Changes in perceived harms of tobacco and cannabis and their correlations with use: A panel study of young adults 2014-2020.

PURPOSE: Perceived harm is associated with substance use. Changes in product and policy landscapes may impact perceived harms of tobacco and cannabis. This study aimed to examine changes in young adults' perceived harms of tobacco and cannabis and their associations with use behavior during a period including both before and after legalization of cannabis. METHODS: We conducted a panel survey of California Bay Area young adults (mean age = 23.5 years old, 64.4% female) in 2014 and 2019-2020. Participants (N = 306) reported past 30-day use and perceived harms of tobacco and cannabis at both waves. Perceived harms to health of cannabis and tobacco (cigarettes, e-cigarettes, hookah, smokeless tobacco, and secondhand tobacco smoke) were measured from 1-"Not at all harmful" to 7-"Extremely harmful." Mixed-effects logistic regressions examined associations between perceived harms and use of tobacco and cannabis, controlling for demographics. RESULTS: Participants perceived lower harm for cannabis than for tobacco products. Perceived harms of e-cigarettes, hookah, and smokeless tobacco significantly increased over time; while perceived harms of cigarettes, secondhand tobacco smoke, and cannabis did not change. Increased perceived harm of e-cigarettes was associated with lower odds of any tobacco use (OR = 0.72, 95%CI = 0.56, 0.92), and increased perceived harm of cannabis was associated with lower odds of any cannabis use (OR = 0.51, 95%CI = 0.42, 0.62). CONCLUSIONS: Findings suggest that perceived harms of e-cigarettes and cannabis play important roles in driving young adult use behaviors. Risk communication efforts that increase perceptions of health harms related to e-cigarettes and cannabis may decrease use of tobacco and cannabis among young people.

Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices.

California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.

Policies restricting flavors and non-cigarette tobacco product availability: A study of vape shops in San Francisco and Alameda Counties, California, USA.

We examined flavored non-cigarette tobacco availability in brick-and-mortar vape shops in San Francisco (SF) and Alameda Counties, California (USA), comparing cities organized by flavored tobacco sales restriction policy. A total of 22 brick-and-mortar vape shops were identified and audited in October-November 2019; shops were located in SF City-County and nine cities in Alameda County. Fisher Exact Tests were used to assess differences in the availability of products between vape shops in cities with versus without comprehensive or partial flavored tobacco sales restrictions enacted before November 21, 2019 (n = 15 shops in six cities with policies vs n = 7 shops in four cities without policies). In the six cities with any flavored sales restrictions, fewer vape shops sold menthol/mint flavored JUUL pods (27% vs 71%, p = 0.074), candy/fruit (53% vs 100%, p = 0.051) and menthol/mint (53% vs 100%, p = 0.051) nicotine e-cigarette liquids compared to cities without flavored tobacco sales restrictions, but results were borderline significant. Tobacco-flavored JUUL pods (47% vs 71%, p = 0.381), tobacco-flavored nicotine e-cigarette liquids (67% vs 100%, p = 0.135), and flavored e-cigarette liquids without nicotine (candy/fruit: 87% vs 71%, p = 0.565 and menthol/mint: 87% vs 57%, p = 0.274) were not included in the policies, and availability was not significantly different between cities with or without policies. Enactment of local policies was associated with lower flavored e-cigarette tobacco product availability but not tobacco-flavored or non-nicotine product availability; federal policies restricting sales of flavored tobacco products may reduce access to flavored e-cigarette products in vape shops.

"The Perfect Formula:" Evaluating Health Claims, Products and Pricing on Cannabis Dispensary Websites in Two Recently Legalized States.

Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.

Flavored Tobacco Sales Restrictions Reduce Tobacco Product Availability and Retailer Advertising.

OBJECTIVE: This study examined differences in the availability and advertising of flavored tobacco products before and after flavored tobacco sales restrictions were enacted in Alameda and San Francisco Counties in California. MAIN OUTCOME MEASURES: Data were collected from a sample of tobacco retailers in Alameda and San Francisco Counties at two time points: 2015, before flavored tobacco policies were enacted, and in 2019-2020, after some cities had enacted policies. Retailers were separated by city into Category 1 (n = 442)-retailers in cities that enacted a flavored tobacco policy between the two data collection periods, and Category 2 (n = 89), those that had not. Means comparison tests were conducted to evaluate significant differences over time and by category. RESULTS: There was significantly reduced availability of menthol cigarettes, flavored little cigars, smokeless tobacco, vape pens, and Blu brand menthol e-cigarettes between 2015 and 2020 in Category 1 retailers. Category 2 retailers had reduced availability only for Blu menthol e-cigarettes and demonstrated an increase in smokeless tobacco availability. Exterior store advertising for cigarettes, little cigars, cigars, and e-cigarettes also decreased significantly in Category 1 cities relative to Category 2 cities; 8.1% of Category 1 stores were advertising flavored tobacco products in 2019-2020 compared to 36.2% of Category 2 stores. There was also a 78% reduction in flavored ads between 2015-2019 in Category 1 cities compared to a 38% decrease in Category 2 cities. Tobacco advertising inside Category 2 stores increased. Finally, Category 2 cities had significantly greater availability of cigalikes, mod or tank vapes, flavored e-cigarettes, and e-liquids compared to Category 1 cities. CONCLUSIONS: Comprehensive flavored sales restriction policies reduce flavored tobacco availability and tobacco advertising, which may help prevent youth tobacco initiation and exposure.

