Recommendations to advance equity in tobacco control.

Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals.

[Un]Forgetting History: Preparing Public Health Professionals to Address Structural Racism.

CONTEXT: Structural racism, a fundamental cause of health inequities, must be dismantled to fulfill society's interest in ensuring conditions in which all people have opportunities conducive to health. Correspondingly, the Ten Essential Public Health Services center equity, and Council on Education for Public Health (CEPH) accreditation criteria require public health students to learn about racism. However, little guidance is provided to help faculty empower future generations of public health professionals to challenge it. PROGRAM: In response to the 2020 murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, faculty at UNC Greensboro denounced racism and recommitted to anti-racist pedagogy and praxis. In this article, we discuss integrated ways a graduate-level public health assessment and planning course empowered students to name structural racism, understand how it operates, and collaborate for action. IMPLEMENTATION: Specifically, we highlight (1) our use of the book The Color of Law as means to understand racism as a structural intervention; (2) the Harvard Case Teaching Method as an organizing framework to make the classroom a critically engaged democratic setting; (3) change experts from local health and nonprofit organizations engaged in policy making to address social determinants and disparities resulting from structural racism (eg, housing, health care access, food insecurity); and (4) engagement with a minority-owned nonprofit to allow for practice applying knowledge and skills to address local inequities. DISCUSSION: Our 4-pronged pedagogical approach provides an innovative, tangible example for other public health programs as they reflect upon academic institutions' unique power and role in addressing the public health crisis of structural racism.

Shifting Loci of Responsibility Upstream to Advance Healthy Behavior and Equity.

Healthy behaviors contribute to healthy people and communities, and a prosperous state. They are, however, more than simply individual choices. This issue of the North Carolina Medical Journal contextualizes current behavioral trends, progress toward advancing healthy behaviors, and policy levers to address substance use, sugary drink consumption, and sexual health practices.

Stewarding Opioid Settlement Funds with Transparency and Equity: An Interview with North Carolina Attorney General Josh Stein.

Before the onset of the COVID-19 pandemic, North Carolina had seen encouraging reductions in opioid overdose deaths. In the years since, this trend has unfortunately reversed. In this interview, Guest Editor Carrie Rosario talks with North Carolina Attorney General Josh Stein about how the state will use settlement funds to prevent future overdose deaths.

Tobacco Advertisements: What Messages Are They Sending in African American Communities?

Racial disparities in tobacco-related death and disease persist. Despite evidence of disparities in exposure to tobacco retailers and point-of-sale advertising, little is known about the extent to which tobacco advertisements within African American communities use three prominent messaging strategies: reassure use is safe despite health risks, redirect attention from health risks to other product features, or incite bravery to use despite health risks. Using a multistage design, we examined tobacco advertisements at 24 retail stores listed on Countertools.org StoreMapper within 15 census tracts where roughly 74% of the population was African American. After confirming interrater reliability, trained data collectors assessed messaging strategy (reassurance, misdirection of attention, or inducement to bravery) usage in ads (n = 165) for various brands (e.g., Newport, Swisher Sweets, Blu) and whether strategies varied by product type (e.g., cigarettes, nonlarge cigar, e-cigarettes). Chi-square analysis of 165 advertisements revealed that the misdirection of attention strategy was used more often than reassurance or inducement to bravery. Tobacco advertisement messaging strategies also varied by product type, with misdirection of attention used more frequently in cigarette and nonlarge cigar advertisements and reassurance used more frequently in e-cigarette advertisements. Cigarette and nonlarge cigar advertisement messages prey on African American communities by redirecting their focus from consequences toward favorable product attributes. Additionally, reassurance messaging may misconstrue risks associated with e-cigarettes; therefore, we should vigilantly monitor e-cigarette trends among this population. Countering misleading messages and advocating policies regarding advertisement content and density within African American communities could help reduce health disparities.

Nativity Status and Poly Tobacco Use among Young Adults in the United States.

Introduction: Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18-30 years of age sampled in the National Health Interview Survey (2015-2019), a nationally representative sample of the US population. We calculated prevalence of use of any and two or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n = 3096) and US-born (n = 6811) young adults. Logistic regression models were adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs. 10.7%; Cigar = 1.8% vs. 4.8%; E-cigarette = 2.3% vs. 4.5%, respectively; p < 0.01) or poly tobacco use (1.9% vs. 4.2%; p < 0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26-0.63)). Conclusions: The findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.

An examination of ecological predictors of health literacy in black college students.

OBJECTIVE: Health literacy is a determinant of health, but disparities in health literacy persist. This study examined the influence of ecological factors on college students' health literacy. PARTICIPANTS: During January 2016 a nonrandom sample of black undergraduate students (n = 298) aged 18-24 were recruited from enrollment lists at two urban universities in the Southeastern United States. METHODS: Information on health literacy as well as numerous intrapersonal, social, and cultural-environment factors was obtained using an electronic questionnaire and then statistically modeled. RESULTS: Ecological factors accounted for 28.7% of the variance in health literacy. In particular, reappraisal (B = 0.323, p < .001), suppression (B = -0.289, p < .001), campus health education (B = 0.192, p < .05), campus tobacco culture (B = -0.174, p < .05), and perceived norms (B = -0.153, p < .05) directly predicted health literacy. CONCLUSIONS: Although intrapersonal factors influence health literacy, the sociocultural environment of college can also foster or hinder college students' health literacy.

Quantifying littered cigarette butts to measure effectiveness of smoking bans to building perimeters.

OBJECTIVE: The authors estimated the number of violations of a university policy that prohibited smoking within 25 ft of all campus buildings. PARTICIPANTS: The project was conducted by 13 student researchers from the university and a member of the local public health department. METHODS: Students quantified cigarette butts that were littered in a 30-day period inside the prohibited smoking area of 7 campus buildings (large residential hall, small residential hall, administrative building, 2 academic buildings, campus cafeteria, and student union). RESULTS: Investigators found a total of 7,861 cigarette butts (large residential hall: 1,198; small residential hall: 344; administrative building: 107; 2 academic buildings: 1,123 and 806; campus cafeteria: 2,651; and student union: 1,632). CONCLUSIONS: Findings suggest that there is low compliance with the university's smoking policy. The described project may be repeated by students at other universities as a method to advocate for policy change.