Tribal Tobacco Use Project II: Planning, Implementation, and Dissemination Using Culturally Relevant Data Collection among American Indian Communities.

American Indians have substantially higher commercial tobacco-related cancer rates when compared to the general population. To effectively combat commercial tobacco-related cancer, it is important that tribal nations obtain current and accurate community-specific data on commercial tobacco use and exposure-related attitudes and behaviors. With the goal to collect, synthesize, and disseminate data on tobacco use, including the role traditional tobacco plays among American Indian people, the American Indian Cancer Foundation (AICAF) and various stakeholders developed and implemented the Tribal Tobacco Use Project II (TTUP II) during 2018-2021. Building upon its predecessor, the Tribal Tobacco Use Project I (TTUP I), TTUP II used principles of community-based participatory research and culturally appropriate methods, such as Reality-Based Research, in partnership with tribal nations. We describe the TTUP II rationale, methods for participant recruitment and data collection, emphasizing the importance of using culturally relevant survey items to disentangle commercial tobacco use from traditional tobacco use. American Indian traditional tobacco is viewed as medicine in these communities with a unique socio-cultural context that must be addressed when engaging in commercial tobacco control efforts in American Indian communities. This approach may be useful to other tribal nations who are interested in conducting culturally relevant tobacco surveillance efforts.

Trajectories of Cigarette Smoking From Teens to Young Adulthood: 2000 to 2013.

PURPOSE: To identify trajectories of smoking behaviors of a cohort of youth followed through young adulthood from 2000 to 2013. DESIGN: The Minnesota Adolescent Community Cohort study, a population-based cohort study. SETTING: Nationwide, originating in the Midwestern United States. PARTICIPANTS: Cohort of youth surveyed for 14 years beginning at ages 12 to 16 (N = 4241 at baseline; 59% recruitment rate). MEASURES: Main variable of interest was the number of days smoked in the past 30 days. Also included time-varying and time-invariant covariates. ANALYSIS: We utilized growth mixture modeling to group individuals into trajectories over time. RESULTS: We identified 5 distinct trajectories: nonsmokers (59.5%), early-onset regular smokers (14.2%), occasional smokers (11.5%), late-onset regular smokers (9.4%), and quitters (5.3%). Adjusted models showed that early- and late-onset regular smokers (compared to nonsmokers) had lower odds of attending or graduating from a 4-year college ( P < .05). Participants in all smoking classes compared to nonsmokers had greater odds of having more close friends who smoked ( P < .05). CONCLUSION: Our results show that individuals in their teens through young adulthood can be classified into 5 smoking trajectories. More people in this age range remained abstainers than found in most previous studies; however, a sizable group was identified as regular smokers by the time they reached young adulthood. Interventions targeted at teens, including those that address social and environmental influences, are clearly still needed to prevent escalation of smoking as they move toward young adulthood.

Social and Environmental Factors Related to Smoking Cessation among Mothers: Findings from the Geographic Research on Wellbeing (GROW) Study.

OBJECTIVES: The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California. METHODS: Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment. RESULTS: In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status. CONCLUSIONS: Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women.

Economic Impact of Tobacco Price Increases Through Taxation: A Community Guide Systematic Review.

CONTEXT: Tobacco use is a leading cause of preventable death in the U.S. and around the world. Increasing tobacco price through higher taxes is an effective intervention both to reduce tobacco use in the population and generate government revenues. The goal of this paper is to review evidence on the economic impact of tobacco price increases through taxation with a focus on the likely healthcare cost savings and improvements in employee productivity. EVIDENCE ACQUISITION: The search covered studies published in English from January 2000 to July 2012 and included evaluations of national, state, and local policies to increase the price of any type of tobacco product by raising taxes in high-income countries. Economic review methods developed for The Guide to Community Preventive Services were used to screen and abstract included studies. Economic impact estimates were standardized to summarize the available evidence. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: The review included eight modeling studies, with seven providing estimates of the impact on healthcare costs and three providing estimates of the value of productivity gains. Only one study provided an estimate of intervention costs. The economic merit of tobacco product price increases through taxation was determined from the overall body of evidence on per capita annual cost savings from a conservative 20% price increase. CONCLUSIONS: The evidence indicates that interventions that raise the unit price of tobacco products through taxes generate substantial healthcare cost savings and can generate additional gains from improved productivity in the workplace.

Frequency and characteristics associated with exposure to tobacco direct mail marketing and its prospective effect on smoking behaviors among young adults from the US Midwest.