Piloting a spatial mixed method for understanding neighborhood tobacco use disparities.

The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.

Same-day use of cigarettes, alcohol, and cannabis among sexual minority and heterosexual young adult smokers.

OBJECTIVE: Sexual minority (SM) young adults have higher rates of substance use than heterosexuals, but little is known about daily use of multiple substances, which confer numerous health risks for this population. Using daily diary data from a smartphone-based study, we examined the associations between sexual identity (i.e., SM vs. heterosexual) and patterns of same-day multiple substance use (i.e., cigarettes and alcohol, cigarettes and cannabis, alcohol and cannabis, and all 3 substances). METHOD: Young adult smokers (N = 147, aged 18-26, 51.7% female, 41.5% SM, 40.8% White) reported consecutive daily assessments on substance use over 30 days. We used generalized estimating equations to examine associations between sexual identity and patterns of same-day multiple substance use, controlling for demographic factors and psychological distress. RESULTS: Of 2,891 daily assessments, 16.7% reported same-day use of cigarettes and alcohol, 18.1% cigarettes and cannabis, 1.5% alcohol and cannabis, and 15.0% use of all 3 substances. SM participants (vs. heterosexuals) had significantly greater odds of reporting days with use of cigarettes and cannabis [Adjusted Odds Ratio (AOR) = 2.05, 95% Confidence Interval (CI) [1.04, 4.01]] and use of all three substances (AOR = 2.79, 95% CI [1.51, 5.14]) than days with single substance use or no use. CONCLUSIONS: These findings warrant tailored interventions addressing multiple substance use among SM young adults and temporally accurate measures of multiple substance use patterns. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived reward from using cigarettes with alcohol or cannabis and concurrent use: A smartphone-based daily diary study.

INTRODUCTION: Smoking cigarettes under the influence of alcohol or cannabis is associated with perceived pleasure. However, it is unclear whether these changes in perceived reward impact the extent of concurrent use of cigarettes with alcohol or cannabis. The current study investigated if self-reported changes in perceived reward from concurrent use of cigarettes with alcohol or cannabis are related to the extent of concurrent use in real-world contexts using a smartphone-based Ecological Momentary Assessment (EMA) study. METHODS: The sample included 126 diverse young adult smokers in the San Francisco Bay Area who reported current alcohol or cannabis use at baseline (M = 22.8 years, 50.8% male, 40.5% sexual minority, 39.7% Non-Hispanic White). Participants completed an online baseline survey and 30 days of smartphone-based daily EMA surveys of cigarette, alcohol, and cannabis use. The baseline assessed self-reported changes in perceived pleasure of smoking cigarettes while using alcohol or cannabis separately. EMA surveys included detailed questions about concurrent use (i.e., the extent of smoking while using another substance) covering the previous day. A total of 2,600 daily assessments were analyzed using mixed models. RESULTS: Higher perceived pleasure from smoking cigarettes while drinking alcohol or using cannabis at baseline were both associated with a greater extent of concurrent use of cigarettes with alcohol (b = 0.140; SE = 0.066; t = 2.1; p = .035) and cannabis (b = 0.136; SE = 0.058; t = 2.4; p = .019) on a given day. CONCLUSIONS: Results suggest that perceived reward from concurrently using cigarettes with alcohol or cannabis is associated with the extent of concurrent use. Findings can inform tailored smoking cessation interventions.

Using Peer Crowd Affiliation to Address Dual Use of Cigarettes and E-Cigarettes among San Francisco Bay Area Young Adults: A Cross Sectional Study.

