abnormal mammogram follow-up, reminders of follow-up appointments, identification and removal of barriers to follow-up, and accompaniment to follow-up appointments. Women in the intervention group were significantly more likely to keep their first abnormal mammogram follow-up appointment, all of their scheduled follow-up appointments, and their biopsy or fine needle aspiration appointment. CLHAs are effective in promoting abnormal mammogram followup among African American women and may be an important resource in reducing racial disparities in breast cancer mortality.