An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

"I Can't Make Perfect Choices All the Time": Perspectives on Tobacco Harm Reduction Among Young Adults Who Identify as Sexual and Gender Minorities.

INTRODUCTION: Cigarette smoking is among the most harmful ways to consume nicotine and tends to be concentrated among socially marginalized groups of people, including sexual and gender minorities (SGM). Though some approaches to tobacco control in the United States are harm reduction strategies (eg, smoke-free environments), often abstinence is an explicitly stated goal and discussions of tobacco harm reduction (THR) are controversial, particularly for young people. Despite this controversy in the tobacco field, emerging research suggests that THR may be gaining momentum as a "community-led" rather than "public health-led" health practice. To date, little is known about how SGM young adults negotiate their use of tobacco products, particularly in terms of minimizing the harms associated with smoking. AIMS AND METHODS: We conducted 100 in-depth interviews with SGM young adults ages 18-25 years living in the San Francisco Bay Area, to better understand participant perceptions and everyday practices related to THR. RESULTS: A thematic analysis of interview narratives revealed the ways in which participants relied upon various THR strategies while balancing their well-being within the context of broader socio-structural harms. Participants' narratives also underscored beliefs about the importance of pragmatic, nonjudgmental, and person-centered approaches to preventing inequities in tobacco-related illnesses. CONCLUSIONS: Findings represent a significant departure from the mainstream discourse in the U. S. surrounding THR, by revealing how understanding the practice of THR among SGM young adults who use nicotine and tobacco can be instrumental in shaping approaches to tobacco control policy and prevention that may ultimately help to reduce inequities in tobacco-related illnesses. IMPLICATIONS: Findings from this study present the perspectives and practices of THR among sexual and gender minority young adults and emphasize the importance of integrating this approach in tobacco control to better achieve tobacco-related equity. Results can be used to better design tobacco prevention, treatment, and policy strategies that are compassionate and responsive to the needs of these important priority populations.

Ethnicity, Coronavirus Disease-Related Stress, and E-cigarette Use and Cigarette Smoking Among Young Adults: A Longitudinal Study.

INTRODUCTION: Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use. AIMS AND METHODS: Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March-May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress. RESULTS: Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status. CONCLUSIONS: The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes. IMPLICATIONS: The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic.

Objective and perceived measures of tobacco marketing are uniquely associated with cigar use.

BACKGROUND: Few studies have examined associations between perceived and objective exposure to tobacco marketing and cigar use, which is the second most commonly used tobacco product by youth. METHODS: We used Geographic Ecological Momentary Assessment data over 14 days from youth aged 16-20 years (n=83 participants, n=948 observations; 34% past month users of any tobacco product) in eight city areas in California. Tobacco outlets in study cities were visited by trained observers to record outlet Global Positioning System (GPS) point locations and outdoor tobacco marketing. We assessed daily perceived exposure to tobacco marketing within participants' activity spaces; daily objective exposure to tobacco outlets with outdoor marketing within 50 m of activity space polylines (number of outlets and time spent near outlets) and daily cigar use excluding and including blunts. RESULTS: Controlling for demographics and baseline tobacco use, results from mixed logistic regression models showed that greater perceived exposure to tobacco marketing was positively associated with higher odds of cigar use each day, excluding blunts (adjusted odds ratios (aOR): 2.00; 95% CI 1.03 to 3.87) and including blunts (aOR: 1.87; 95% CI 1.26 to 2.77). Also, exposure to a greater number of tobacco outlets with outdoor marketing was associated with higher odds of cigar use each day, excluding blunts (aOR: 1.34; 95% CI 1.01 to 1.78), but not including blunts. CONCLUSIONS: Tobacco control efforts should consider both perceived and objective exposure to tobacco marketing and unique associations with blunt use to prevent cigar use.

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

OBJECTIVE: A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups. METHODS: Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018. RESULTS: Multilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups. CONCLUSIONS: Our findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

"I don't know whose mouth has been on this": youth nicotine and cannabis vaping practices in the context of the COVID-19 pandemic.

Early COVID-19 safety protocols urged physical and social distancing, resulting in minimal contact with others. As social contexts are central to vaping among youth, we used semi-structured interviews to describe how youth who vape are making sense of their use practices and adaptations. The qualitative analyses revealed changes in vaping frequency and access, social isolation shaping substance- and product-specific use, and motivations and outcomes of dual use of nicotine and cannabis which were closely linked to the pandemic. The findings indicate variation of youth vaping experiences within the early stages of the pandemic that should be attended to in future studies.

Socio-temporal contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study.