Given the emerging tobacco landscape, dual use of cigarettes and e-cigarettes has increased among young adults, but little is known about its associated factors. Peer crowds, defined as macro-level connections between individuals with similar core values (e.g., "Hip Hop" describing a group that prefers hip hop music and values strength, honor, and respect), are a promising way to understand tobacco use patterns. We examined associations between peer crowds and tobacco use patterns by using data from a cross sectional survey of 1340 young adults in the San Francisco Bay Area in 2014. Outcomes were the past 30-day use of: neither cigarettes nor e-cigarettes; cigarettes but not e-cigarettes; e-cigarettes but not cigarettes; and both cigarettes and e-cigarettes. Peer crowds included Hipster, Hip Hop, Country, Partier, Homebody, and Young Professional. Multinomial regression analysis indicated that peer crowds were significantly associated with different tobacco use patterns. Compared to Young Professionals, Hip Hop and Hipster crowds were more likely to dual use; Hipsters were more likely to use e-cigarettes only, and Country participants were more likely to smoke cigarettes only. These findings suggest that tobacco control campaigns and cessation interventions should be tailored to different young adult peer crowds and address poly-tobacco use.

Drifting Tobacco Smoke Exposure among Young Adults in Multiunit Housing.

This study evaluated young adults' exposure to drifting secondhand smoke in San Francisco County housing units using the 2014 Bay Area Young Adult Health Survey (N = 1363). Logistic and geographically weighted regression models were used to determine whether residing in multiunit housing or in areas with greater neighborhood disorder were risk factors for exposure, and how drifting smoke exposure varied spatially within San Francisco County. Residing in buildings with five or more units significantly increased the odds of reporting drifting smoke exposure [OR (3.5 1.3, 9.9)], but neighborhood disorder did not have a significant association in the fully adjusted logistic regression model. At the local level, however, neighborhood disorder was significantly associated with exposure in lower income residential and downtown areas. Multiunit housing was significantly associated with exposure across all neighborhoods.

Does Experienced Discrimination Explain Patterns of Menthol Use Among Young Adults? Evidence from the 2014 San Francisco Bay Area Young Adult Health Survey.

BACKGROUND: Young adults are at high risk for using flavored tobacco, including menthol and underrepresented populations, such as Latino and African American young adults, are at particular risk. OBJECTIVES: The purpose of this study is to identify sociodemographic correlates of menthol use among young adult smokers and examine the potential role of experienced discrimination in explaining any associations. METHODS: We conducted a probabilistic multimode household survey of young adults (aged 18-26) residing in Alameda and San Francisco Counties in California in 2014 (n = 1,350). We used logistic regression to evaluate associations between menthol cigarette use and experienced discrimination among young adult smokers as well as with respect to sociodemographic, attitudinal, and behavioral predictors. Interactions between experienced discrimination and race/ethnicity, sex and LGB identity were also modeled. RESULTS: Latino and non-Hispanic Black young adult smokers were more likely to report current menthol use than non-Hispanic Whites, while those with college education were less likely to do so. Experienced discrimination mediated the relationship between race and menthol use for Asian/Pacific Islander and Multiracial young adult smokers with odds of use increasing by 32 and 42% respectively for each additional unit on the experienced discrimination scale. Conclusions/Importance: Latino and African American young adult smokers have disproportionately high menthol use rates; however, discrimination only predicted higher use for Asian/Pacific Islander and Multiracial young adult smokers. Limits on the sale of menthol cigarettes may benefit all nonwhite race/ethnic groups as well as those with less education.

Psychometric evaluation of an abbreviated version of the intragroup marginalization inventory.

Tobacco and marijuana use among U.S. young adults is a top public health concern, and racial/ethnic minorities may be at particular risk. Past research examining cultural variables has focused on the individual in relation to the mainstream U.S. culture; however, an individual can also experience within-group stress, or intragroup marginalization. We used the 2014 San Francisco Bay Area Young Adult Health Survey to validate an abbreviated measure of intragroup marginalization and identify associations between intragroup marginalization and tobacco and marijuana use among ethnic minority young adults (N = 1,058). Exploratory factor analysis was conducted to identify factors within the abbreviated scale, and logistic regressions were conducted to examine relationships between intragroup marginalization and tobacco and marijuana use. Two factors emerged from the abbreviated scale. The first factor encompassed items related to belonging and membership, capturing whether individuals experienced marginalization due to not fitting in because of physical appearance or behavior. The second factor encompassed whether individuals shared similar hopes and dreams to their friends and family members. Factor 1 (membership) was associated with increased odds of marijuana use (OR = 1.34, p < .05) and lower odds of using cigars (OR = 0.79, p < .05), controlling for sociodemographic factors. Results suggest that young adults may use marijuana as a means to build connection and belonging to cope with feeling marginalized. Health education programs focused on ethnic minority young adults are needed to help them effectively cope with intragroup marginalization without resorting to marijuana use.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study.

