Charu Mathur

Differences in prevalence of tobacco use among Indian urban youth : The role of socioeconomic status

This study examined whether the distribution of tobacco use and related psychosocial risk factors among youth in urban India vary by socioeconomic status (SES). Data were derived from a cross-sectional survey of students enrolled in the 6th and 8th grades in 32 schools in Delhi and Chennai (N = 11,642). The survey was conducted in 2004, before the implementation of a program designed to prevent and reduce tobacco use (MYTRI). Mixed-effect regression models were used (a) to determine the prevalence of tobacco use among private (higher SES) and government (lower SES) school students, (b) to investigate whether certain psychosocial factors were associated with increased tobacco use, and (c) to determine how these factors varied by school type. Ever-use of multiple forms of tobacco (e.g., gutkha, bidis, and cigarettes) was more prevalent among government school students than private school students. After adjusting for city, gender, grade, and age, we found the prevalence rate for ever-use of any tobacco product to be 18.9% for government school students, compared with 12.2% for private school students (p<.01). Students in government schools scored lower than private school students on most psychosocial risk factors for tobacco use studied here, indicating higher risk. Government school students scored the lowest for refusal skills, self-efficacy, and reasons not to use tobacco. Social susceptibility to chewing tobacco and social susceptibility to smoking were strong correlates of current tobacco use among government school students. Exposure to tobacco advertising was also a strong correlate of current tobacco use for government school students but not private school students. In two large cities of India, students attending government schools are using many forms of tobacco at higher rates than private school students. The psychosocial risk profile of government school students suggests they are more vulnerable to initiation and use and to outside influences that encourage use.

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.

Intermediate outcomes from Project MYTRI: mobilizing youth for tobacco-related initiatives in India.

The purpose of this article is to present the intermediate results for Project MYTRI, a school-based, multiple component intervention designed to prevent and reduce many forms of tobacco use (chewing tobacco, cigarettes, and bidis) among youth in India. The intervention is based on effective models in the United States “translated” for use in this context. The intervention targets two cohorts of students who were in the 6th and 8th grade when the study started. Thirty-two schools in Delhi (north India) and Chennai (south India) were randomized to receive the intervention (n = 16) or serve as a delayed intervention control (n = 16). Students in these schools were surveyed before the intervention began and at an intermediate point, 1 year into this 2-year intervention (n = 8,369). A test of the changes in risk factors for tobacco use between the baseline and intermediate surveys revealed that, compared with the control, students in the intervention condition (a) had better knowledge about the health effects of tobacco (P < 0.01); (b) believed that there were more negative social consequences to using tobacco (P = 0.04); (c) had fewer reasons to use tobacco (P < 0.01); (d) had more reasons not to use tobacco (P = 0.03); (e) were less socially susceptible to chewing (P = 0.04) and smoking (P = 0.03) tobacco; (f) perceived fewer peers and adults around them smoked (P < 0.01) or chewed (P < 0.01) tobacco; (g) felt that tobacco use was not acceptable, especially among their peers (P < 0.01); (h) were more confident in their ability to advocate for tobacco control (P = 0.03); (i) were more knowledgeable about tobacco control policies (P < 0.01); and (j) supported these policies, too (P = 0.04). Fewer students in the intervention condition reported having intentions to smoke tobacco in the next year (P = 0.02) or chew tobacco when they reached college (P < 0.01). No changes in actual tobacco use were observed at this stage of the study. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1050–6)

Remission of vulvar pain among women with primary vulvodynia

Objective To determine whether rates of remission differed among women with primary versus secondary vulvodynia. Methods Using a community-based observational study based in Minneapolis/St. Paul, 138 clinically confirmed cases of vulvodynia between 18 and 40 years old were classified as primary (vulvar pain starting at the time of sexual debut or first tampon insertion) or secondary (vulvar pain starting after a period of pain-free intercourse) and queried regarding their pain history to determine whether they had ever experienced any vulvar pain-free time (remission) or pain-free time lasting 3 months or longer. Results Remission prevalence was 26% (9/34) for women in the shortest quartile of duration of vulvar pain (<3.8 y) and 38% (13/34) for the longest quartile of duration (≥13 y). After adjusting for vulvar pain duration, generalized vestibular pain, medical treatment, body mass index, and history of pregnancy, women who had primary vulvodynia were 43% less likely to report remission (95% CI = 0.33–0.99) than women with later onset (secondary cases). The association was strengthened when restricting to only remissions lasting 3 months or longer (adjusted risk ratio = 0.43, 95% CI = 0.22–0.84). Generalized vestibulodynia and obesity also reduced the likelihood of remission. Conclusions Our study underscores the heterogeneity of vulvodynia and provides evidence that primary vulvodynia may have a less wavering course and, as such, a potentially different underlying mechanism than that of secondary vulvodynia.