BACKGROUND: Adolescents who dual use ENDS with tobacco cigarettes are more likely to have an increased risk of developing dependence. Yet, little is understood about the factors driving dual use among adolescents. The current study sought to reveal the day-to-day socio-temporal contextual and community factors associated with adolescents' use of electronic nicotine delivery systems (ENDS), and how these factors predict dual use with tobacco cigarettes. METHODS: We collected ecological momentary assessments (EMA) from a sample of 50 adolescent past two-week vapers (ages 14-17 years old) over 14 days. Daily EMA data were collected on ENDS and tobacco cigarette use, as well as a range of contextual (i.e., motivations to vape, location of vaping, who with when vaping) and community factors (i.e., exposure to peers vaping, to adults vaping, to ENDS advertising, to ENDS warning messages). Our primary analyses were multilevel regressions, accounting for daily observations nested within individuals (N = 700 observations). RESULTS: Participants used ENDS exclusively on 44% of days and dual used ENDS and tobacco cigarettes on 8% of the days. Dual use days (versus exclusive ENDS use days) were associated with "vaping because tobacco use was prohibited" (OR = 34.65, p < .05). Also, dual use days (versus no use days) were associated with greater exposure to adults vaping (OR = 5.59, p < .05), peers vaping (OR = 7.48, p < .05), and (c) ENDS advertisements or promotions (OR = 2.12, p < .01), whereas exclusive use days (versus no use days) were only associated with greater exposure to peers vaping (OR = 2.58, p < .01). CONCLUSIONS: Results showed that exposure to peers and adults vaping and exposure to ENDS marketing were associated with same day dual use behaviors. And, that adolescents who dual used were motivated to use ENDS because they were easy to conceal. Findings support stricter regulation of ENDS marketing and for smoke-free air laws that include ENDS. In addition, these findings support prioritizing family- and school-based prevention programming that effectively communicates risk associated with ENDS use, including heightened risk of dual use and dependence. Such efforts can reduce the number of adolescents who use ENDS as well as the number who transition to tobacco cigarette use.

Context-Specific Drinking Risks among Adolescents.

Background: Research has shown that specific contexts are associated with alcohol related problems in adults, but less is known about adolescents. Objectives: We examined how frequencies of drinking in different contexts and the amount of alcohol consumed in these contexts may be related to different alcohol-related problems among adolescent drinkers. Methods: Data were collected through a cross-sectional survey with 377 adolescents (13 to 18 years old) who reported past-6-month alcohol use, sampled from California households. Outcome measures included the breadth of alcohol-related problems participants experienced in the past 6-months overall and in 4 domains (physical, personal, social, and driving under the influence of alcohol or riding with a drunk driver [DUI/RDD]). We also assessed socio-demographics, the number of days adolescents drank alcohol in five contexts (restaurants, own homes, others' homes, outdoors, and fraternities/sororities) and the typical number of drinks they had in each context. Context-specific dose-response models were used to analyze data. Results: In adjusted models, drinking more frequently in outdoor venues was associated with greater number of alcohol-related problems. Drinking frequency in others' homes and in fraternities/sororities was positively associated with a greater number of physical problems. Drinking frequencies in outdoor venues and in others' homes were associated with greater number of personal problems. Finally, drinking more frequently in outdoor venues was associated with greater number of social problems and DUI/RDD. Conclusions/Importance: Results suggest the importance of considering drinking contexts independent of heavier drinking in the context, and they can be used to inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts.KEY POINT SUMMARYThe associations between contexts and drinking problems among adolescents cannot be fully explained by heavier drinking in these contexts.Adolescents' drinking frequencies in specific contexts are uniquely associated with different types of alcohol-related problems.Results inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts among adolescents.

Time Perspective and Substance Use: An Examination Across Three Adolescent Samples.

Time perspective is conceptualized as a multidimensional construct that assesses individuals' feelings and thoughts about the past, present, and future. The current study examined relationships between feelings (time attitudes) and thoughts (time orientation) about time and substance use behaviors across three adolescent samples. Participants included a high-risk sample of adjudicated youth (N=124; M age =15.54, SD=1.69; 51.61% female) and two general population school samples (N=777; M age =15.82, SD=1.23; 53.41% female; N=1873; M age =15.87, SD=1.28; 52.22% female). Cross-sectional survey data were collected from samples in schools during 2010, 2016, and 2011, respectively. Poisson and negative binomial regression analyses indicated that overall, more positive feelings about time were associated with fewer substances used and, conversely, more negative feelings about time were associated with more substances used. These findings were particularly salient for participants with stronger positive and negative feelings toward the past and present time periods. Further, across the three samples, adolescents with a balanced time orientation (i.e., equal emphasis on all three time periods) generally reported less substance use than individuals who emphasized only one or two time periods. Findings highlight relationships between time perspective dimensions and substance use across diverse samples and illustrate opportunities for adapting time perspective-based substance use interventions for adolescents.

