Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey.

INTRODUCTION: Youth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed. METHODS: For 3117 youth, aged 13-18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed. RESULTS: Female sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12-3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level. CONCLUSIONS: Study findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

Tobacco Cessation and Referral to the National Quitline.

Background: Smoking is the leading cause of preventable deaths in the United States. The rates of smoking remain elevated in rural, low income populations in comparison with the rest of the United States. Thus, prompting the process improvement project of implementing the Ask-Advise-Connect (AAC) method to the national quitline in a nurse practitioner-managed clinic for an automotive manufacturing plant in rural Tennessee. Methods: Ask-Advise-Connect method was added to the current smoking cessation program. The employees who utilized the clinic were assessed for smoking status at each visit and subsequently counseled on cessation. Individuals interested in cessation were connected to the national quitline with the AAC method. Pharmaceutical options and nicotine replacement therapy was also offered at no cost to the employee. Findings: In the 4-month period, the clinic provided 102 tobacco cessation counseling visits to workers who smoke. Twenty-four employees enrolled in the cessation program. The participants reported a cessation rate of 12.5% and 21% had a significant decrease in the number of cigarettes smoked. Of the participants, 12.5% (n = 3) engaged in behavioral counseling with the quitline. Conclusion/application to practice: The addition of the AAC method as part of the smoking cessation program had limited success. As smoking cessation is difficult to achieve, any success greater than 7% can be considered an achievement. The 12.5% cessation rate of the participants was above the national average. Thus, demonstrating the benefit of having a workplace cessation program and incorporating the AAC method to the current smoking cessation program.

Dual Users and Electronic Cigarette Only Users: Consumption and Characteristics.

BACKGROUND: E-cigarette use has grown in popularity, especially as the devices have been touted as smoking cessation tools. In an exploratory study, we sought to compare dual users (i.e., users of both combustible tobacco and e-cigarettes) to e-cigarette only users. METHODS: The Electronic Cigarette Opinion Survey (ECOS) was employed to assess users' (n=78) perceptions and consumption of e-cigarettes and combustible cigarettes. Quantity of e-juice and nicotine used and time of initial nicotine exposure were assessed. Multivariable logistic regression was used to evaluate the association between e-cigarette use behaviors and being an e-cigarette only user compared to a dual user. RESULTS: Compared to dual users, e-cigarette only users consumed higher levels of nicotine in e-juice (p=0.0009) and more nicotine per month (p=0.03). For dual users, the time of first nicotine exposure after waking was significantly earlier than for e-cigarette only users (mean= 9.6 minutes (SD= 8.0) and mean= 26.6 minutes (SD= 22.0), respectively; p=0.0056). Results from the regression models suggest the amount of e-juice consumed and time of first nicotine exposure after waking are significantly associated with being an e-cigarette only user. CONCLUSIONS: These findings shed light on the perceptions and use patterns of e-cigarette only users compared to dual users. As regulation of e-cigarettes is considered, understanding the impact of e-cigarettes and dual use is imperative. Despite frequent marketing claims that e-cigarettes are completely safe, health campaigns need to convey emerging and mixed findings on safety as well as current scientific uncertainty to the public.

Differences in quality of life among college student electronic cigarette users.

PURPOSE: The purpose of this study was to explore an association between e-cigarette use and Quality of Life (QOL) among college students. METHODS: During February 2016, 1,132 students completed an online survey that included measures of tobacco use and the WHOQOL-BREF instrument. Differences were tested using Chi-square, Fisher's exact test, and ANOVA, and regression was used to assess possible relationships. RESULTS: E-cigarettes were used by 6.97% of the participants, either solo or along with traditional cigarettes. Bivariate analyses suggest that male college students are more likely than females to use e-cigarettes, either solo or in combination with traditional cigarettes (χ2 =19.4, P < .01). Lesbian, gay, and bisexual students are more likely than heterosexual students to use traditional cigarettes, either solo or in combination with e-cigarettes (χ2 = 32.9, P < .01). Multivariate models suggest that for every 10-unit increase in overall QOL, psychological well-being, social relations or environmental health the adjusted odds of being a sole cigarette user were significantly lower (all, P < .01), respectively. For every 10-unit increase in psychological well-being the adjusted odds of being a dual user was significantly lower (OR = .83, P = .026). CONCLUSIONS: Findings indicate that lower quality of life appears to be connected to tobacco use.

A novel text message-based motivational interviewing intervention for college students who smoke cigarettes.