OBJECTIVES: We examined the exposure to tobacco direct mail marketing and its effect on subsequent smoking behaviors in a US Midwest regional cohort of young adults. METHODS: Data were collected from 2622 young adults (mean age = 24 years) in 2010 to 2011 (baseline) and 2011 to 2012 (follow-up). We collected information on demographics, tobacco use, and exposure to tobacco direct mail materials in the previous 6 months at baseline. Smoking behaviors were reassessed at follow-up. We investigated the characteristics associated with receiving these materials at baseline, and the associations between receiving cigarette coupons in the mail at baseline and smoking behaviors at follow-up. RESULTS: Thirteen percent of participants reported receiving tobacco direct mail materials in the previous 6 months. Receipt of these materials was associated with age, education, and tobacco use (P < .05). Among those who received these materials, 77% and 56% reported receiving coupons for cigarettes and other tobacco products, respectively. Among baseline nonsmokers and ex-smokers, receiving coupons was associated with becoming current smokers at follow-up (P < .05). Among baseline current smokers, receiving coupons was associated with lower likelihood of smoking cessation at follow-up (P < .05). CONCLUSIONS: Tobacco direct mail marketing promoted and sustained smoking behaviors among US Midwest young adults. Regulating this marketing strategy might reduce the prevalence of smoking in this population.

Latent classes of young adults based on use of multiple types of tobacco and nicotine products.

INTRODUCTION: New tobacco and nicotine products such as snus, hookah, and electronic cigarettes have risen in popularity in recent years. Use of these products among young adults is of particular interest given that experimentation with new products is common in young adulthood. METHODS: We conducted latent class analysis among a population-based sample of young adults to identify separate classes based on use of 6 types of tobacco or nicotine products: snus, hookah, electronic cigarettes, cigarillos, snuff, and cigarettes. We then examined how identified classes differed on demographic characteristics and marijuana and alcohol use. RESULTS: We identified 5 classes: the largest group (60%) was characterized as reporting no or limited use of any of the products, while the smallest group (7%) was characterized by use of many types of products (poly-users). Of the 3 middle classes, 2 were the same size (10%) and were characterized by primarily using 2 of the products: one class used snus and snuff, and the other used cigarillos and hookah; the third class (13%) was characterized by primarily cigarette smoking. Numerous differences were seen across classes, including the poly-users being less likely to be college students/graduates and more likely to be male and use marijuana and alcohol. CONCLUSIONS: We found that young adults can be grouped into 5 subgroups based on types of tobacco/nicotine products they do and do not use. A poly-use group that uses all types of tobacco products is concerning, particularly given high levels of marijuana and alcohol use reported in this group.

Do Sources of Cigarettes Among Adolescents Vary by Age Over Time?

Trends in sources of cigarettes among adolescents were assessed using data from a teen cohort (2000-2006). Five sources-bought from store, got from other teen, stole from others, bought from others, and got from an adult-were measured over time by age. The most common source among all ages was other teens. Fewer teens bought cigarettes from stores, with a downward trend for all ages. Among all ages there was an upward trend in stealing with younger teens more likely to steal cigarettes. In addition to targeting cigarette sales, interventions are needed to target other youth cigarette sources.

Transitions in smoking behavior during emerging adulthood: a longitudinal analysis of the effect of home smoking bans.

OBJECTIVES: We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood. METHODS: We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16-18 years) to young adulthood (ages 18-20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006. RESULTS: Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time. CONCLUSIONS: In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.

Beliefs and experimentation with electronic cigarettes: a prospective analysis among young adults.

BACKGROUND: Previous cross-sectional studies found that positive beliefs about electronic nicotine delivery systems (commonly known as electronic cigarettes or e-cigarettes) were associated with use of these products. However, the prospective association between these beliefs and subsequent use of e-cigarettes is unclear. PURPOSE: To identify the beliefs predicting subsequent use of e-cigarettes. METHODS: A total of 1379 young adults (mean age=24.1 years) from the Minnesota Adolescent Community Cohort who reported never using e-cigarettes at baseline (collected Oct 2010-Mar 2011) and completed follow-up data collection (during Oct 2011-Mar 2012) were included in this analysis. Participants' beliefs about e-cigarettes (potential as quit aids, harmfulness and addictiveness relative to cigarettes) were asked at baseline (yes/no). At follow-up, participants were asked if they had ever used e-cigarettes. Logistic regression models were used to assess the associations between beliefs about e-cigarettes and subsequent experimentation. Analysis was conducted in 2012. RESULTS: At follow-up, 7.4% of the sample reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Participants who believed e-cigarettes can help people quit smoking and perceived e-cigarettes to be less harmful than cigarettes at baseline were more likely to report experimenting with e-cigarettes at follow-up (p<0.05). These associations did not differ by smoking status. CONCLUSIONS: Given that young adults are still developing their tobacco use behaviors, informing them about the lack of evidence to support e-cigarettes as quit aids and the unknown health risk of e-cigarettes may deter young adults from trying these products.

