Examining the Role of Neighborhood-Level Foreclosure in Smoking and Alcohol Use Among Older Adults in the Multi-Ethnic Study of Atherosclerosis.

The US Great Recession resulted in an alarming number of home foreclosures that weakened the social and physical environment of thousands of neighborhoods. Few studies have evaluated whether these neighborhood changes were related to changes in individual behaviors. We examined the relationship between changes in neighborhood-level home foreclosure within a quarter-mile (0.4-km) buffer of the residence and changes in cigarette smoking and alcohol use among 3,807 adults enrolled in the Multi-Ethnic Study of Atherosclerosis during 2005-2012, using econometric individual-level fixed-effects models. Increases in neighborhood-level foreclosure were associated with small decreases in the number of cigarettes smoked per day (mean difference = -0.08, 95% confidence interval: -0.11, -0.04) and small increases in the number of alcoholic beverages consumed per week (mean difference = 0.11, 95% confidence interval: 0.05, 0.17). Neighborhood-level foreclosure may not uniformly influence high-risk behaviors. The impact of home foreclosure on adult drinking should be further explored, given its potentially negative implications for health.

Cardiovascular Risk Factors, Depression, and Alcohol Consumption During Joblessness and During Recessions Among Young Adults in CARDIA.

Research has shown that recessions are associated with lower cardiovascular mortality, but unemployed individuals have a higher risk of cardiovascular disease (CVD) or death. We used data from 8 consecutive examinations (1985-2011) of the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, modeled in fixed-effect panel regressions, to investigate simultaneously the associations of CVD risk factors with the employment status of individuals and the macroeconomic conditions prevalent in the state where the individual lives. We found that unemployed individuals had lower levels of blood pressure, high-density lipoprotein cholesterol, and physical activity, and they had significantly higher depression scores, but they were similar to their counterparts in smoking status, alcohol consumption, low-density lipoprotein cholesterol levels, body mass index, and waist circumference. A 1-percentage-point higher unemployment rate at the state level was associated with lower systolic (-0.41 mm Hg, 95% CI: -0.65, -0.17) and diastolic (-0.19, 95% CI: -0.39, 0.01) blood pressure, higher physical activity levels, higher depressive symptom scores, lower waist circumference, and less smoking. We conclude that levels of CVD risk factors tend to improve during recessions, but mental health tends to deteriorate. Unemployed individuals are significantly more depressed, and they likely have lower levels of physical activity and high-density lipoprotein cholesterol.

Modeling the Effects of E-cigarettes on Smoking Behavior: Implications for Future Adult Smoking Prevalence.

BACKGROUND: Electronic cigarette (e-cigarette) use has increased rapidly in recent years. Given the unknown effects of e-cigarette use on cigarette smoking behaviors, e-cigarette regulation has become the subject of considerable controversy. In the absence of longitudinal data documenting the long-term effects of e-cigarette use on smoking behavior and population smoking outcomes, computational models can guide future empirical research and provide insights into the possible effects of e-cigarette use on smoking prevalence over time. METHODS: Agent-based model examining hypothetical scenarios of e-cigarette use by smoking status and e-cigarette effects on smoking initiation and smoking cessation. RESULTS: If e-cigarettes increase individual-level smoking cessation probabilities by 20%, the model estimates a 6% reduction in smoking prevalence by 2060 compared with baseline model (no effects) outcomes. In contrast, e-cigarette use prevalence among never smokers would have to rise dramatically from current estimates, with e-cigarettes increasing smoking initiation by more than 200% relative to baseline model estimates to achieve a corresponding 6% increase in smoking prevalence by 2060. CONCLUSIONS: Based on current knowledge of the patterns of e-cigarette use by smoking status and the heavy concentration of e-cigarette use among current smokers, the simulated effects of e-cigarettes on smoking cessation generate substantially larger changes to smoking prevalence compared with their effects on smoking initiation.

Behaviours and opinions towards outdoor smoking bans and cigarette littering in Baja California, Mexico.