Risk perception and intention to quit among a tri-ethnic sample of nondaily, light daily, and moderate/heavy daily smokers

INTRODUCTION Although the relationship between risk perceptions and quit intentions has been established, few studies explore the potential impact of smoking level on these associations, and none have done so among diversely-aged samples of multiple ethnicities. METHODS Participants, ranging in age from 25 to 81, were 1133 nondaily smokers (smoked ≥1 cigarette on 4 to 24days in the past 30days), 556 light daily smokers (≤10 cigarettes per day), and 585 moderate to heavy daily smokers (>10 cigarettes per day). Each smoking level comprised approximately equal numbers of African Americans, Latinos, and Whites. A logistic regression analysis, adjusted for sociodemographics, self-rated health, time to the first cigarette of the day and smoking level, was used to examine the association between risk perception (perceived risk of acquiring lung cancer, lung disease, and heart disease) and intention to quit (≤6months versus >6months/never). A second adjusted model tested moderation by smoking level with an interaction term. RESULTS Greater risk perception was associated with a higher odds of planning to quit within 6months (AOR=1.34, CI.95=1.24, 1.45). Smoking level did not moderate this association (p=.85). CONCLUSIONS Results suggest that educating all smokers, irrespective of their smoking level, about increased risk of developing smoking-related diseases might be a helpful strategy to enhance their intention to make a smoking quit attempt.

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.

A Latent Class Analysis of Weight-Related Health Behaviors Among 2- and 4-Year College Students and Associated Risk of Obesity

Little is known about the complex patterning of weight-related health behaviors in 2- and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college students. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health behaviors that represent multiple theoretically/clinically relevant dimensions of obesity risk among 2- versus 4-year college students using cross-sectional statewide surveillance data (N = 17,584). Additionally, differences in class membership on selected sociodemographic characteristics were examined using a model-based approach. Analysis was conducted separately for both college groups, and five and four classes were identified for 2- and 4-year college students, respectively. Four classes were similar across 2- and 4-year college groups and were characterized as “mostly healthy dietary habits, active”; “moderately high screen time, active”; “moderately healthy dietary habits, inactive”; and “moderately high screen time, inactive.” “Moderately healthy dietary habits, high screen time” was the additional class unique to 2-year college students. These classes differed on a number of sociodemographic characteristics, including the proportion in each class who were classified as obese. Implications for prevention scientists and future intervention programs are considered.

Comparison of native light daily smokers and light daily smokers who were former heavy smokers.

INTRODUCTION An increasing proportion of daily smokers are light smokers (≤10 cigarettes per day). Some light smokers have never smoked more than 10 cigarettes per day (native light smokers) and others smoked at higher levels but have cut down (converted light smokers). It is important that we expand our understanding of these distinct subgroups of light smokers in order to develop effective interventions. METHODS Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service. The sample of 522 light smokers included 256 native light smokers and 266 as converted light smokers. The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. RESULTS Multivariable logistic regression results showed 4 variables that differentiated between native and converted light smokers. Native light smokers were more likely to be Black than White, smoke fewer cigarettes per day, smoked fewer total years, and had higher perceived risk of heart disease than converted light smokers. CONCLUSIONS Native and converted light smokers are similar in many ways and also differ on some important characteristics. Further exploration of group difference is needed and could help to inform for cessation strategies for daily light smokers.

Correlates of Converted and Native Nondaily Smoking

OBJECTIVES Nondaily smokers represent a growing proportion of current smokers in the United States. However, little is known about which characteristics are important in distinguishing between nondaily smokers who are former daily smokers (converted nondaily) and nondaily smokers who never smoked daily (native nondaily). This study contrasts converted and native nondaily smokers on demographic, psychosocial, tobacco-related characteristics and quit intentions and behaviors in a tri-ethnic sample (Blacks, Whites, and Latinos) of smokers. METHODS Smokers were recruited for a web-based survey using an online panel survey company. Participants were 1,201 nondaily smokers (904 converted nondaily smokers and 297 native nondaily smokers). A multivariable logistic regression was conducted to assess the associations between demographic, smoking-related, and psychosocial variables with converted versus native nondaily smoking. RESULTS Logistic regression indicated that number of years smoking, years as a nondaily smoker, number of days smoked in a month, smoking dependence, identity as a smoker, and number of smoking cessation methods used were correlates of being converted nondaily smokers versus native nondaily smokers. CONCLUSIONS Clinicians and researchers should consider characteristic variations in nondaily smokers when designing and implementing intervention efforts targeting this smoking population.

Change in Tobacco Use Over Time in Urban Indian Youth The Moderating Role of Socioeconomic Status

This study investigates socioeconomic differences in patterns and trends of tobacco consumption over time among youth in India. Additionally, the distribution of tobacco use risk factors across social class was examined. The data were derived from a longitudinal study of adolescents, Project Mobilizing Youth for Tobacco Related Initiatives. Students in eight private (high socioeconomic status [SES; n = 2,881) and eight government (lower SES; n = 5,476) schools in two large cities in India (Delhi and Chennai) were surveyed annually about their tobacco use and related psychosocial risk factors from 2004 to 2006. Results suggest the relationship between SES and tobacco use over time was not consistent. At baseline (in 2004), lower SES was associated with higher prevalence of tobacco use but the relation between SES and tobacco use reversed 2 years later (2006). These findings were mirrored in the distribution of related psychosocial risk factors by SES at baseline (in 2004), and thereafter in 2006. Implications for prevention scientists and future intervention programs are considered.