BACKGROUND: Sexual minority young adults have higher smoking rates than the general young adult population, but reasons for this disparity are poorly understood. The current study aimed to: 1) identify real-time predictors of smoking among sexual minority and heterosexual smokers and 2) examine between-group differences in these predictors. METHODS: We conducted an ecological momentary assessment (EMA) study in the San Francisco Bay Area, California in 2016-2017. Data from 84 young adult smokers (44% identified as sexual minority, including 29 bisexual and 8 gay/lesbian) with 6498 EMA assessments were analyzed. Both internal and external predictors and interaction terms between each predictor and sexual group were examined using generalized estimating equation models. RESULTS: Common correlates of smoking were found for both groups (e.g., craving, absence of smoking bans, presence of other smokers, outside location, and seeing triggers). Unique factors for sexual minority smokers were being at a bar (aOR = 1.75, 95% CI = 1.06-2.90) and the number of other smokers present (aOR = 1.12, 95%CI = 1.04-1.20), while the presence of a smoking family member reduced the odds of smoking in this group (aOR = 0.13, 95%CI = 0.02-0.85). In interaction models, the number of other smokers exerted a greater influence on sexual minority participants compared to their heterosexual counterparts (aOR = 1.10, 95%CI = 1.01-1.20), while craving (aOR = 0.84, 95%CI = 0.75-0.93) and presence of a smoking family member (aOR = 0.11, 95%CI = 0.01-0.82) had weaker influences. CONCLUSIONS: Our study highlights unique situational factors associated with smoking among sexual minority young adults and differences in these factors by sexual identity. Future interventions targeting sexual minorities should address bar attendance and specific triggers.

Bars, Nightclubs, and Cancer Prevention: New Approaches to Reduce Young Adult Cigarette Smoking.

INTRODUCTION: Tobacco contributes to multiple cancers, and it is largely preventable. As overall smoking prevalence in California declines, smoking has become concentrated among high-risk groups. Targeting social/cultural groups (i.e., "peer crowds") that share common values, aspirations, and activities in social venues like bars and nightclubs may reach high-risk young adult smokers. Lack of population data on young adult peer crowds limits the ability to assess the potential reach of such interventions. METHODS: This multimodal population-based household survey included young adults residing in San Francisco and Alameda counties. Data were collected in 2014 and analyzed in 2016. Multivariable logistic regressions assessed smoking by sociodemographic factors, attitudes, self-rated health, peer crowd affiliation, and bar/nightclub attendance. RESULTS: Smoking prevalence was 15.1% overall; 35.3% of respondents sometimes or frequently attended bars. In controlled analyses, bar attendance (AOR=2.13, 95% CI=1.00, 4.53) and binge drinking (AOR=3.17, 95% CI=1.59, 6.32) were associated with greater odds of smoking, as was affiliation with "Hip Hop" (AOR=4.32, 95% CI=1.48, 12.67) and "Country" (AOR=3.13, 95% CI=1.21, 8.09) peer crowds. Multivariable models controlling for demographics estimated a high probability of smoking among bar patrons affiliating with Hip Hop (47%) and Country (52%) peer crowds. CONCLUSIONS: Bar attendance and affiliation with certain peer crowds confers significantly higher smoking risk. Interventions targeting Hip Hop and Country peer crowds could efficiently reach smokers, and peer crowd-tailored interventions have been associated with decreased smoking and binge drinking. Targeted interventions in bars and nightclubs may be an efficient way to address these cancer risks.

Workplace secondhand smoke exposure: a lingering hazard for young adults in California.

OBJECTIVE: To examine occupational differences in workplace exposure to secondhand smoke (SHS) among young adults in California. METHODS: Data are taken from the 2014 Bay Area Young Adult Health Survey, a probabilistic multimode cross-sectional household survey of young adults, aged 18-26, in Alameda and San Francisco Counties. Respondents were asked whether they had been exposed to SHS 'indoors' or 'outdoors' at their workplace in the previous 7 days and also reported their current employment status, industry and occupation. Sociodemographic characteristics and measures of health perception and behaviour were included in the final model. RESULTS: Young adults employed in service (p<0.001), construction and maintenance (p<0.01), and transportation and material moving (p<0.05) sectors were more likely to report workplace SHS exposure while those reporting very good or excellent self-rated health were less likely (p<0.001). CONCLUSIONS: Despite California's clean indoor air policy, 33% of young adults in the San Francisco Bay Area still reported workplace SHS exposure in the past week, with those in lower income occupations and working in non-office environments experiencing the greatest exposure. Closing the gaps that exempt certain types of workplaces from the Smoke-Free Workplace Act may be especially beneficial for young adults.

