Anne Berit Petersen

Positive and instructive anti-smoking messages speak to older smokers: a focus group study

BackgroundSmokers over the age of 45 are the only group with an increase in smoking prevalence, are the least likely to quit smoking, and bear most of the burden of tobacco-related disease. Research characterizing older adult perceptions of warning labels and anti-tobacco messages has not been reported in the literature. The purpose of this study was to describe whether older smokers perceived warning labels and anti-tobacco messages as effective for the promotion of smoking cessation. A secondary aim was to explore what types of messages and message delivery formats are most relevant to older adult smokers.MethodsThis focus group study is part of a larger study to characterize older smokers’ perceptions of the risks and benefits associated with conventional and emerging tobacco products and determine the extent to which these perceptions relate to exposure to pro- and anti-tobacco messages. From April 2013 to August 2014 we conducted eight focus groups with 51 current and former smokers a focus group study in urban and suburban California. A semi-structured format about current use of conventional and emerging tobacco products was used. Participants were asked to recall and comment on examples of warning labels and anti-tobacco messages. Data were transcribed and thematically coded.ResultsWarning labels and anti-smoking messages were seen as ineffective for smoking cessation motivation among older California smokers. Positive framed anti-tobacco messages were identified as most effective. Text-only warnings were seen as ineffective due to desensitizing effects of repeated exposure. Negative messages were described as easy to ignore, and some trigger urges to smoke. Older adults are knowledgeable about the risks and health effects of smoking. However, they tend to be less knowledgeable about the benefits of cessation and may underestimate their ability to quit.ConclusionThese findings suggest that messages with a positive frame that outline immediate and long-term benefits of cessation would be an effective approach for long-term smokers.Current anti-tobacco messaging was generally not seen as effective for smoking cessation among long-term smokers.

Factors that Influence Diabetes Self-Management in Hispanics Living in Low Socioeconomic Neighborhoods in San Bernardino, California

The growing incidence of diabetes among Hispanics is a serious public health concern. To identify factors that influence diabetes self-management in Hispanics, qualitative data gathered through five focus group interviews was examined using grounded theory methods. Four major themes emerged which were perceived by participants as enhancing or limiting factors: (1) access to resources, (2) struggle with diet, (3) self-efficacy, and (4) social support. The family’s role as a determinant of diabetes self-management emerged as the underlying sub-theme to all four themes and underscores its importance among Hispanics living with diabetes. Results suggest that for the family to be an enhancing factor, health care providers need to educate, empower, and include the family in diabetes management and prevention. Programs which aim to improve the practice of self-management should incorporate the sociocultural and socioeconomic context in which Hispanics with diabetes live.

Suffering in Silence: Impact of Tobacco Use on Communication Dynamics Within Vietnamese and Chinese Immigrant Families

The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker–family member pairs of Vietnamese (n = 9 dyads, 18 individuals) and Chinese (n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members “suffering in silence” and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.

E‐cigarette use in pregnancy: a human rights‐based approach to policy and practice

The health risks associated with e‐cigarette use in pregnancy are mostly unknown. Guidelines by the World Health Organization and national health agencies warn women against using e‐cigarettes in pregnancy; however, in the UK, a recent multiagency guideline takes a different approach by not discouraging e‐cigarette use in pregnancy. Furthermore, e‐Voke™, an e‐cigarette, has been approved for use in pregnancy in the UK. We analyze United Nations human rights treaties to examine how they might inform best practice recommendations for e‐cigarette use in pregnancy. These treaties oblige Parties to adopt policies that protect childrens and womens right to health, appropriate pregnancy services, and health education. We argue that clinical practice guidelines related to use of e‐cigarettes in pregnancy should consider both evidence and human rights principles, and ensure that healthcare providers and patients are given clear, accurate messages about the known and potential risks associated with e‐cigarette use in pregnancy.

Smoking Policy Change Within Permanent Supportive Housing

Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7–9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: −38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.