Direct Outreach in Bars and Clubs to Enroll Cigarette Smokers in Mobile Cessation Services: Exploratory Study.

BACKGROUND: Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. OBJECTIVE: The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. METHODS: We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. RESULTS: The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. CONCLUSIONS: Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates.

Facebook Chat Application to Prompt and Assist Smoking Cessation Among Spanish-Speaking Young Adults in South Texas.

Given how smart phones, internet services, and social media have shown great potential for assisting smoking cessation, we constructed a Facebook chat application based on our previous work with SMS texting services. This report summarizes findings from 2,364 Spanish-speaking young adults recruited through Facebook advertising in South Texas during the 2020 New Year holiday season. Among these service users, 926 (39%) were ready to make a quit attempt, and 26 (3.1%) of those users reported that they were tobacco free 1 month later. There were no responses to a chat question survey 72 days after the dates selected for quitting. Although more research with longer follow up is needed, these findings show that social media chat applications may be helpful for at least prompting quit attempts and short-term cessation among young adult Spanish-speaking smokers. There is no evidence of an impact on long-term cessation, and more research is clearly needed.

Using Tweetchats to Build Community Awareness and Advocacy around Alzheimer's Disease for Latinos.

U.S. Latinos are 1.5 times more likely to develop Alzheimer's disease (AD) than non-Latino Whites. To raise awareness of and action around this rising public health issue, Salud America!, a national Latino health advocacy network, organized three #SaludTues tweetchats on Twitter between 2018 and 2020. For the three Alzheimer's tweetchats ─Aug. 14, 2018, June 6, 2019, and Oct. 6, 2020─Salud America! partnered with global groups that advocate for AD solutions in Latino and other communities. We analyzed the three tweetchats' #Saludtues hashtag usage, participant demographics, and other metrics using Symplur analytics software. For the first tweetchat in 2018, there were 579 tweets with a total of 3.89 million impressions; the second tweetchat in 2019 had a bigger impact with 704 tweets with 5.72 million impressions; the third tweetchat had the biggest impact with 932 tweets and 6.62 million impressions. Most tweetchat participants were from states with large Latino populations, and most tweets indicated positive sentiment related to increasing awareness of solutions to AD issues among Latinos. The three Alzheimer's-focused #SaludTues tweetchats particularly served as unique testing grounds for the fast dissemination and increasingly exposed many people to the issue of AD and the need to advocate for the Latino community.

Communication for Awareness and Action on Inequitable Impacts of COVID-19 on Latinos.

In response to coronavirus disease (COVID-19) in 2020, the national Salud America! Latino health equity program at University of Texas Health San Antonio applied its digital content curation model to create and communicate culturally relevant news, stories, and data to raise immediate awareness and generate action against the pandemic's inequitable impacts on U.S. Latinos. Digital content curation is an emerging public health communication strategy using a systematic, refined process to create tailored online and social health messages and prevent mixed messaging and information overload for an audience. Salud America! curated culturally relevant digital content to raise awareness of the pandemic's inequitable impact on Latinos and promote solutions for health equity, with a unique combination of website blog posts exploring pandemic effects on Latinos, peer-modeled stories of people responding meaningfully to the crisis, podcast episodes and Tweetchats engaging people in COVID-19 solutions for Latinos, action tools and campaigns equipping school leaders to make grassroots changes, and supplying advocates with a local data tool on health equity identification. The digital health promotion intervention produced curated content that spiked program website traffic to record highs, revealing the model's effectiveness in increasing exposure to culturally relevant and action-oriented information for a novel topic.

Prevalence and correlates of never vaccinated Nigerian children, aged 1-5 years.