Availability of snus and its sale to minors in a large Minnesota city.

INTRODUCTION: Previous studies examining tobacco retailers' compliance with youth tobacco access policies have mostly evaluated retailers' likelihood of selling cigarettes to minors, and none have evaluated the likelihood of selling snus (a new smokeless tobacco product) to minors. We assessed the availability of snus and the likelihood of selling snus to adolescents in tobacco retailers in a large city in Minnesota. METHODS: We randomly selected 71 eligible retailers located in a large city in Minnesota, and assessed the availability of snus through Camel snus retailer listings and phone inquiry. Purchase attempts by an underage buyer were used to assess the likelihood of selling snus to minors. χ2 tests were used to examine the store and neighbourhood characteristics associated with availability of snus. RESULTS: We found that 31 retailers (43.7%) carried snus in the store, and 4 (12.9%) sold snus to the underage buyer. Retailers who sold gasoline were more likely to carry snus in the store (p<0.01). Neighbourhood demographic characteristics were not associated with availability of snus (p>0.10). CONCLUSIONS: Prevalence of snus sales to minors appeared to be higher than that of cigarette sales to minors according to the 2011 Synar report. Futures studies are needed to determine whether tobacco retailers are more likely to sell snus than cigarettes to minors. Interventions such as public and retailer policies are needed to reduce the likelihood of tobacco retailers selling snus to minors.

Designing and evaluating culturally specific smoking cessation interventions for American Indian communities.

INTRODUCTION: American Indians have the highest smoking rates in the United States, yet few randomized controlled trials of culturally specific interventions exist. This study assessed American Indians' opinions about evidence-based treatment and attitudes toward participating in clinical trials. METHODS: Six focus groups were conducted based on smoking status (current/former smoker), sex, and elder status (55 years and older or younger). Meetings were held at local American Indian community organizations. This project was accomplished in partnership with the American Indian Community Tobacco Projects, a community-academic research partnership at the University of Minnesota. Thematic qualitative data analyses were conducted. RESULTS: Participants desired the following: (a) programs led by trained American Indian community members, (b) the opportunity to connect with other American Indian smokers interested in quitting, and (c) programs promoting healthy lifestyles. Strategies desired for treatment included (a) free pharmacotherapy, including nicotine replacement therapy (NRT); (b) nominal incentives, e.g., gift cards for groceries; and (c) culturally specific program components such as American Indian images, education on traditional tobacco use, and quit-smoking messages that target the value of family and include narratives or story telling in recruitment and program materials. Biochemical verification of smoking abstinence, such as salivary cotinine or carbon monoxide breathalyzers, is likely acceptable. Standard treatment or delayed treatment control groups were viewed as potentially acceptable for randomized study designs. CONCLUSIONS: Rigorously conducted randomized controlled trials of culturally specific smoking cessation interventions are sorely needed but will only be accomplished with the commitment of funders, researchers, and collaborative trusting relationships with the community.

The effects of a tobacco intervention on binge drinking among African American light smokers.

Tobacco use and binge drinking are commonly associated with each other and research has shown that reducing smoking may influence alcohol use in alcohol-dependent populations. Although African Americans report a lower prevalence of binge drinking than other racial/ethnic groups, they are more likely to report consequences associated with this behavior. The aim of this article was to study the effect of a smoking intervention (counseling) on binge drinking prevalence and the frequency and average daily alcohol consumption in a sample of African American light smokers (those who smoke 10 cigarettes or less per day). Multivariate models were used to assess whether counseling type (health education or motivational interviewing) affected binge drinking prevalence and frequency or average daily alcohol consumption among participants (N = 755). Generalized linear models were run to assess the mediation effect of smoking cessation on the relationship between the counseling intervention and drinking outcomes. Finally, smoking cessation (regardless of counseling type) was assessed to determine the effect on alcohol use outcomes. Overall, counseling type was significantly related to a reduction in past 30-day binge drinking prevalence at week 8 among participants in the health education counseling (P = .045); however, these results diminished within 6 months. Smoking cessation did not appear to mediate the relationship between counseling type and alcohol use outcomes. Regardless of counseling type, individuals who quit smoking within the first 8 weeks of the study reported lower past 30-day binge drinking prevalence at week 8 than those who did not quit during the first 8 weeks (P = .035), but the effect was not sustained at the end of the study (week 26). These results show that tobacco interventions can affect binge drinking, but the effect does not appear to be sustained over time.