State of transition: Marijuana use among young adults in the San Francisco Bay Area.

BACKGROUND: California may vote on marijuana legalization in 2016. Young adults have the highest rates of marijuana use, but little is known about the correlates of use in this age group, including factors that may be affected by policy change. We investigated whether there are differences in marijuana use by sociodemographic characteristics, psychological distress, loneliness and social support, controlling for risk factors such as alcohol and cigarette use as well as perceived harm of marijuana. METHODS: Bivariate and multivariable analysis of past 30day marijuana use using the 2014 San Francisco Bay Area Young Adult Health Survey, a probabilistic multi-mode survey of (N=1324) young adults (aged 18-26years) residing in Alameda and San Francisco Counties, stratified by race/ethnicity. RESULTS: 291 (27%) sample participants reported current marijuana use. Compared to non-Hispanic Whites (referent) Asian/Pacific Islander respondents were less likely to use marijuana (AOR, 0.42; 95% CI, 0.22-0.80) while multiracial participants were twice as likely (AOR, 2.27; 95% CI, 1.06-4.85). Psychological distress was not related to marijuana use, but social support (AOR, 1.42; 95% CI, 1.08-1.88) and loneliness (AOR, 1.42; 95% CI, 1.09-1.86) were. Perceived harm of marijuana was inversely related to marijuana use (AOR, 0.60; 95% CI, 0.51-0.70), while smoking cigarettes (AOR, 3.95; 95% CI, 2.28-6.84) and binge drinking (AOR, 1.13; 95% CI, 1.03-1.24) were positively related. CONCLUSIONS: Legalization policies should include public education campaigns addressing potential harms of marijuana use particularly targeting multiracial young adults who also engage in other risk behaviors, such as cigarette smoking and binge drinking.

The Social Prioritization Index and Tobacco Use Among Young Adult Bar Patrons.

Social benefits likely play a role in young adult tobacco use. The Social Prioritization Index (SPI) was developed to measure the degree to which young adults place a great importance on their social lives. We examined the usefulness of this measure as a potential predictor of tobacco use controlling for demographics and tobacco-related attitudes. Young adults completed cross-sectional surveys between 2012 and 2014 in bars in seven U.S. cities (N = 5,503). The SPI is a 13-item scale that includes personality items and information on how frequently participants attend bars and how late they stay out. Three step-by-step multinomial regression models were run using the SPI as a predictor of smoking status (nondaily and daily smoking vs. nonsmoking): (1) SPI as the sole predictor, (2) SPI and demographics, and (3) SPI, demographics, and tobacco-related attitude variables. Next, we conducted an exploratory factor analysis to examine if the number of items in SPI could be reduced and retain its strong relationship with smoking. Higher scores on the SPI were related to an increased probability of being a Nondaily Smoker (odds ratio = 1.09, 95% confidence interval [1.04, 1.14], p < .001) or Daily Smoker (odds ratio = 1.14, 95% confidence interval [1.07, 1.22], p < .0001) compared to a Nonsmoker, controlling for demographics and other tobacco-related attitudes. The SPI and reduced SPI were independently related to young adult tobacco use. The measure's brevity, ease of use, and strong association with tobacco use may make it useful to tobacco and other prevention researchers.

Neighborhood social cohesion and smoking among legal and unauthorized Brazilian migrants in metropolitan Boston.

Tobacco smoking is estimated to be the largest preventable cause of mortality in the USA, but little is known about the relationship between neighborhood social environment and current smoking behavior or how this may differ by population and geography. We investigate how neighborhood social cohesion and disorder are associated with smoking behavior among legal and unauthorized Brazilian migrant adults using data from the 2007 Harvard-UMASS Boston Metropolitan Immigrant Health and Legal Status Survey (BM-IHLSS), a probabilistic household survey of adult Brazilian migrants. We employ logistic regression to estimate associations between neighborhood social cohesion, neighborhood disorder, and current smoking. We find that neighborhood-level social cohesion is associated with lower likelihood of being a current smoker (O.R. = .836; p < .05), and neighborhood disorder, measured as crime experienced in the neighborhood, is not associated with current smoking. Neighborhood population density, age, being male, and residing with someone who smokes are each positively associated with current smoking (p < .10). The health of participants' parents at the age of 35, being married, and individual earnings are associated with a reduction in the probability of being a current smoker (p < .05). Migrant legal status and length of residence in the USA are not associated with current smoking. Our findings suggest that neighborhood social cohesion may be protective against smoking. Alternatively, neighborhood disorder does not appear to be related to current smoking among Brazilian migrants.