INTRODUCTION: A unique population of Nigerian children, aged 1-5 years, never receive any of the recommended childhood vaccines. However, the characteristics of this population has not been previously described. Given Nigeria's historically poor childhood immunization coverage and high child mortality rates, it was imperative we investigate the prevalence and correlates of never-vacccination among Nigerian children. METHODS: We conducted secondary analysis of the 2013 Nigeria Demographic Health Survey data of Nigerian children, aged 12-59 months (n = 20,586). Weighted multivariate logistic regressions were used to examine the relationship between socio-demographic factors and never-vaccination of Nigerian children. Further regression analysis was conducted after stratifying by Northern and Southern regions. RESULTS: About twenty one percent of study sample, had never been vaccinated. Over eighty percent of the never-vaccinated children in our study resided in the Northern geopolitical zones of Nigeria. Child never-vaccination was found to be significantly associated with key socio-demographic characteristics. Children born into poor households, with mothers who are unemployed and uneducation, were more likely to be never-vaccinated. Unique predictors of child never-vaccination specific to Northern Nigeria were identified. Islam (aOR: 1.56, 95% CI: 1.11-2.17) and lack of access to Television or Radio (aOR: 1.49, 95% CI: 1.22-1.81) promoted never-vaccination, while increasing maternal age and rural residence (aOR: 0.63, 95% CI: 0.42-0.95) were associated with lower odds of never-vaccination. CONCLUSION: Socio-demographic factors are predictors of child never-vaccination in Nigeria. Further investigations are needed to better understand the underlying contexts that conribute to child never-vaccination in populations identified in this study. More so, it is important to examine the mechanism through which predictors that are region-speific, culminate in child never-vaccination.

Text and Mobile Media Smoking Cessation Service for Young Adults in South Texas: Operation and Cost-Effectiveness Estimation.

To realize the promising potential of services delivered via smart phones to help young adults quit smoking at a high level of cost-efficiency, we constructed a texting and mobile media system that was promoted in South Texas via social media advertising and other recruitment channels. During the 6-month service period described here, enrollments were achieved for 798 participants with a mean age of 29.3 years. Seven-month texted follow-up found that 21% (171) of the enrollees reported abstinence at that point. This is consistent with high rates of success found in studies of telephone counseling for young adults and confirms that text and mobile media service specifically designed for young adults provide a feasible and potentially cost-effective approach to promoting cessation.

Advocacy, Efficacy, and Engagement in an Online Network for Latino Childhood Obesity Prevention.

Salud America! is a national network created to engage Latino researchers, health professionals and community leaders in actions to reduce Latino childhood obesity. An online survey of 148 Salud America! network members investigated relationships between (1) their levels of engagement with the network, (2) self- and collective-efficacy, and (3) behavioral intentions to engage in advocacy for policies that can help reduce Latino childhood obesity. Analyses of these data found that higher levels of Salud America! engagement was associated with collective-advocacy efficacy-greater confidence in organized group advocacy as a way of advancing policies to reduce Latino childhood obesity. A multiple regression analysis found that this sense of collective-efficacy moderately predicted intentions to engage in advocacy behaviors. Salud America! engagement levels were less strongly associated with members' confidence in their personal ability to be an effective advocate, yet this sense of self-efficacy was a very strong predictor of a behavioral intention to advocate. Based on these findings, new online applications aimed at increasing self- and collective-efficacy through peer modeling are being developed for Salud America! in order to help individuals interested in Latino childhood obesity prevention to connect with each other and with opportunities for concerted local actions in their communities.

Scales of smoking-related self-efficacy, beliefs, and intention: assessing measurement invariance among intermittent and daily high school smokers.

PURPOSE: To examine the factorial validity and measurement invariance of scales that measure smoking-related self-efficacy, beliefs, and intention between daily and intermittent adolescent smokers. DESIGN: Cross-sectional survey design. SETTING: Selected high schools in eastern Texas. SUBJECTS: Subjects were 2888 high school current smokers; mean age 16.2 years; 53.5% male; 67.4% White, 17.8% Hispanic, 6.2% Black, 8.6% "other." Daily smokers comprised 37.9% of the sample (i.e., smoked at least one cigarette every day 30 days prior to the survey). MEASURES: Smoking-related self-efficacy and intention were measured by three items; beliefs were measured by four items. ANALYSIS: Confirmatory factor analyses were conducted to test the invariance of the measures between daily and intermittent smokers. Fit indices included comparative fit index (CFI), nonnormed fix index (NNFI), and root mean square error of approximation (RMSEA). RESULTS: The three-factor measurement model had good fit for daily (CFI = .97, NNFI = .95, RMSEA = .09) and intermittent (CFI = .96, NNFI = .95, RMSEA = .09) smokers. Evidence of strong factorial invariance was found for the factors between the smoking subgroups (CFI = .96, NNFI = .96, RMSEA = .08). CONCLUSION: These measures may be used to capture and compare scores on self-efficacy to resist smoking, beliefs about benefits of smoking, and intention to smoke between daily and intermittent adolescent smokers.