Longitudinal predictors of stopping smoking in young adulthood.

PURPOSE: This study aims to describe the longitudinal individual and environmental predictors of stopping smoking among a group of young adult smokers. METHODS: From a longitudinal population-based cohort of Midwestern youth, we analyzed semi-annual surveys when study participants were between the ages of 18 and 21 years. Using data from 2001-2008, we restricted analyses to individuals who, at age 18 years, reported smoking between 1 and 30 days in the previous month (n = 1,022). We used generalized linear mixed modeling to analyze demographic, attitudinal, and social-environmental predictors of stopping smoking over time. RESULTS: After adjusting for smoking frequency at baseline, demographic and attitudinal factors that were associated with stopping smoking over time included increased age and attending college; male gender, smoking frequency and agreeing that cigarettes are calming were significantly associated with continued smoking. Social-environmental factors associated with stopping smoking over time included a household ban on smoking and living in a state with a clean indoor air policy; factors associated with continued smoking included living with a smoker and having close friends who smoke. CONCLUSIONS: Both individual and social-environmental factors can serve as risk and protective factors for stopping smoking between ages 18 and 21 years. These factors should be used to refine more effective smoking cessation and prevention interventions in young adults.

Neighborhood socioeconomic characteristics, the retail environment, and alcohol consumption: a multilevel analysis.

BACKGROUND: The neighborhoods where people live can influence their drinking behavior. We hypothesized that living in a neighborhood with lower median income, higher alcohol outlet density, and only liquor stores and no grocery stores would be associated with higher alcohol consumption after adjusting for individual demographic and lifestyle factors. METHODS: We used two self-report measures to assess alcohol consumption in a sample of 9959 adults living in a large Midwestern county: volume of alcohol consumed (count) and binge drinking (5 or more drinks vs.<5 drinks). We measured census tract median annual household income based on U.S. Census data. Alcohol outlet density was measured using the number of liquor stores divided by the census tract roadway miles. The mix of liquor and food stores in census tracts was assessed using a categorical variable based on the number of liquor and number of food stores using data from InfoUSA. Weighted hierarchical linear and Poisson regression were used to test our study hypothesis. RESULTS: Retail mix was associated with binge drinking. Individuals living in census tracts with only liquor stores had a 46% higher risk of binge drinking than individuals living in census tracts with food stores only after controlling for demographic and lifestyle factors. CONCLUSION: Census tract characteristics such as retail mix may partly explain variability in drinking behavior. Future research should explore the mix of stores, not just the over-concentration of liquor stores in census tracts.

Nondaily smoking patterns in young adulthood.

PURPOSE: Many young adult smokers routinely smoke less than daily. Prospective, longitudinal data are needed to describe and predict the influences on smoking patterns among nondaily young adult smokers. METHODS: Latent class growth analysis was used to examine developmental trajectories and predictors of nondaily cigarette smoking among young adults aged 18 to 21 in the Upper Midwestern United States. RESULTS: There were three distinct groups of nondaily smokers during young adulthood (n=519). College status, previous quit attempts, attitudes toward the meanings of cigarettes, and situational factors influencing smoking were significant predictors of group membership. CONCLUSIONS: Nondaily smoking in young adulthood may result in several discrete patterns of smoking between age 18 and 21. Predictors that differentiate smoking trajectories may be useful to promote cessation or reduction in young adult smoking.

Individual and neighborhood socioeconomic status effects on adolescent smoking: a multilevel cohort-sequential latent growth analysis.

OBJECTIVES: We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES. METHODS: The study included 3635 randomly recruited adolescents from 5 age cohorts (12-16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort-sequential latent growth model to examine smoking from age 12 to 18 years with predictors. RESULTS: Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES. CONCLUSIONS: We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.

Receipt and redemption of cigarette coupons, perceptions of cigarette companies and smoking cessation.