Understanding the Impact of COVID-19 on Tobacco and Nicotine Use among Young Adults Identified as Sexual and Gender Minorities: A Mixed Methods Approach.

We investigated the perceived impact of COVID-19 on changes in tobacco and nicotine (NT) use among sexual and gender minority (SGM) young adults. We used a mixed methods approach that included closed- and open-ended survey questions and in-depth interviews. Participants were 53 SGM young adults in California who reported current or past cigarette smoking. Of study participants, 63% (n=33) reported any changes in their NT use, and of those, 60% reported initial increase of NT use. Content analysis of an open-ended survey question revealed three reported reasons for changes in NT use: (1) changes in routine activities (27%), (2) stress (46%), and (3) health (24%). Thematic analysis of qualitative interviews identified several related themes: (1) in discussions of increased NT use, stress and boredom/free time were important aspects of changes to daily routines, (2) fluctuations in NT use behaviors occurred over time, (3) reasons for NT changes were multiple and intertwined, and (4) NT use changes were shaped by experiences related to intersectional forms of structural and social stigmatization. Results reveal the dynamic and complex ways in which participants described their pandemic-related changes in NT use-nuance that is crucial for compassionate and participant-centered approaches to tobacco prevention and cessation.

Changes in Drinking Contexts over the Night Course: Concurrent and Lagged Associations with Adolescents' Nightly Alcohol Use.

BACKGROUND: Examining underage drinking contexts can advance the field of adolescent substance use prevention by supporting and informing interventions that can target adolescents in specific contexts. The current study examines how concurrent and lagged situational (i.e., alcohol availability and adult supervision), social (i.e., the number of people and presence of friends), and location (i.e., home vs other location) context characteristics change risks for alcohol use over the night course. METHODS: Text messages with links to online surveys were used to collect ecological momentary assessment (EMA) data over 2 weekends from adolescents in California. Data were collected using adolescents' personal cell phones early and late in the evening and the following morning. Analyses were limited to adolescents with at least 1 drinking occasion during EMA (N = 58; Mage = 16.64, SD = 0.74; 48% female; 83% White). RESULTS: Drinking earlier in the evening was positively associated with continued drinking over the night course. Context characteristics were found to play important concurrent and lagged roles in increasing the likelihood of alcohol use over evening hours. CONCLUSIONS: Findings indicated substantive concurrent and lagged social, situational, and location-based contextual effects on adolescent alcohol use over the course of an evening. Importantly, context characteristics were differentially associated with alcohol use over the course of the evening. The fact that these contextual factors are modifiable suggests that the use of prevention strategies delivered to adolescents throughout the evening may reduce adolescents' drinking and related problems over the evening hours.

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.

Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California.

INTRODUCTION: Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. METHODS: We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. RESULTS: The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. CONCLUSION: Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. IMPLICATIONS: This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.

Tobacco outlet density and adolescents' cigarette smoking: a meta-analysis.

OBJECTIVE: We conducted meta-analyses of studies that investigated the associations between tobacco outlet density around homes and schools and adolescents' past-month cigarette smoking. DATA SOURCES: Systematic literature searches of eight databases were carried out in February 2017. Searches were not limited by date, language, country or peer-reviewed status. STUDY SELECTION: After screening for quality, studies that examined the relationship between tobacco outlet density and adolescents' past-month smoking were selected for inclusion. DATA EXTRACTION: Two investigators screened study abstracts and full texts and independently extracted data. Consensus was reached at each stage. DATA SYNTHESIS: Random-effects meta-analyses were conducted on 11 studies that provided 13 effect sizes. Results showed that there was a significant association between tobacco outlet density around homes and adolescents' past-month smoking behaviour, with an overall effect size of OR=1.08 (95% CI 1.04 to 1.13; P<0.001; I2=0%). For density around schools, the association was not statistically significant (OR=1.01, 95% CI 0.98 to 1.03; P=0.53; I2=39%). CONCLUSIONS: These findings suggest that exposure to tobacco outlets near home environments may be important for understanding adolescents' past-month smoking. Restricting access to tobacco outlets and controlling the number of outlets in residential areas may be an effective preventive strategy to help reduce adolescents' smoking.

Associations of Early Age of First Intoxication with Past Year Drinking Contexts and Problems.