Assessing the invariance of smoking-related self-efficacy, beliefs, and intention among high school current smokers.

Measures of correlates of youth smoking should be invariant. We examined the measurement invariance of smoking-related self-efficacy, beliefs, and intention across gender, race (White vs. Black), ethnicity (non-Hispanic vs. Hispanic), and grade level (9th/10th vs. 11th/12th grade) for 2767 high school current smokers. Strong factorial invariance was found in the factors across gender (NNFI:0.959; CFI:0.959; RMSEA:0.085), grade (NNFI:0.962; CFI:0.962; RMSEA: 0.079), race (NNFI: 0.967; CFI: 0.967; RMSEA: 0.074), and ethnicity (NNFI: 0.965; CFI: 0.965; RMSEA: 0.078). Smoking-related self-efficacy, beliefs, and intention measures may be confidently used to understand attitudinal differences across gender, race, ethnicity, and grade level for youth smokers.

Assessing the psychometric properties of smoking-related attitudes, self-efficacy, and intention among a diverse population of middle school students.

Large-scale surveys frequently assess smoking-related attitudes, self-efficacy and intention to understand differences in smoking behavior. However, a critical assumption is that measures of these determinants should be equivalent across different subgroups of a target population. The current study examined the factorial invariance of measures of smoking-related attitudes, self-efficacy, and intention with a large sample (N=13,733) of middle school students from 25 schools in Texas. We examined five levels of factorial invariance using a sequential process, in which increasingly constrained models assess the equivalence of a measure across subgroups. Strong factorial invariance provided a good fit for the model across all of the subgroups: race/ethnicity (CFI=.93), gender (CFI=.96), age (CFI=.95), and grade level (CFI=.95). Invariance results provide strong empirical support for the validity of smoking-related attitudes, self-efficacy, and intention measures across race/ethnicity, gender, age, and grade level for middle school students.

African American participation and success in telephone counseling for smoking cessation.

INTRODUCTION: Quitlines that provide telephone counseling for smoking cessation have been proved to be effective. All 50 states currently provide free quitline access to their residents; however, little research has been published on African American utilization of quitlines or their success rates. METHODS: This study evaluated how effectively African Americans are served by telephone counseling (quitline) for smoking cessation based on empirical data from 45,510 callers from Texas, Louisiana, Washington, and District of Columbia and randomized clinical trial data from 3,522 participants. RESULTS: African Americans tended to use a quitline in proportions greater than their proportional representation in the smoking communities in both states and the District. African American quit rates were equivalent to those of non-Hispanic "Whites" as were their levels of satisfaction with the service and the number of counseling sessions they completed. African Americans were more likely to request counseling than non-Hispanic Whites. CONCLUSIONS: This study demonstrates that telephone counseling is a promising tool for addressing health disparities related to smoking among African Americans.

Using social media to communicate child health information to low-income parents.

The objective of this study was to determine the value of using social media to communicate child health information to low-income parents. We evaluated qualitative data obtained through focus groups with low-income, predominantly Hispanic parents. Results were mixed; lack of time and credibility were the primary objections parents cited in using social media to obtain information about their children's health. Social media has value as part of an overall communication strategy, but more work is needed to determine the most effective way to use this channel in low-income populations.

Dyadic efficacy for smoking cessation: preliminary assessment of a new instrument.

INTRODUCTION: Smoking cessation research has demonstrated a link between social support and quitting, but interventions designed to enhance partner support have often failed. We adapted and tested a measure of dyadic efficacy to assess smokers' confidence in their abilities to work together as a team with their partners to quit smoking and cope with quitting challenges. Our goal was to establish the psychometric properties of the dyadic efficacy instrument, including its associations with cessation outcomes. METHODS: We recruited partnered smokers who called the American Cancer Society's Quitline and administered telephone interviews (N = 634, 59% female, average age = 40 years). Interviews included 8 dyadic efficacy items and a variety of sociodemographic, smoking history, and relationship variables at baseline and quit outcomes at 4 months. RESULTS: Factor analysis of the dyadic efficacy items yielded a 1-factor scale with strong internal consistency (α = .92). Dyadic efficacy was positively associated (p < .0001) with smoking-specific support (r = .51), relationship satisfaction (r = .44), and dyadic coping (r = .54). Dyadic efficacy was not associated with age, gender, race, relationship length, smoking quantity, or previous quit attempts. Respondents with smoking partners who were willing to quit with them had higher dyadic efficacy than those whose smoking partners were not (p < .0001). Higher baseline dyadic efficacy was predictive of 7-day point prevalence quit rates at follow-up (odds ratio = 1.25, 95% CI = 1.02-1.53). CONCLUSIONS: With further study, dyadic efficacy may enhance our understanding of the role of partner relationships in smoking cessation.