OBJECTIVE: Outdoor smoking bans have been implemented to reduce secondhand smoke exposure and cigarette littering. We aimed to explore outdoor smoking behaviours, cigarette littering, and support towards a recently enacted outdoor smoking ban in Baja California, Mexico. METHODS: From October 2013 to April 2014 a representative sample of 800 adults from urban areas of Baja California was surveyed to obtain information on demographics, smoking status, opinion towards outdoor smoking bans in general and in specific locations, and perceptions and habits regarding cigarette littering. Descriptive statistics and Poisson regression analyses were conducted to estimate prevalence ratios and corresponding 95% CI taking into account the complex survey design. RESULTS: Outdoor smoking was frequently observed, as 86.8% of the population reported having seen people smoking in parks and beaches and 94.4% in open venues such as concerts or stadiums. A smoking ban in all outdoor areas was supported by 71.8% of Baja California residents. Site-specific support ranged from 80% (stadiums) to 89% (public parks). Support for the ban was higher among never and ex-smokers than in current smokers. Cigarette littering was negatively perceived by 98% of the participants, yet 45% of all cigarettes smoked were thrown on the ground. Based on cigarette consumption and butt littering reported in the survey, we estimated that 27 million cigarette butts become litter every month in urban areas of Baja California. CONCLUSIONS: Outdoor smoking is still frequent in outdoor areas where people gather, and an important source of littering. We found substantial public support towards the outdoor smoking ban, which should translate into easier implementation and compliance in Baja California, Mexico.

Longitudinal Associations Between Neighborhood Physical and Social Environments and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA).

IMPORTANCE: Neighborhood environments may influence the risk for developing type 2 diabetes mellitus (T2DM), but, to our knowledge, no longitudinal study has evaluated specific neighborhood exposures. OBJECTIVE: To determine whether long-term exposures to neighborhood physical and social environments, including the availability of healthy food and physical activity resources and levels of social cohesion and safety, are associated with incident T2DM during a 10-year period. DESIGN, SETTING, AND PARTICIPANTS: We used data from the Multi-Ethnic Study of Atherosclerosis, a population-based cohort study of adults aged 45 to 84 years at baseline (July 17, 2000, through August 29, 2002). A total of 5124 participants free of T2DM at baseline underwent 5 clinical follow-up examinations from July 17, 2000, through February 4, 2012. Time-varying measurements of neighborhood healthy food and physical activity resources and social environments were linked to individual participant addresses. Neighborhood environments were measured using geographic information system (GIS)- and survey-based methods and combined into a summary score. We estimated hazard ratios (HRs) of incident T2DM associated with cumulative exposure to neighborhood resources using Cox proportional hazards regression models adjusted for age, sex, income, educational level, race/ethnicity, alcohol use, and cigarette smoking. Data were analyzed from December 15, 2013, through September 22, 2014. MAIN OUTCOMES AND MEASURES: Incident T2DM defined as a fasting glucose level of at least 126 mg/dL or use of insulin or oral antihyperglycemics. RESULTS: During a median follow-up of 8.9 years (37,394 person-years), 616 of 5124 participants (12.0%) developed T2DM (crude incidence rate, 16.47 [95% CI, 15.22-17.83] per 1000 person-years). In adjusted models, a lower risk for developing T2DM was associated with greater cumulative exposure to indicators of neighborhood healthy food (12%; HR per interquartile range [IQR] increase in summary score, 0.88 [95% CI, 0.79-0.98]) and physical activity resources (21%; HR per IQR increase in summary score, 0.79 [95% CI, 0.71-0.88]), with associations driven primarily by the survey exposure measures. Neighborhood social environment was not associated with incident T2DM (HR per IQR increase in summary score, 0.96 [95% CI, 0.88-1.07]). CONCLUSIONS AND RELEVANCE: Long-term exposure to residential environments with greater resources to support physical activity and, to a lesser extent, healthy diets was associated with a lower incidence of T2DM, although results varied by measurement method. Modifying neighborhood environments may represent a complementary, population-based approach to prevention of T2DM, although further intervention studies are needed.