Daniel A. Gundersen

Exploring the relationship between race/ethnicity, menthol smoking, and cessation, in a nationally representative sample of adults.

OBJECTIVE To explore the relationship between race/ethnicity, menthol smoking, and cessation in a nationally representative sample of adults. METHODS Data from the 2005 U.S. National Health Interview Survey was analyzed. Our analyses were restricted to 7815 white, black, and Hispanic current and former cigarette smokers who indicated that they do not currently use other tobacco products and have made a quit attempt. We used multiple logistic regressions to test the relationship of menthol smoking and cessation controlling for various factors. RESULTS Significant interaction effects were found indicating that the association between menthol smoking and cessation differs between whites and blacks, and whites and Hispanics. When blacks and Hispanics are collapsed as non-white, we found that non-white menthol smokers were significantly less likely to have quit smoking (adjusted odds ratio=0.55, p<0.01) compared to their non-menthol smoking counterparts. In contrast, among whites, menthol smokers were more likely to be former smokers than nonmenthol smokers (adjusted odds ratio=1.17, p<0.05). CONCLUSION Our findings provide some support for the hypothesis that menthol smoking can lead to poorer cessation outcomes, but only for non-white smokers.

Smoking-Cessation Prevalence Among U.S. Smokers of Menthol Versus Non-Menthol Cigarettes

BACKGROUND The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. PURPOSE To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. METHODS Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. RESULTS In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. CONCLUSIONS Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.

Assessing the Feasibility and Sample Quality of a National Random-digit Dialing Cellular Phone Survey of Young Adults

The majority of adults aged 18-34 years have only cellular phones, making random-digit dialing of landline telephones an obsolete methodology for surveillance of this population. However, 95% of this group has cellular phones. This article reports on the 2011 National Young Adult Health Survey (NYAHS), a pilot study conducted in the 50 US states and Washington, DC, that used random-digit dialing of cellular phones and benchmarked this methodology against that of the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Comparisons of the demographic distributions of subjects in the NYAHS and BRFSS (aged 18-34 years) with US Census data revealed adequate reach for all demographic subgroups. After adjustment for design factors, the mean absolute deviations across demographic groups were 3 percentage points for the NYAHS and 2.8 percentage points for the BRFSS, nationally, and were comparable for each census region. Two-sided z tests comparing cigarette smoking prevalence revealed no significant differences between NYAHS and BRFSS participants overall or by subgroups. The design effects of the sampling weight were 2.09 for the NYAHS and 3.26 for the BRFSS. Response rates for the NYAHS and BRFSS cellular phone sampling frames were comparable. Our assessment of the NYAHS methodology found that random-digit dialing of cellular phones is a feasible methodology for surveillance of young adults.

Social norms and its correlates as a pathway to smoking among young Latino adults

Socially and culturally embedded norms regarding smoking may be one pathway by which individuals adopt smoking behaviors. However, few studies have examined if social norms operate in young adults, a population at high risk of becoming regular smokers. There is also little research examining correlates of social norms in populations with a large immigrant segment, where social norms are likely to differ from the receiving country and could contribute to a better understanding of previously reported acculturation-health associations. Using data from a nationally representative sample of young adults in the United States reached via a novel cell-phone sampling design, we explored the relationships between acculturation proxies (nativity, language spoken and generational status), socioeconomic position (SEP), smoking social norms and current smoking status among Latinos 18-34 years of age (n = 873). Specifically, we examined if a measure of injunctive norms assessed by asking participants about the acceptability of smoking among Latino co-ethnic peers was associated with acculturation proxies and SEP. Results showed a strong gradient in smoking social norms by acculturation proxies, with significantly less acceptance of smoking reported among the foreign-born and increasing acceptance among those speaking only/mostly English at home and third-generation individuals. No consistent and significant pattern in smoking social norms was observed by education, income or employment status, possibly due to the age of the study population. Lastly, those who reported that their Latino peers do not find smoking acceptable were significantly less likely to be current smokers compared to those who said their Latino peers were ambivalent about smoking (do not care either way) in crude models, and in models that adjusted for age, sex, generational status, language spoken, and SEP. This study provides new evidence regarding the role of social norms in shaping smoking behaviors among Latino young adults and suggests distinct influences of acculturation proxies and socioeconomic condition on smoking social norms in this population.