Reductions in cigarette smoking and acute myocardial infarction mortality in Jefferson County, Texas.

After litigation against the tobacco industry ended in a settlement, the Texas legislature funded pilot projects to reduce tobacco use in selected areas of the state. Subsequent telephone surveys showed that well-funded activities were successful in reducing population rates of self-reported cigarette smoking. We present evidence that the reduction in smoking promptly led to lower rates of death from acute myocardial infarctions.

Process evaluation and participatory methods in an obesity-prevention media campaign for Mexican Americans.

To address obesity and related morbidities, community-based participatory research (CBPR) strategies were employed to design and evaluate a Spanish-language media campaign promoting physical activity and healthful food choices among Mexican Americans. Process evaluation including content analyses on types and focus of media messages was conducted. Focus groups assessed appeal and trustworthiness of messages. All media campaign products featured role models and experts. Campaign messages primarily (91%) appeared in TV morning show segments. Newsletters presented individual and family role model stories. A majority of newsletters (68%) were distributed through churches and "promotora" outreach efforts. CBPR lends itself to the selection and tailoring of evidence-based media campaigns. Moreover, CBPR guidance resulted in media messages that were credible and appealing to audience. Process evaluation strategies that gather information from the community provide solid evidence for how to modify the campaign to best meet audience expectations.

Validation of scales measuring attitudes, self-efficacy, and intention related to smoking among middle school students.

Attitudes toward smoking, self-efficacy to avoid smoking, and smoking intention, widely cited correlates of youth smoking prevention, are often measured in large-scale youth tobacco surveys. The psychometric properties of these scales have not been well studied among middle school youth. We examined the factorial, discriminate, and convergent validity of these scales among sixth to eighth graders from a convenience sample of 22 Texas middle schools (51.2% female; 51.21% White, 32.1% Hispanic, 16.9% African American, and 8.8% Other; 67.8% nonsmokers, 21.9% experimental smokers; 3.3% former smokers; and 7.6% current smokers). Confirmatory factor analysis and invariance testing suggest that smoking attitudes, self-efficacy, and intention have evidence of construct validity in this multiethnic sample, and the scales are appropriate to assess these constructs among middle school adolescents. Additional studies are needed to establish additional evidence of validity of these constructs in other middle school samples and other subgroups (e.g. current, experimental, and former smokers).

Smoking cessation counseling practices of Texas pharmacists.

A cross-sectional study was conducted to determine pharmacists' awareness and education about smoking cessation and their communication with patients about smoking cessation. A survey was mailed to East Texas pharmacists practicing in the areas of hospital or clinical, retail or community, managed care, consultant, or academic pharmacy. Outcome measurements included: measures of the awareness of the 5 A's and 5 R's of smoking cessation, training received in smoking cessation, and communication practices regarding smoking cessation. There were 320 respondents. Approximately 10% of the respondents indicated they had received tobacco cessation counseling education during their formal educational training, 36% during continuing education programs, and 9% during both formal training and continuing education. About 44% reported they had received no tobacco cessation counseling training. Among pharmacists surveyed, 5% responded that they usually or always ask their patients if they smoke cigarettes, pipe, or cigars, 43% reported they sometimes or half of the time ask, and 45% said they never ask. There is a clear relationship between pharmacists awareness and education of smoking cessation techniques and their communication with patients about them. Pharmacy education leaders must continue their movement to include public health in the pharmacy curricula to produce pharmacists who are prepared to better serve the community.

Comparing internet assistance for smoking cessation: 13-month follow-up of a six-arm randomized controlled trial.

