Elizabeth M. Barbeau

Working Class Matters: Socioeconomic Disadvantage, Race/Ethnicity, Gender, and Smoking in NHIS 2000

OBJECTIVES We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures. METHODS We analyzed data from the 2000 National Health Interview Survey. RESULTS Overall, the prevalence of current smoking was greatest among persons in--and independently associated with--working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was greatest among those with the most socioeconomic resources. These patterns held in most but not all race/ethnicity-gender groups. Finer resolution of smoking patterns was obtained using a relational UK occupational measure, compared to the skill-based measure commonly used in US studies. CONCLUSIONS Reducing social disparities in smoking requires attention to the complexities of class along with race/ethnicity and gender.

Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations

BACKGROUND This article proposes a conceptual framework for addressing social contextual factors in cancer prevention interventions, and describes work that operationalizes this model in interventions for working class, multiethnic populations. METHODS The Harvard Cancer Prevention Program Project Includes Three Studies: (1) an intervention study in 25 small businesses; (2) an intervention study in 10 health centers; and (3) a computer simulation modeling project that translates risk factor modifications into gains in life expectancy and number of cancers averted. The conceptual framework guiding this work articulates pathways by which social context may influence health behaviors, and is used to frame the interventions and guide evaluation design. RESULTS Social contextual factors cut across multiple levels of influence, and include individual factors (e.g., material circumstances, psychosocial factors), interpersonal factors (e.g., social ties, roles/responsibilities, social norms), organizational factors (e.g., work organization, access to health care), and neighborhood/community factors (e.g., safety, access to grocery stores). Social context is shaped by sociodemographic characteristics (e.g., social class, race/ethnicity, gender, age, language) that impact day-to-day realities. CONCLUSIONS By illuminating the pathways by which social contextual factors influence health behaviors, it will be possible to enhance the effectiveness of interventions aimed at reducing social inequalities in risk behaviors.

Unfair Treatment, Racial/Ethnic Discrimination, Ethnic Identification, and Smoking Among Asian Americans in the National Latino and Asian American Study

OBJECTIVES We examined the relations of self-report of general unfair treatment and self-report of race/ethnicity-specific discrimination with current smoking among Asian Americans. We investigated whether ethnic identification moderated either association. METHODS Weighted logistic regressions were performed among 1977 Asian Americans recruited to the National Latino and Asian American Study (2002-2003). RESULTS In weighted multivariate logistic regression models including both general unfair treatment and racial/ethnic discrimination, odds of current smoking were higher among Asian Americans who reported high levels of unfair treatment (odds ratio [OR]=2.80; 95% confidence interval [CI]=1.13, 6.95) and high levels of racial/ethnic discrimination (OR=2.40; 95% CI=0.94, 6.12) compared with those who reported no unfair treatment and discrimination, respectively. High levels of ethnic identification moderated racial/ethnic discrimination (F(3) =3.25; P =.03). High levels of ethnic identification were associated with lower probability of current smoking among participants reporting high levels of racial/ethnic discrimination. CONCLUSIONS Our findings suggest that experiences of unfair treatment and racial/ethnic discrimination are risk factors for smoking among Asian Americans. Efforts to promote ethnic identification may be effective in mitigating the influence of racial/ethnic discrimination on smoking in this population.

Effects of individual and proximate educational context on intimate partner violence: A population-based study of women in India.

OBJECTIVES We examined the role of womens education and proximate educational context on intimate partner violence (IPV). METHODS We examined a sample of 83627 married women aged 15 to 49 years from the 1998 to 1999 Indian National Family Health Survey. We used multilevel multiple logistic regression modeling to estimate the relative effect of womens and their husbands levels of education, spousal education differential, and community-level literacy on womens risk of recent and lifetime IPV. RESULTS In adjusted models, odds of recent IPV among women without any education were 5.61 times (95% confidence interval [CI] = 3.53, 8.92) those of college-educated women, and odds among wives of uneducated men were 1.84 times (95% CI=1.44, 2.35) those of wives of college-educated men. Women with more education than their husbands were more likely than those with educational parity to report recent IPV (odds ratio [OR]=1.18; 95% CI=1.05, 1.33). The results were similar for lifetime IPV. After we controlled for individual factors, as community male and female literacy levels increased, likelihood of IPV declined. CONCLUSIONS Although increasing womens levels of education is crucial to reducing IPV for women, proximate educational context is also an important factor in reducing this public health burden.

Promoting Behavior Change Among Working-Class, Multiethnic Workers: Results of the Healthy Directions—Small Business Study

OBJECTIVES We examined the efficacy of a cancer prevention intervention designed to improve health behaviors among working-class, multiethnic populations employed in small manufacturing businesses. METHODS Worksites were randomly assigned to an intervention or minimal-intervention control condition. The intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin use, and physical activity. RESULTS Employees in the intervention group showed greater improvements for every outcome compared with employees in the control group. Differences in improvement were statistically significant for multivitamin use and physical activity. Intervention effects were larger among workers than among managers for fruit and vegetable consumption and for physical activity. CONCLUSIONS The social-context model holds promise for reducing disparities in health behaviors. Further research is needed to improve the effectiveness of the intervention.