INTRODUCTION: Tobacco use disorder is critical among people aged 16 to 25 years. College campuses are prime locations for smoking cessation interventions for young adults. The vast majority of the smoking research with college students has been epidemiological in nature. This study examined a novel motivational interviewing intervention designed for college students, and explored predictors of smoking behavior change. METHODS: A quasi-experimental one group pretest-posttest design with repeated measures was used to evaluate a novel text message-based brief motivational interviewing intervention. The data were collected from undergraduate students (N=33) who smoked cigarettes in Fall 2015. RESULTS: Students' level of autonomy and relatedness needs satisfaction, autonomous motivation, and smoking cessation self-efficacy increased (p < 0.05), and their rate of daily smoking declined (p <0 .05) over time. However, competence need satisfaction, readiness to quit smoking and severity of nicotine addiction remained unchanged. Smoking cessation self-efficacy was the strongest predictor of smoking behavior change in college students. CONCLUSIONS: This study adds to the knowledge on smoking behavior among college students. Preliminary evidence indicates that text message-based motivational interviewing and smoking cessation self-efficacy may help guide successful smoking behavior interventions for college students.

Pathways From Socioeconomic Status to Prenatal Smoking: A Test of the Reserve Capacity Model.

BACKGROUND: Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated. OBJECTIVE: The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking. METHODS: A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis. RESULTS: Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit. DISCUSSION: Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking.

Predictors of well-being among college students.

OBJECTIVES: Identification of health-related risk behaviors associated with well-being in college students is essential to guide the development of health promotion strategies for this population. The purposes were to evaluate well-being among undergraduate students and to identify health-related risk behaviors that predict well-being in this population. METHODS: A cross-sectional Web-based survey of undergraduate students was conducted at a metropolitan university in the Southeast United States. A total of 568 students responded (response rate 14.2%). Data were collected on health-related risk behaviors using the National College Health Assessment II. RESULTS: Controlling demographic characteristics, the best predictive model included physical activity, current tobacco user, depression, ever received mental health services, and sleep quality, which was the strongest predictor (ß = .45, p < .001). This model explained 35% of the variance in well-being. CONCLUSIONS: Interventions that promote sleep quality among college students may be most beneficial in improving well-being.

Vape Shop Employees: Public Health Advocates?

INTRODUCTION: E-cigarettes have increased in popularity and given rise to a new type of sales outlet-the vape shop. Expanding on work examining vape shop employee e-cigarette and tobacco attitudes and behaviors1, this study examined key messages that vape shop employees communicate to customers. METHODS: Using informal interviews, observations, and a cross-sectional survey, we examined vape shop employees' (n=16) perceptions and e-cigarette use. Data were collected in nine vape shops in Louisville, Kentucky. We used open coding to analyze the qualitative interviews, observation notes, and open-ended survey responses. Descriptive statistics were used to analyze survey data. RESULTS: The findings revealed that nearly all employees were former smokers (93.8%), who now only use e-cigarettes. Over one-third of the employees (37.5%) began using e-cigarettes as a replacement for traditional cigarettes, and 93.8% reported better health (e.g., easier breathing, less coughing) since starting to use e-cigarettes. Although most employees believed e-cigarettes should be regulated, 56.3% thought regulations should be different from those governing traditional cigarettes. Analysis of qualitative data revealed that employees see themselves as health advocates who: 1) provide instructions on vaping and promote a vape community, 2) encourage cessation of traditional cigarettes, and 3) support some regulations. CONCLUSIONS: The findings reveal that vape shop employees regard e-cigarettes as viable smoking cessation tools and relish their role in assisting others in taking what employees view as positive health actions. Future research addressing communication between vape shop employees and customers, especially related to smoking cessation and health, is needed.

Using motivational interviewing for smoking cessation in primary care.

OBJECTIVES: To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach--ask, advise, assess, assist, and arrange follow-up (5 As)--on current smokers' behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence. METHODS: The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit. RESULTS: There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores. CONCLUSIONS: Resident physicians who use MI techniques have a tremendous effect on patients' smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.

Evidence-based smoking cessation for college students.

Despite a strong stance by the American College Health Association and years of prevention and control efforts on US college campuses, smoking and exposure to secondhand smoke remain a problem among college students. This article provides an overview of what is known about cigarette smoking in this population as well as existing interventions for smoking prevention, cessation, and exposure to secondhand smoke on college campuses. Strategies to reduce tobacco use are presented, many of which have been demonstrated to be effective in the short-term.

College students' exposure to tobacco marketing in nightclubs and bars.