BACKGROUND: Although many smokers seek Internet-based cessation assistance, few studies have experimentally evaluated long-term cessation rates among cigarette smokers who receive Internet assistance in quitting. OBJECTIVE: The purpose of this study is to describe long-term smoking cessation rates associated with 6 different Internet-based cessation services and the variation among them, to test the hypothesis that interactive and tailored Internet services yield higher long-term quit rates than more static Web-posted assistance, and to explore the possible effects of level of site utilization and a self-reported indicator of depression on long-term cessation rates. METHOD: In 2004-05, a link was placed on the American Cancer Society (ACS) website for smokers who wanted help in quitting via the Internet. The link led smokers to the QuitLink study website, where they could answer eligibility questions, provide informed consent, and complete the baseline survey. Enrolled participants were randomly assigned to receive emailed access to one of five tailored interactive sites provided by cooperating research partners or to a targeted, minimally interactive ACS site with text, photographs, and graphics providing stage-based quitting advice and peer modeling. RESULTS: 6451 of the visitors met eligibility requirements and completed consent procedures and the baseline survey. All of these smokers were randomly assigned to one of the six experimental groups. Follow-up surveys done online and via telephone interviews at approximately 13 months after randomization yielded 2468 respondents (38%) and found no significant overall quit rate differences among those assigned to the different websites (P = .15). At baseline, 1961 participants (30%) reported an indicator of depression. Post hoc analyses found that this group had significantly lower 13-month quit rates than those who did not report the indicator (all enrolled, 8% vs 12%, P < .001; followed only, 25% vs 31%, P = .003). When the 4490 participants (70%) who did not report an indicator of depression at baseline were separated for analysis, the more interactive, tailored sites, as a whole, were associated with higher quitting rates than the less interactive ACS site: 13% vs 10% (P = .04) among 4490 enrolled and 32% vs 26% (P = .06) among 1798 followed. CONCLUSIONS: These findings show that Internet assistance is attractive and potentially cost-effective and suggest that tailored, interactive websites may help cigarette smokers who do not report an indicator of depression at baseline to quit and maintain cessation.

American Cancer Society's QuitLink: randomized trial of Internet assistance.

Eligible smokers (N = 6,451) visiting the American Cancer Society's Internet site offering cessation assistance were, with informed consent, randomized to receive access either to a static Internet site with quitting advice or to one of five interactive sites provided by cooperating research partners. Three-month follow-up surveys were conducted via online survey with E-mail prompts, or telephone calls, to assess quitting success; 54% of participants provided follow-up data. Results showed no significant overall difference in cessation rates among participants assigned to the interactive or static sites. We found large differences in the utilization of the five interactive sites. When sites were grouped by level of use, a significantly higher reported 3-month cessation rate was observed among participants assigned to the more highly utilized sites than among those assigned to the less utilized sites (12.2% vs. 10.2% of all randomized participants, 26.0% vs. 22.1% of followed participants). These findings show that interactive Internet sites yielding high levels of utilization can increase quitting success among smokers seeking assistance via the Internet.

Smoking-related self-efficacy, beliefs, and intention: assessing factorial validity and structural relationships in 9th-12th grade current smokers.

Smoking-related self-efficacy and beliefs about the benefits of smoking are consistently related to intention to continue smoking, a common proximal outcome in youth smoking cessation studies. Some measures of these constructs are used frequently in national and state youth tobacco surveys, despite little evidence of validity for high school smokers. Further, the association of the constructs with intention has not been demonstrated in this group. The factorial validity of the measures and the cross-sectional correlations among self-efficacy, beliefs, and intention were examined among 9th-12th grade current smokers (N=2,767, 13.8% reporting smoking >1 cigarette in the previous 30 days; mean age 16.2; 61.2% white, 6.2% Black, 17.8% Hispanic, 5.0% Asian, 3.5% other; response rate 70%) from a convenience sample of 22 Texas schools. Confirmatory factor analyses supported evidence of factorial validity for the scales in this sample. Structural equation modeling analyses suggested youth smokers have low confidence in their ability to avoid smoking, believe smoking offers emotional or social benefits, and intend to continue smoking. The scales assess smoking-related self-efficacy, beliefs, and intention in this sample. Prospective studies are needed before intervention development implications are suggested.