BACKGROUND: Although it is known that cigarette companies use cigarette coupons to market their products, little is known about the characteristics of those who receive these coupons. The influence of receipt and redemption of these coupons is also unknown. METHODS: Participants of the Minnesota Adult Tobacco Survey Cohort Study who were smokers in 2008, completed surveys in 2008 and 2009, and had smoked for at least 6 months between those surveys, were included. In 2009, participants reported whether they had received cigarette coupons in the past 12 months, and whether they had used the coupons. They also reported their perceptions of cigarette companies and their smoking status. Multivariate logistic regressions were used to assess associations between receiving and redeeming coupons, perceptions of cigarette companies, and smoking status. RESULTS: Overall, 49.4% of the sample reported receiving cigarette coupons, and 39.9% redeemed them (80.1% of those who received these coupons). Female, younger and heavier smokers were more likely to report receiving these coupons (p<0.05). Smokers who received these coupons were more likely to agree that cigarette companies care about their health and do the best they can to make cigarettes safe, and less likely to agree that cigarette companies lie (p<0.05). Smokers who used these coupons were less likely to quit smoking (p<0.05). CONCLUSIONS: Our findings suggest a negative association between cigarette coupons and smoking cessation. Longitudinal studies are needed to establish whether cigarette coupons influence smoking behaviour to inform the necessity for policies to prohibit the use of these coupons to assist smokers to quit smoking.

The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing.

OBJECTIVES: Exposure to tobacco marketing has been associated with an increased likelihood that youth start smoking and may interfere with tobacco cessation. We aimed to describe the prevalence, placement, and features of tobacco advertising at the point of sale by race, ethnicity, and other neighborhood demographics, as well as by store type. DESIGN: A cross-sectional assessment of the advertising environment in establishments that held tobacco licenses in our study region (a metropolitan area in the Midwest USA) was conducted in 2007. Stores were geocoded and linked with block group demographic data taken from the Year 2000 US census. We calculated associations between our hypothesized predictors, race, ethnicity, and other neighborhood demographics, and two types of outcomes (1) amount and (2) characteristics of the advertising. RESULTS: Tobacco advertising at the point of sale was most common in gas stations/convenience stores, liquor stores, and tobacco stores. A 10% difference in a block group's African-American/Black population was associated with 9% (95% confidence interval [CI]=3%, 16%) more ads as well as a greater likelihood that ads would be close to the ground (prevalence ratio [PR]=1.15 [95% CI=1.04, 1.28]). Block groups with greater African-American/Black, Asian, people on public assistance or below 150% of the poverty threshold, or people under the age of 18 years had more ads for menthol brands. Block groups with greater proportions of Whites were more likely to have ads that used health words, such as 'light' or 'natural' (PR for 10% difference in White population=1.41 [95% CI=1.17-1.70]). Chain stores were more likely to have greater amounts of advertising, ads close to the ground, ads for price deals, or ads that use words that imply health. CONCLUSION: Tobacco advertising targets communities with various racial and ethnic profiles in different ways. Now that US Food and Drug Administration has the authority to regulate the marketing and sale of tobacco products, there is new opportunity to reduce the harmful impact of tobacco advertising.

Did a local clean indoor air policy increase alcohol-related crime around bars and restaurants?

OBJECTIVE: To evaluate whether the adoption of a local clean indoor air (CIA) policy in St. Paul, Minnesota, was associated with changes in alcohol-related crimes outside on-premises alcohol-licensed businesses. DESIGN: The enactment of a comprehensive CIA policy on 31 March 2006 was used as the intervention time point in an interrupted time-series analysis to assess changes in weekly crime frequency prior to the policy enactment compared with the period after the policy was established (n=261 weeks). SETTING: St. Paul, Minnesota, USA. SUBJECTS: On-premise alcohol-licensed business addresses were collected from St. Paul, Minnesota, for the period of January 2003 to December 2007, and geocoded. A 500-foot (152.4 m) buffer was drawn around each business. MAIN OUTCOME MEASURES: Alcohol-related crime (ie, arrest) data were obtained from the St. Paul Police Department; crimes had been geocoded by the police department. They were aggregated by week to include only those crimes that occurred within the drawn buffer. Relevant types of crimes included serious (eg, aggravated assaults, homicide, robbery, rape and theft) and less serious (eg, lesser assault, fighting, noise violations, public drunkenness/lewdness or other liquor law violations) crimes. RESULTS: Within a buffer of 500 foot of alcohol-licensed businesses, 23 978 serious alcohol-related crimes and 49 560 less serious alcohol-related crimes occurred over 5 years. Using interrupted time-series analyses to compare the weekly alcohol-related crime frequency in proximity with the bars and restaurants, we found no significant change in either type of crime associated with the local comprehensive CIA policy (p=0.13) after adjustment for seasonal differences and overall crime frequencies. CONCLUSIONS: Evidence from this study suggests that alcohol-related crimes were not significantly affected by a local comprehensive CIA policy that banned smoking in public workplaces in St. Paul, Minnesota.