OBJECTIVE: to examine whether a college student's exposure to tobacco marketing in nightclubs and bars was affected by the presence of a smoke-free law. PARTICIPANTS: a random sample (N = 478) of students participated in the survey (no smoke-free law, n = 240; smoke-free law, n = 238). The analysis was limited to students who reported being in nightclubs and bars (n = 171). METHODS: a nonexperimental, cross-sectional, 2-group design was used. RESULTS: students in the smoke-free law city were more likely to be approached by tobacco marketers (34.7% versus 20.2%, p = .02), offered free gifts (41.7% versus 24.2%, p = .02), and take free gifts for themselves (34.7% versus 19.2%, p = .02). They were more likely to be exposed to direct marketing strategies (1.83 versus 1.12, p = .02). There was no difference on indirect tobacco marketing by site. CONCLUSIONS: tobacco marketing is pervasive in nightclubs and bars. Smoke-free laws may protect against exposure to secondhand smoke but not the "pro" smoking messages students encounter.

Smoking identities and behavior: evidence of discrepancies, issues for measurement and intervention.

Although researchers and health care practitioners tend to use standard categories to classify smokers and nonsmokers, recent research suggests that individual smokers may use a variety of self-definitions regarding their smoking behavior. The purpose of this study was to examine smoking identity and smoking behavior among college students, specifically, the relationship between self-identifying as a smoker, nonsmoker, occasional smoker, or social smoker and number of days smoked in the past month. Data were obtained during a campuswide health assessment of randomly selected full-time students (N = 741). Results indicate discrepancy between smoking identity and cigarette use. Twenty percent of students who smoked in the past 30 days self-identified as nonsmokers. Such discrepancies have implications for data collection in research as well as on questionnaires and in health care interviews. Failure to understand actual smoking behavior may increase the risk that individuals will not receive effective smoking prevention and cessation interventions.

Smoke-free laws and smoking and drinking among college students.

Little is known about the impact of smoke-free legislation on smoking and drinking alcohol among college students. The purpose was to examine whether strength and duration of municipal smoke-free laws are associated with cigarette and alcohol use among college students. Full-time undergraduates from two Southeastern universities participated in mailed (Site A) or electronic (Site B) surveys assessing tobacco and alcohol use and other risk behaviors pre and post comprehensive municipal smoke-free laws (Site A, N = 1,366. Site B, N = 1,404). The first cohort at each site participated prior to a municipal smoke-free law in the community. The second survey was conducted post-law (Site A, 3.5 years, Site B, 8 months). Past 30-day cigarette and alcohol use and other demographic and personal characteristics were assessed. At Site A, controlling for demographic differences and current alcohol use, the odds of being a current smoker were 32% lower post-law (28% pre-law vs. 19% post-law; odds ratio = 0.68, P = 0.02). At Site B, with demographics and drinking status in the model, the decrease in smoking rate from pre- to post-law was not significant. At both sites, controlling for demographics and current smoking status, change in the likelihood of drinking was not significant. Comprehensive smoke-free laws in the surrounding community may reduce smoking rates among college students who live, work and recreate there, particularly after the laws are well-established. While alcohol prevalence is very high among college students, enacting smoke-free legislation was not associated with alcohol use.

Health information and health risk behaviors in a sample of college students.

College students often engage in behaviors that put their health at risk. In this study, 810 University of Louisville students (ages 18-24) completed an online assessment of their health risk behaviors. Additional information was collected concerning the types and sources of health information received by the students and how much trust the students had in the information sources. Results indicate that many students engage in health risk behaviors, including substance use, risky sexual activities, infrequent helmet use, and others, with little evidence to suggest that health information affects these behaviors. However, most students say they get their health information from sources that they don't particularly trust, such as friends, the media, and the internet. Health professionals and health educators are highly trusted by the students, yet among the least common providers of health information. Suggestions are made to encourage health professionals to prescribe health information sources on the internet to their college-age patients.

Nursing research in community-based approaches to reduce exposure to secondhand smoke.

Secondhand smoke (SHS) is the third leading cause of preventable death in the United States and a major source of indoor air pollution, accounting for an estimated 53,000 deaths per year among nonsmokers. Secondhand smoke exposure varies by gender, race/ethnicity, and socioeconomic status. The most effective public health intervention to reduce SHS exposure is to implement and enforce smoke-free workplace policies that protect entire populations including all workers regardless of occupation, race/ethnicity, gender, age, and socioeconomic status. This chapter summarizes community and population-based nursing research to reduce SHS exposure. Most of the nursing research in this area has been policy outcome studies, documenting improvement in indoor air quality, worker's health, public opinion, and reduction in Emergency Department visits for asthma, acute myocardial infarction among women, and adult smoking prevalence. These findings suggest a differential health effect by strength of law. Further, smoke-free laws do not harm business or employee turnover, nor are revenues from charitable gaming affected. Additionally, smoke-free laws may eventually have a positive effect on cessation among adults. There is emerging nursing science exploring the link between SHS exposure to nicotine and tobacco dependence, suggesting one reason that SHS reduction is a quit smoking strategy. Other nursing research studies address community readiness for smoke-free policy, and examine factors that build capacity for smoke-free policy. Emerging trends in the field include tobacco free health care and college campuses. A growing body of nursing research provides an excellent opportunity to conduct and participate in community and population-based research to reduce SHS exposure for both vulnerable populations and society at large.