The Influence of Social Context on Changes in Fruit and Vegetable Consumption: Results of the Healthy Directions Studies

As part of the Harvard Cancer Prevention Program Project, we used a social contextual model of health behavior change to test an intervention targeting multiple risk-related behaviors in working-class, multiethnic populations. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in health centers and small business studies. We analyzed change in fruit and vegetable consumption, measured at baseline and final assessments by self-report, in 2 randomized controlled prevention trials: 1 in small businesses (n = 974) and 1 in health centers (n = 1954). Stronger social networks, social norms that were more supportive, food sufficiency, and less household crowding were associated with greater change in fruit and vegetable intake. We also observed differences between our intervention sites. Social context can play an important role in promoting changes in fruit and vegetable consumption.

Smoking, social class, and gender: what can public health learn from the tobacco industry about disparities in smoking?

Objective: To discover how the tobacco industry considers social class and gender in its efforts to market cigarettes in the USA, particularly to socially disadvantaged young women. Methods: A systematic on-line search of tobacco industry documents using selected keywords was conducted, and epidemiological data on smoking rates reviewed. Results: The two largest cigarette manufacturers in the USA consider “working class” young adults to be a critical market segment to promote growth of key brands. Through their own market research, these companies discovered that socially disadvantaged young women do not necessarily desire a “feminine” cigarette brand. Conclusions: Considering the tobacco industry’s efforts, alongside the persistent and growing disparities in cigarette smoking by social class, and the narrowing of differences in smoking by gender, it is concluded that additional tobacco control resources ought to be directed toward working class women.

R.J. Reynolds’ Targeting of African Americans: 1988–2000

OBJECTIVES The purpose of this study was to describe RJ Reynolds (RJR) Tobacco Companys strategy for targeting African Americans, as revealed in tobacco industry documents and magazine advertisements. METHODS The authors searched industry documents to determine RJRs strategies and analyzed magazine advertising during 2 periods: the time of the launch of the companys Uptown cigarette (1989-1990) and a decade later (1999-2000). RESULTS RJRs efforts to target the African American market segment existed before and after Uptown, and the companys strategy was largely implemented via other RJR brands. Advertisements featured mentholated cigarettes, fantasy/escape, expensive objects, and nightlife. CONCLUSIONS To help all populations become tobacco-free, tobacco control practitioners must understand and counter tobacco industry strategies.

Alcohol disorders among Asian Americans: associations with unfair treatment, racial/ethnic discrimination, and ethnic identification (the national Latino and Asian Americans study, 2002–2003)

Study objective: To examine history of alcohol abuse/dependence disorder in relation to unfair treatment, racial/ethnic discrimination, and ethnic identification among Asian Americans. Design: Weighted multivariate analyses of cross-sectional national survey data predicting lifetime history of alcohol abuse/dependence disorders. Setting: USA, Asian Americans. Participants: 2007 Asian American adults recruited to the National Latino and Asian American Study (NLAAS; 2002–2003). Results: Controlling for sociodemographic characteristics, Asian Americans who reported experiencing unfair treatment had higher odds of history of alcohol abuse/dependence disorder (OR 5.26, 95% CI 1.90 to 14.56). Participants who reported high levels of ethnic identification had lower odds of history of alcohol abuse/dependence disorders (OR 0.46, 95% CI 0.23 to 0.90). Ethnic identification moderated the influence of racial/ethnic discrimination (p  =  0.097). Among participants with low levels of ethnic identification, racial/ethnic discrimination was associated with greater odds of having a history of alcohol disorder compared with those with high levels of ethnic identification. Conclusions: Social hazards such as unfair treatment and racial/ethnic discrimination should be considered in the development of programmes addressing alcohol disorders among Asian Americans. Interventions that promote ethnic identification in this population may be particularly relevant in mitigating the negative influence of racial/ethnic discrimination on alcohol disorders.

Tobacco industry documents: comparing the Minnesota Depository and internet access

Objective: To assess the comparability of searches conducted on two publicly available tobacco industry document collections: hard copies housed and maintained by a neutral party in the Minnesota Depository and electronic copies available through tobacco industry maintained websites. Methods: We conducted a set of searches in Minnesota and then conducted the same searches using the industry websites. We matched documents by Bates number, weeded out duplicates, and coded documents that were unique to either collection as major, minor, or trivial. Results: Among hundreds of documents produced by several searches, we found only four unique major documents in the Minnesota Depository. By contrast, we found 62 unique major documents using the websites. Conclusion: These results suggest that researchers can rely on industry websites while waiting for improved access resulting from searching, indexing, and document storage administered by the tobacco control community. Searching the tobacco industry websites is at least as good as searching in Minnesota and may in some instances actually be better. Four smaller subcollections, however, can only be searched by hand in Minnesota.