The influence of menthol, e-cigarettes and other tobacco products on young adults’ self-reported changes in past year smoking

Objective Progression to regular smoking often occurs during young adulthood. This study examines self-reported changes in past year smoking among young adults and the potential influence of tobacco products on these trajectories. Methods Respondents to the 2011 National Young Adult Health Survey who smoked 100 cigarettes in their lifetime (n=909) described smoking behaviour at the time of the survey and 1 year prior. Cigarette smoking trajectories were categorised as: no change, quit, decreased smoking or increased smoking. Participants were also asked about current use of menthol cigarettes and other tobacco products (ie, cigars, smokeless tobacco, hookah) and ever use of e-cigarettes. Results Most young adults (73.1%) reported stable cigarette smoking behaviours, while 8.2% reported having quit, 5.8% reported that they smoke on fewer days, 5% progressed from someday to daily smoking and 8% increased from not at all to current smoking. The youngest smokers (18–20) had significantly higher odds (adjusted OR (AOR) =2.6) of increasing cigarette use over the past year compared to those aged 30–34, as did blacks versus whites (AOR=2.35). Menthol cigarette use nearly doubled (AOR=1.87) the odds of increased smoking behaviour. E-cigarette and other tobacco product (OTP) use were not associated with increasing smoking but OTP use was negatively associated with remaining quit from cigarettes. Conclusions Young adulthood is a critical period for smoking interventions, particularly among those most vulnerable to increasing smoking behaviours (ie, black and younger young adults). Policy efforts to restrict menthol cigarettes may reduce young adult smoking progression.

Heterogeneity in Past Year Cigarette Smoking Quit Attempts among Latinos

Objective. Examine the association between English language proficiency (ELP) and immigrant generation and having made a cigarette smoking quit attempt in the past 12 months among Latinos. Examine if gender moderates the association between acculturation and quit attempts. Methods. Latino past year smokers from the 2003 and 2006/07 Tobacco Use Supplement to the Current Population Survey were analyzed. Logistic regression was used to examine the association between quit attempt and ELP and immigrant generation, controlling for demographics and smoking characteristics. Results. Latinos with poor ELP were more likely to have made a quit attempt compared to those with good ELP (adjusted odds ratio [AOR] = 1.22, confidence interval [CI]: 1.02–1.46) after controlling for demographic and smoking characteristics. First (AOR = 1.21, CI: 1.02–1.43) and second generation immigrants (AOR = 1.36, CI: 1.12–1.64) were more likely than third generation immigrants to have made a quit attempt in the past 12 months. Conclusion. Quit behaviors are shaped by differences in language ability and generational status among Latinos. This underscores the need to disaggregate Latinos beyond racial/ethnic categories to identify subgroup differences relevant for smoking and smoking cessation behaviors in this population.

Estimates of cigarette smoking from the NJ Adult Tobacco Survey: real or spurious?

OBJECTIVE To explore, post hoc, whether a large decline in smoking estimates between the 2005 and 2006 New Jersey Adult Tobacco Surveys is real or spurious given various methodological and environmental changes between the 2 time periods of data collection. METHODS Using multiple data sources, we explored survey timing, poststratification approach, midinterview terminations, wireless substitution, and question order. RESULTS Changes in question order were likely responsible for the majority of the unexpected decline in smoking prevalence; to a lesser degree, wireless substitution and midinterview terminations also likely contributed to an artificially exaggerated decline. CONCLUSION Methodological changes can artificially affect trends in prevalence estimates.

Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships.

The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships.

Stability of Sample Quality for a National Random-Digit Dialing Cellular Phone Survey of Young Adults

During the 2000s, rapid adoption of cellular phones and foregoing of landline telephones (i.e., wireless substitution) were observed (1–3). This affected behavioral surveillance by creating a staggering decrease in coverage for surveys that relied on random-digit dialing (RDD) sampling, resulting in biased health estimates (1–5). During this time, innovative sampling approaches that integrated both landlines and cellular phones were developed (6). Recently, some have suggested that the rate of wireless substitution has reached the point at which it is no longer necessary to sample landlines (7, 8). Indeed, the 2011 National Young Adult Health Survey (NYAHS), a national cellular phone–only RDD survey, demonstrated equal sample quality and some efficiency relative to the Behavioral Risk Factor Surveillance System, which samples both landlines and cellular phones (7). Emergent communication technologies continue to be rapidly adopted. There has been a dramatic increase in smart-phone use, particularly among males, younger adults, and minorities (9). These devices have communication abilities beyond those of traditional cellular phones that provide users alternative ways to communicate instantly (e.g., chat functions, social media), and these functions have been adopted rapidly in recent years (10). In the context of telephone survey methodology, perhaps the most worrisome development is technologies to verbally communicate via smartphone applications without using a telephone number. Young adults, men, and Latinos are most likely to use such features (10). Cellular phones are now used less as “traditional” telephones and more as broad communication and media devices. Although the impact of this technological advance on RDD sampling of cellular phones is not known, it may affect cellular phone surveys in a manner similar to that in which wireless substitution affected landline surveys. As such, we seek to answer 2 questions. 1) Is the use of cellular phone RDD a stable method of sampling? 2) Has the sample representativeness changed (i.e., deteriorated or improved) for population subgroups?

Complementary and alternative medicine treatments for atopic eczema (Protocol)

The objectives are as follows: To assess the effects of complementary and alternative medicine treatments for atopic eczema.