Social influences on cigarette initiation among college students.

OBJECTIVES: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. METHODS: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). RESULTS: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. CONCLUSIONS: Strategies that focus on reducing alcohol and tobacco use need to be tested.

College students' perspective on smoking cessation: "If the message doesn't speak to me, I don't hear it".

The purpose of this study was to document the smoking cessation experiences of three groups of 18-24-year-old college students and explore their ideas for cessation. Focus group interviews were conducted with former smokers (n = 7), smokers struggling to quit (n = 7), and smokers with no desire to quit (n = 5). Participants indicated a need for smoking cessation programs that would help the students understand the immediate physiological impact of smoking, addictive nature of nicotine, and benefits of using nicotine replacement therapy. They believed emotional and cognitive strategies for coping with cravings and environmental cues to smoking should be included in smoking cessation programs. Students indicated that cost and convenience were important considerations for smoking cessation programs. They stated that the media messages were for teens and older adults and did not relate to them as college students or young adults.

Methodological issues in identifying sexuality for research.

Sexuality is a complex concept that can be measured based on various aspects. Depending on the variable of interest, investigators may wish to focus on sexual behavior (activity), sexual orientation (attraction to a particular gender), or sexual identity (self-identification with a particular group of people). Further complicating the process is the fact that these aspects of sexuality are not always congruent with one another. Lesbian, gay, and bisexuals (LGB) are sexual minorities that have been identified as one of several groups that experience health disparities. For researchers working with the LGB population, properly identifying and defining which aspect of sexuality is of interest to the investigator is paramount in obtaining accurate outcomes.

Health information and risk behaviors among lesbian, gay, and bisexual college students.

PURPOSE: To describe differences in alcohol use, marijuana use, and smoking behaviors between lesbian, gay, and bisexual (LGB) and heterosexual college students, and determine whether there was a difference in the health information each group received. DATA SOURCES: A random sample of 3000 college students aged 18-24 years who were currently enrolled at a southeastern metropolitan university on a full-time basis were invited to participate. The final sample (n = 772) consisted of heterosexuals (n = 731) and LGB (n = 41) college students. Gay and bisexual men (n = 20) and lesbian and bisexual women (n = 21) were compared to heterosexual college students. CONCLUSIONS: Lesbian/bisexual women were 4.9 times more likely to smoke, 10.7 times more likely to drink, and 4.9 times more likely to use marijuana than heterosexual women. Gay/bisexual men did not significantly differ from heterosexual men. There was no difference in the health information on alcohol and drug prevention the groups received. Gay/bisexual men were less likely (p = .02) compared to heterosexual men to have received tobacco prevention information. IMPLICATION FOR PRACTICE: Advanced practice nurses must ensure that every patient receives preventive services and anticipatory guidance at every visit. LGB clients in particular need health assessments and interventions appropriate to their individual risk profiles.

Predicting smoking status in a college-age population.

OBJECTIVE: The purpose of this study was to determine the factors that predict smoking group membership in a college-age population. DESIGN: A nonexperimental cross-sectional design was used to examine factors that distinguished among four groups: never established (n = 591), former (n = 41), nondaily (n = 80), and daily (n = 76) cigarette smokers. SAMPLE: A pencil and paper questionnaire was returned by 788 randomly selected college students, 18-24 years of age. RESULTS: Significant differences were found among the groups on their mothers', fathers', siblings', and peers' smoking behaviors and attitudes toward smoking. The nondaily and daily smoking groups reported a greater number of risk behaviors than the never established and former smoking groups. The two groups of current smokers also were more likely to report an increased level of depressive symptoms compared with the nonsmoking groups. The number of high school and college friends who smoke and self-reported high-risk alcohol and drug behaviors predicted smoking group membership in a polytomous logistic regression. CONCLUSIONS: Strategies to alter the social environment and decrease the exposure of nonsmoking students to others who model smoking behaviors may help decrease smoking initiation and prevent relapse on college campuses.