Association between E-Cigarette Use Behaviors and Anxiety/Depression among Black/African American Adults Based on Sexual Identity.

Limited studies have examined disparities in e-cigarette use among Black/African American adults by sexual identity and whether the relationship between symptoms of anxiety/depression and e-cigarette use varies by sexual identity. We examined the association between e-cigarette use behaviors (never, former, and current use) and anxiety/depression among a nationally representative sample of Black/African American adults who identified as a sexual minority (lesbian/gay, bisexual, and others) or heterosexual individuals. We combined cross-sectional data from the 2011 to 2020 Health Information National Trends Survey (n = 6267), which is a nationally representative data set. We computed weighted e-cigarette use prevalence and multinomial logistic regression results (never use compared with former and current use, respectively). Among Blacks/African Americans, a larger percentage of sexual minority individuals compared with heterosexual individuals reported former and current e-cigarette use. Among sexual minorities, lesbian/gay individuals reported higher former e-cigarette use, whereas bisexual individuals reported higher current e-cigarette use. Among sexual minority individuals, moderate symptoms of anxiety/depression, compared with no symptoms of anxiety/depression, were associated with a higher likelihood of former e-cigarette use. Among heterosexuals, moderate symptoms of anxiety/depression were also associated with a higher likelihood of former e-cigarette use, while mild and severe symptoms of anxiety/depression were associated with current e-cigarette use compared with no symptoms of anxiety/depression. The intersection between sexual identity and anxiety/depression influenced e-cigarette use behaviors in different ways among Black/African Americans. The findings reinforce the heterogeneity within the Black/African American population, indicating the dangers of not considering subgroup differences as a standard part of public health research practice.

Association between e-cigarette use behaviors and perceived harmfulness of e-cigarettes and anxiety/depression symptoms among Black/African American Adults.

Black/African American adults are at greater risk of experiencing negative health outcomes stemming from tobacco use, yet little research has examined e-cigarette use behavior in the Black/African American adult-only population. We examined the association between e-cigarette use behaviors (never, former, and current use) and perceived harmfulness of e-cigarette use and anxiety/depression symptoms among Black/African American adults. This cross-sectional study was a secondary analysis of nationally representative data from the 2011-2020 Health Information National Trends Survey (n = 6,268). Multinomial logit models were used to examine differences in e-cigarette use behaviors (reference group = never used e-cigarettes), given the risk factors named above. The prevalence of former and current e-cigarette use among Blacks/African Americans was 11.65 % and 3.52 %, respectively. There was a significant interaction between the perceived harmfulness of e-cigarette use and anxiety/depression. Moderate or severe anxiety/depression symptoms were associated with a higher likelihood of current e-cigarette use, but not former e-cigarette use. Compared to individuals who perceived e-cigarette use as less harmful than smoking cigarettes, those who perceived e-cigarette use as just as harmful were less likely to be current e-cigarette users. Those who perceived e-cigarette use as more harmful or were uncertain were less likely to be former or current e-cigarette users. Anxiety/depression and perceived harmfulness of e-cigarette use and their interactions were significantly associated with e-cigarette use behaviors. These findings provide an opportunity to offer tobacco cessation and prevention interventions to subgroups in this population and inform development of content for the same.

Relationship among interpersonal stressors in adolescence, social support buffers, and obesity in adulthood 14 years later.

OBJECTIVE: Early life stress may be linked to adult obesity. Alternatively, social support can buffer the effects of stress. The study's objective was to examine in a nationally representative sample, whether adolescent interpersonal and financial stress predict later obesity in adulthood and whether social support and social cohesion might buffer this effect. METHOD: The sample includes 6,504 participants across four waves in the Add Health dataset. Researchers created a structural equation model whereby latent measures of interpersonal stress and financial stress during adolescence were used to predict obesity (Body Mass Index, BMI ≥ 30) at Wave 4, 14 years later. Latent measures of social support and social cohesion were added to observe whether they buffered the effect of stress on adult BMI. Covariates included race/ethnicity, gender, self-rated health, smoking status, and age. RESULTS: In an initial model of interpersonal and financial stressors and covariates predicting BMI, interpersonal stress (p < .001) but not financial stress (p > .05) predicted adult BMI. In the full model including stressors, buffers and covariates, social support (p < .001) and social cohesion (p = .038) negatively predicted adult BMI, and they covaried with interpersonal stress in opposing directions, buffering the effects of interpersonal stress on adult BMI. CONCLUSIONS: Stressful interpersonal life events in adolescence such as having family members in jail or being the victim of a crime are linked to adult obesity 14 years later. However, these stress effects are buffered by the effects of social support and social cohesion, which are linked to lower adult BMI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Between and Within Sexual Identity-Group Differences in Asthma Prevalence in the United States.

BACKGROUND: Although prior studies have established the association of asthma with smoking and obesity, literature on difference-in-differences analyses involving sexual identity is sparse. Therefore, this study aimed to examine the between and within sexual identity-group differences in asthma prevalence among individuals who smoke and are obese. METHODS: We aggregated the 2017-2019 National Survey on Drug Use and Health data on adults (N = 128,319) to perform weighted multivariable logistic regression analysis and marginal estimates and marginsplot to determine asthma prevalence by sexual identity and the status of smoking and obesity. RESULTS: About 66% of the study population reported having asthma. Among the individuals with asthma, 42% were obese, 10% were daily cigarette smokers, and 6% identified as bisexual persons. Lesbian/gay daily smokers (86%) or former smokers (75%) had a higher probability of having asthma than bisexual (daily smokers = 78% vs former smokers = 72%) and heterosexual (daily smokers = 68% vs former smokers = 65%) persons. Within each sexual identity subgroup, daily smokers (68-86%) had the highest probability of asthma. Obese bisexual (73%) or lesbian/gay (72%) persons had higher probabilities of having asthma than heterosexual persons (69%). Obese (73%) or overweight (72%) bisexual (compared to normal weight = 70% or underweight = 51%) and obese (69%) or overweight (65%) heterosexual (compared to normal weight = 62% or underweight = 57%) persons had the highest probabilities of having asthma within their groups, whereas overweight persons (overweight = 81% vs underweight = 79%, normal weight = 78%, and obese = 72%) had the highest probabilities within lesbian/gay persons. CONCLUSIONS: Smoking and obesity show heightened odds for asthma, with significant odds for sexual minorities in asthma diagnosis relative to heterosexuals. These findings provide formative information for future longitudinal and experimental studies to explore these mechanisms of asthma risks among sexual and gender minorities.

Exploring Patterns of the Use of Electronic Nicotine Delivery Systems among Adolescents in High-Risk Appalachian (U.S.A) Communities.

Background: Electronic nicotine delivery systems (ENDS) use among adolescents in the United States (U.S.) has surpassed conventional tobacco products (CTPs), including cigarettes. Increasingly, ENDS are used concurrently with CTPs and substances such as cannabis. However, few studies involve Central Appalachia, a region with historically high rates of tobacco and other substance use. Objective:  To examine prevalence of concurrent use of ENDS and cannabis among school-going adolescents in Appalachian Tennessee and delineate associations between ENDS use and substance-related risk behavior (cannabis use), social relations (peer use), and school-related risk behavior (academic performance). Methods: Data were obtained from a survey conducted with youth aged 13-17 years in 2018 in a county in Appalachian Tennessee (n = 280). A multivariable logistic regression model was fit to evaluate associations between ENDS and cannabis use, and other factors. Results: Overall, lifetime ENDS and cannabis prevalence estimates were 31.1% and 18.6%, respectively. Lifetime ENDS users had increased odds of also being lifetime cannabis users [OR = 9.22, 95% confidence interval (CI): 3.44-24.75]. Lifetime ENDS users had increased odds of reporting ENDS use among peers [OR = 12.11; 95% CI: 5.40-27.12] and lower academic performance (OR associated with mostly C or D vs. A grades was 4.28, 95% CI: 1.68-10.90). Conclusion: This study found an association between ENDS and cannabis use among adolescents in Appalachian Tennessee exists. Additionally, peer use and academic performance were associated with ENDS use. The findings have implications for public health intervention planning to address not only ENDS but also substance use among Appalachian youth.

Exploring Associations between Susceptibility to the Use of Electronic Nicotine Delivery Systems and E-Cigarette Use among School-Going Adolescents in Rural Appalachia.

Electronic nicotine delivery systems (ENDS) use, including e-cigarettes, has surpassed the use of conventional tobacco products. Emerging research suggests that susceptibility to e-cigarette use is associated with actual use among adolescents. However, few studies exist involving adolescents in high-risk, rural, socioeconomically distressed environments. This study examines susceptibility to and subsequent usage in school-going adolescents in a rural distressed county in Appalachian Tennessee using data from an online survey (N = 399). Relying on bivariate analyses and logistic regression, this study finds that while 30.6% of adolescents are ever e-cigarette users, 15.5% are current users. Approximately one in three adolescents are susceptible to e-cigarettes use, and susceptibility is associated with lower odds of being a current e-cigarette user (OR = 0.03; CI: 0.01-0.12; p < 0.00). The age of tobacco use initiation was significantly associated with decreased current use of e-cigarettes (OR = 0.89; CI: 0.83-0.0.97; p < 0.01). Overall, the results of this exploratory study suggest the need for larger studies to identify unique and generalizable factors that predispose adolescents in this high-risk rural, socioeconomically disadvantaged region to ENDS use. Nevertheless, this study offers insight into e-cigarette usage among U.S adolescents in rural, socioeconomically disadvantaged environments and provides a foundation for a closer examination of this vulnerable population.

Diabetes, subclinical atherosclerosis and multiple cardiovascular risk factors in hard-to-reach asymptomatic patients.

AIM: To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes. METHODS: A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted. RESULTS: In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemia and smoking increased the odds of the presence of coronary artery calcium (coronary artery calcium score ⩾1) regardless of diabetes status; however, with larger odds ratios in subjects with diabetes. Compared to subjects without diabetes with coronary artery calcium score = 0, having 3, 4 and ⩾5 risk factors increased the odds of presence of coronary artery calcium in subjects with diabetes by 14.06 (confidence interval = 3.26-62.69), 32.30 (confidence interval = 7.41-140.82) and 47.12 (confidence interval = 10.35-214.66) times, respectively. CONCLUSION: There is a need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.

INTERGENERATIONAL EDUCATIONAL ATTAINMENT, FAMILY CHARACTERISTICS AND CHILD OBESITY.

This study used US National Longitudinal Study of Youth data to explore how exposure to different socioeconomic conditions (proxied by maternal education) before birth can shape child weight. Using endogenous selection regression models, the findings suggest that educational selectivity affects weight gain. Mothers whose mothers graduated from high school were more likely to complete high school, and mothers reared in an intact family had higher levels of education. However, mothers who had given birth as a teenager had the same educational outcomes as mothers who gave birth in their post-teenage years. Based on this intergenerational educational selectivity, caretaking (e.g. breast-feeding) was found to be associated with a lower child body mass index (BMI), while negative maternal characteristics (e.g. mothers with high BMIs) were associated with higher child BMIs. Thus, educational selectivity influences child health through values passed on to the child and the lifestyle in which the child is reared. Maternal education may be tied to parenting, which relates to child obesity risk.

Neighborhood Disadvantage, Physical Activity Barriers, and Physical Activity among African American Breast Cancer Survivors.

BACKGROUND: In view of evidence that African American cancer survivors experience the greatest challenges in maintaining adequate levels of physical activity, this cross-section study was designed to determine whether individual and residential environment characteristics are associated with physical activity in this population. METHODS: A total of 275 breast cancer survivors completed self-report items measuring sociodemographic variables, physical activity, and select barriers to physical activity in Spring of 2012. Neighborhood disadvantage variables were extracted from national databases. Regression models were computed to assess relationships. RESULTS: Traditional correlates of smoking status and the presence of health complications were associated with physical activity. In addition, the relative number of renters versus homeowners in one's neighborhood was associated with lower levels of physical activity in the context of individual level barriers (i.e., interest and space), which were also associated with lower levels of physical activity. DISCUSSION: Higher renter rates and individual barriers both contribute to lower levels of physical activity in African American breast cancer survivors. These data suggest that the potential for constant residential turnover (via rentership) and perceived barriers may increase physical inactivity even where facilities may be available.

Differences in tobacco use between Canada and the United States.

OBJECTIVES: This study explores differences in who smokes (smoker type) and exposure to smoking (pack-years) between Canada and the US. Both countries have policies to limit the number of smokers and smoking-related deaths. METHODS: This research uses The Joint Canada/United States Survey of Health (JCUSH) and employs multinomial logistic regression and ordinary least squares regression. RESULTS: In Canada, native-born, young, White males without a degree, with poor health and who had been previously married predominate in smoking. This profile is the same for the US. However, different characteristics predict exposure to smoking for the two countries. Native-born males without a degree, with poor health and who had been previously married smoked more cigarettes per day in Canada. For the US, younger individuals smoked more cigarettes per day. CONCLUSIONS: If countries want to focus on limiting the number of new cases of smokers, the target population is different from the target population that should be used if countries are interested in converting smokers into non-smokers, based on the demographic analyses presented.

Rural, suburban and urban differences in the self-diagnosis of coronary heart disease in the United States.

This study explores rural, suburban and urban differences in coronary heart disease (CHD) using the 2005 Behavior Risk Factor Surveillance Survey conducted in the United States. Although areal context is not often considered in morbidity studies, this study evaluates the importance of place of residence given that areas offer differential access to health infrastructures and different contextual factors that could affect health. Also examined is the role of geographic heterogeneity on the recent racial divergence in CHD in the United States. Results indicate that area of residence is associated with CHD diagnosis, net of health and demographic variables. The area-stratified analysis documents that rural residents are most impacted by exercise and smoking, while being male or above age 50 are most detrimental for suburban residents. In addition, the racial divergence in CHD is driven by differences in rural locales. These findings indicate a disparate impact of geography on CHD and highlight the need for health research to take into account areal context.