BACKGROUND: Mechanisms underlying associations between early drinking and problems are largely unknown. OBJECTIVES: We investigated (a) associations between early age of first intoxication (≤15 years) and past year drinking in different contexts and (b) whether early age of first intoxication is differentially associated with problems in these contexts. METHODS: We used survey data collected in 2013-2014 from 405 past-year adolescent drinkers in 24 midsized California cities. Data included demographics; drinking behaviors; age of first intoxication; frequency of being at and drinking at restaurants, bars/nightclubs, outdoor places, and home; and problems. We used multilevel logistic and negative binomial models to account for the clustering of adolescents within cities. Probabilities were corrected to maintain family-wise error rates. RESULTS: Early age of first intoxication was associated with a 120% increase in the odds of drinking at outdoor settings (OR = 2.20, pc < .05). Early age of first intoxication was associated with increased numbers of problems related to drinking in restaurants (IRR = 5.72, pc < .001), outdoor settings (IRR = 3.40, pc < .001), and homes (IRR = 2.84, pc < .001). Later intoxication (≥16 years) was not significantly associated with increased drinking or problems in any of these contexts. CONCLUSIONS: Results suggest that underage drinkers who report early intoxication are more likely to drink at outdoor settings, but not other contexts. However, they may differentially experience drinking problems across contexts. To target youths who have experienced intoxication at an early age and to reduce problems, prevention interventions should focus on outdoor settings.

"It just depends on the environment": Patterns and decisions of substance use and co-use by adolescents.

This study used rich qualitative data to examine the role that social and physical contexts play in decision-making related to simultaneous use of alcohol and marijuana among adolescents. In-depth, semi-structured interviews were conducted with 13 adolescents who used alcohol and marijuana within several hours of each other. Decisions about whether to use alcohol and marijuana simultaneously as well as use patterns (e.g. the sequence in which substances were used) were informed by the context and the desired effect of the substance(s). Also, simultaneous alcohol and marijuana use was described as occurring in multiple contexts, both destination and transitional. Interventions designed to reduce simultaneous alcohol and marijuana use could benefit from paying attention to substance use contexts.

The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers.

AIMS: We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma. FINDINGS: Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.

Tobacco Denormalization as a Public Health Strategy: Implications for Sexual and Gender Minorities.

Although the population-level success of tobacco denormalization is widely accepted, it remains unclear whether these strategies alleviate health inequities for sexual and gender minorities. The high risk of smoking among sexual and gender minorities together with research that documents a relationship between stigma-related processes and smoking prevalence for these groups raises questions about whether tobacco-related stigma intensifies the disadvantages associated with the stigmas of other social identities. We have not adequately considered how tobacco-related stigma overlaps with other social identity stigmas. Given concerns about the intensification of inequality, this type of inquiry has important implications for understanding both the effectiveness and limitations of tobacco denormalization strategies for sexual and gender minorities and identifying those tobacco prevention, treatment, and public health policies that work to ameliorate health inequities.

Adolescent Drinking Risks Associated with Specific Drinking Contexts.

BACKGROUND: To identify drinking contexts toward which prevention efforts should be directed, associations of context-specific alcohol use (past-year frequency of drinking and heavier drinking in the context) with a range of alcohol-related problems were examined in a population sample of adolescents. METHODS: A sample of youths (ages 15 to 18) residing in 50 medium-to-large California cities (n = 473 drinkers) was obtained. Respondents provided information about 7 past-year alcohol-related problems in 3 domains (physiological consequences, alcohol-related violence, and conflict/trouble) and the number of times in the past year they used 6 distinct drinking contexts (parties, restaurants/bars, parking lots/street corners, beaches/parks, respondent's home without parents, and someone else's home without parents). Context-specific dose-response model was estimated for each context using censored Tobit models with heteroskedasticity corrections. RESULTS: Physiological problems were associated with more frequent drinking in 5 of 6 contexts. Heavier drinking in restaurants/bars/nightclubs (b = 0.22, SE = 0.10) and someone else's home without parents (b = 0.14, SE = 0.06) was associated with greater risk of violence. Conflict/trouble was associated with more frequent drinking in parking lots/street corners, declining at higher levels of drinking. CONCLUSIONS: Certain drinking contexts are related to problems among youths, some because they are associated with frequent alcohol consumption and others because they are associated with heavier drinking. Identifying which drinking contexts are related to specific alcohol-related problems and why is an essential component of developing effective preventive interventions.

Who drinks where: youth selection of drinking contexts.

BACKGROUND: Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. METHODS: We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. RESULTS: Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. CONCLUSIONS: The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts.