Navigating Threats of Wildfires and Individual Rights to Adopt 100% Tobacco-Free Policy in Rural California Community Colleges.

BACKGROUND: In California, all four-year public colleges have adopted 100% smoke-/tobacco-free policies (TFP) whereas community colleges (CCs), particularly rural CCs, are less likely to have tobacco-free environments. This raises concerns about health equity, particularly because smoking prevalence is higher in rural areas compared to urban. We examined policy adoption barriers and facilitators for rural California CCs with the aim of providing lessons learned to support TFP adoption by rural CCs and improve conditions for student health and well-being. METHODS: A multiple case study of four CCs in California with (n = 2) and without (n = 2) TFPs was conducted. Semi-structured interviews with 12 campus and community stakeholders, school administrative data, and policy-relevant documents were analyzed at the case level with comparison across cases to identify key barriers, facilitators and campus-specific experiences. RESULTS: All four CCs shared similar barriers to policy adoption including concerns about wildfires, individual rights, and fear of marginalizing people who smoke on campus. These CCs have experienced serious wildfires in the last ten years, have high community smoking prevalence, and fewer school resources for student health. For the two tobacco-free CCs, long-term wildfire mitigation efforts along with leadership support, campus/community partnerships and a collective approach involving diverse campus sectors were essential facilitators in successful TFP adoption. CONCLUSION: Study results underscore contextual pressures and campus dynamics that impact tobacco control efforts at colleges in rural communities. Strategies to advance college TFP adoption and implementation should recognize rural cultural and community priorities.

Engaging Students in Advancing Campus Tobacco-Free Policies: A Qualitative Study of California Community Colleges' Efforts.

Introduction: Tobacco use remains a serious problem for young adults. Given the large number of young adults attending college, a tobacco-free campus is one strategy to reduce tobacco use. Young adult engagement is recognized as a common strategic practice in tobacco control policy efforts, especially in changing social norms around tobacco use. Community colleges can leverage and engage students in adoption of campus 100% tobacco-free policies. This qualitative study examines the importance of student engagement in advancing 100% tobacco-free policies in community colleges and identifies strategies for campuses to involve students in such efforts. Methods: We selected 12 community colleges and conducted key informant interviews with campus and community-based organizations that were involved in campus policy adoption efforts. We conducted 33 semistructured interviews and transcribed, coded, and analyzed them by using a thematic analytic framework with inductive and deductive approaches to examine student engagement processes. Results: Community colleges represented campuses with (n = 6) and without (n = 6) tobacco-free policy and varied by geography (urban vs rural) and student population size. Three main themes emerged: 1) no "wrong door" for students to engage in tobacco control work, 2) a myriad of ways for students to be involved in policy adoption, and 3) benefits of student engagement. Conclusion: We found that students are doers, allies, and champions in adoption of 100% campus tobacco-free policy. Colleges should leverage their campuses' most important assets - students - to be agents of change and to involve them in the full spectrum of interventions and advocacy.

School and Community Factors Associated With the Adoption of 100% Smoke-free Policy by California Community Colleges, 2003-2019.

PURPOSE: Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults. DESIGN: Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data. SETTING: California community colleges (CC) and cities/communities where colleges are located, 2003-2019. SAMPLE: 114 California CCs. DATA: School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019. MEASURES: Key outcome is the year CC adopted a 100% SFP. ANALYSIS: Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption. RESULTS: By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP. CONCLUSION: Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.

Lifecourse Drinking Patterns, Hypertension, and Heart Problems Among U.S. Adults.

INTRODUCTION: Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21-55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. METHODS: Data from the U.S. National Longitudinal Survey of Youth, aged 14-21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017-18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. RESULTS: Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15-28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. CONCLUSIONS: This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol-health relationship.

Racial/Ethnic Variations in Clustered Risk Behaviors in the U.S.

INTRODUCTION: Alcohol misuse, cigarette smoking, poor diet, and physical inactivity, known as the "big four" contributors to chronic conditions and mortality, typically co-occur or cluster together, with their synergistic effect more detrimental to health than their cumulative individual effects. Little research has been reported on race/ethnicity-specific analyses of the clustering of these behaviors in the U.S. This study identified clustered risk behaviors among whites, blacks, and Hispanics and examined whether unhealthy clusters were associated with lower SES (assessed by education level and family income) and poor health status. METHODS: A nationally representative sample of U.S. adults aged 30-69 years (n=9,761) from the 2010 and 2015 National Alcohol Surveys was used to perform latent class analysis and multinomial and logistic regression modeling in 2018-2019. Obesity was used as a proxy for unhealthy diet. RESULTS: Three lifestyle classes were identified in each group. The relatively healthy lifestyle class was identified among whites and Hispanics. The nonsmoking and low risky drinking class among blacks, though showing a healthier lifestyle than the other 2 classes, still had relatively high prevalence of inactivity and obesity. The inactive and obese class was found in all 3 groups. Also identified were the smoking and risky drinking class among whites; the smoking and inactive class among blacks; and the smoking, inactive, and risky drinking class among Hispanics. For all 3 groups, unhealthy lifestyle classes mostly were associated with lower SES. Unhealthy lifestyle classes were also associated with poorer health status. CONCLUSIONS: Multi-behavior interventions are warranted to address inactivity and obesity in all 3 groups and unhealthy clusters involving smoking in each group.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort.

BACKGROUND: Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. METHODS: Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. RESULTS: T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2-3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02-1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). CONCLUSION: ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Alcohol use patterns and risk of diabetes onset in the 1979 National Longitudinal Survey of Youth Cohort.

One of the major limitations in studying alcohol's effect on risk for diabetes is the issue of classifying drinking patterns across the life course prior to the onset of diabetes. Furthermore, this research often overlooks important life course risk factors such as obesity and early-life health problems that may complicate estimation of the relationship between alcohol and diabetes. This study used data from the US National Longitudinal Survey of Youth 1979 cohort of 14-21 year olds followed through 2012 (n = 8289). Alcohol use was captured through time-varying measures of past month volume and frequency of days with 6+ drinks. Discrete-time survival models controlling for demographics, early-life characteristics and time-varying risk factors of employment, smoking, and body mass index (BMI) group, stratified by sex and race/ethnicity, were estimated. Increased odds of diabetes onset was found among lifetime abstainers for women compared to the low volume reference group (odds ratio (OR) 1.57; 95% Confidence Interval (CI) 1.07-2.3). Increased odds of diabetes onset was also found among women who reported drinking 6+ drinks in a day on a weekly basis during the prior 10 years (OR 1.55; CI 1.04-2.31). Models interacting alcohol and BMI groups found increased odds of diabetes onset from lifetime abstention among overweight women only (OR 3.06; CI 1.67-5.60). This study confirms previous findings of protective effects from low volume drinking compared to lifetime abstention and harmful effects from regular heavy occasion drinking for women. Further, protective effects in this US sample were found to be limited to overweight women only.

Changes in heavy drinking following onset of health problems in a U.S. general population sample.

Heavy episodic drinking is a well-established risk factor for heart disease, diabetes, certain cancers, stroke, hypertension and injuries, however, little is known about whether health problems precipitate changes in subsequent drinking patterns. Retrospective cohort analyses of heavy drinking by decade were conducted using data from the 2010 U.S. National Alcohol Survey (n=5240). Generalized estimating equations models were used to predict any, monthly, and weekly heavy (5+) drinking occasions across decades of life following a diagnosis of hypertension, heart problems, diabetes, stroke, cancer, or serious injury. Experiencing heart problems was associated with higher odds of reduced weekly heavy drinking (adjusted odds ratio (ORadj)=3.5; 95% confidence interval (CI); 1.7-7.4). The onset of diabetes was also associated with higher odds of reducing any heavy drinking over the decade (ORadj=1.7; 95% CI; 1.1-2.6). Cancer survivors were less likely to report no heavy drinking (ORadj=0.5; 95% CI; 0.3-0.8) or no weekly heavy drinking (ORadj=0.3; 95% CI; 0.2-0.7). Hypertension, stroke and injury were not found to have any significant associations. Reduced heavy drinking was more likely to be reported by Black drinkers following heart problems and Whites following a diabetes diagnosis. Increased heavy drinking following a cancer diagnosis was significant among women and Whites. Future studies on alcohol's heath and mortality risks should take into consideration effects of health problems on drinking patterns. Additionally, study results support increased prevention efforts targeting heavy drinking among cancer survivors, especially White women, and individuals with or being treated for hypertension.