Joyce Moon-Howard

The

OBJECTIVES We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase. METHODS Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City. RESULTS A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation. CONCLUSIONS Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.

5 Man: The Underground Economic Response to a Large Cigarette Tax Increase in New York City

It is commonly accepted that adolescence is the period for initiation into smoking and other tobacco use behaviors. However, evidence is increasing that the set of presumptions about adolescent onset of tobacco use may not be true for all cultural or subpopulation groups. Secondary analysis of data from the 2000 National Health Interview Survey (NHIS) was used to examine ethnic differences in smoking patterns among African American and White women. Results showed a striking racial/ethnic difference in age of onset; African American women initiate smoking later than White women at each age group. Prevention interventions need to continue beyond adolescence well into the adult years, especially for African American women. Late onset for these women represents an often missed window of opportunity for prevention.

African American Women and Smoking: Starting Later

BACKGROUND Tissue plasminogen activator (tPA), the only approved treatment for acute ischemic stroke (IS), is significantly underutilized likely due to poor lay information about stroke as an emergency. In order to improve outcomes in acute IS, it is critical to raise awareness and recognition of stroke symptoms particularly among minority populations. This manuscript describes the application of a stroke preparedness behavioral intervention and includes baseline information in a multi-ethnic population of stroke and transient ischemic attack (TIA) survivors. METHODS In the Stroke Warning Information and Faster Treatment Study (SWIFT), we prospectively identified, and randomized IS and TIA patients to determine efficacy of a culturally tailored interactive stroke preparedness strategy. Data collected at baseline included acute stroke parameters, stroke knowledge, severity, social resources and vascular risk assessment. RESULTS Of the 736 enrolled to date, 76% were IS and 24% TIA events. The cohort was 51% female: 45% Hispanic, 26% White and 25% Black. Over 75% reported hypertension, 36% diabetes, and 16% cardiac disease. Mean time from onset to emergency department (ED) arrival was 46h (median 13h) differing significantly between Whites (mean 52h, median 11h) and Blacks (mean 52h, median 17h) versus Hispanics (mean 39h, median 11h). Knowledge that a stroke occurs in the brain differed significantly by between Whites (85%), Blacks (64%), Hispanics (66%, p<0.000). CONCLUSIONS Disparities remain in both action and knowledge surrounding acute stroke. Use of written information has not proven an effective means of changing health behaviors. We propose an interactive culturally tailored intervention to address behavioral change in acute stroke.

A stroke preparedness RCT in a multi-ethnic cohort: Design and methods

Use of electronic cigarettes (e-cigarettes) has increased significantly in the past 2 years1 ,2 and sales are estimated to reach

Electronic cigarette advertising at the point-of-sale: a gap in tobacco control research

10 billion by 2017.3 All of the major tobacco companies have recently introduced their own e-cigarette and e-cigar brands into the tobacco marketplace or have plans to do so in the near future.4–9 News reports suggest that tobacco and e-cigarette companies have begun to significantly expand e-cigarette product distribution in retail channels in the past year.10 ,11 Many e-cigarette manufacturers, such as V2 Cigs, are expanding their products into the global market, selling them in Europe, India, Africa and the Middle East.12 While tobacco control stakeholders are learning more about how e-cigarettes are used and promoted, there is very little published research to date on the advertising and promotion of e-cigarettes in the retail environment.13 A pilot study was conducted from February to July 2013 to examine tobacco point-of-sale advertising and promotion …

A Cluster-Based Randomized Controlled Trial Promoting Community Participation in Arsenic Mitigation Efforts in Bangladesh

ObjectiveTo reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks.MethodsWe conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks.ResultsOverall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50 μg/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source . Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased.ConclusionThe overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.

Computer Use, Internet Access, and Online Health Searching among Harlem Adults:

Purpose. Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion. Design. Cross-sectional random digit dial landline phone survey. Setting. Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City. Subjects. Adults 18 years and older (N = 646). Measures. Demographic characteristics, computer use, Internet access, and online searching for health information. Analysis. Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods. Results. Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p < .01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%). Conclusions. Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups. (Am J Health Promot 2011;25[5]:325-333.)

Religious responses to HIV and AIDS: understanding the role of religious cultures and institutions in confronting the epidemic.

Since the very beginning of the HIV epidemic, few social institutions have been as important as religion in shaping the ways in which individuals, communities and societies have responded to HIV and AIDS. In societies around the world, what are sometimes described as religious belief systems or religious cultures have been fundamental to the interpretation of AIDS to the ways in which a newly emerging infectious disease was incorporated into existing understandings of the world. Over the course of more than three decades now, religious meaning systems have mediated the attitudes and policies related to the epidemic and public health programmes, and religious organisations have been central to the response to HIV and AIDS in countries and cultures around the world (Lagarde et al. 2000, Agadjanian 2005, Global Health Council 2005, McGirk 2008, Garcia et al. 2009, Akintola 2010, Murray et al. 2011, Trinitapoli 2011). This impact has been profoundly complex and often contradictory. At the same time, religious organisations play a key role globally in providing front-line access to primary and terminal care, advocating for health and social welfare resources and influencing public health and social policies (Sanders 1997, Chatter 2000, DeHaven et al. 2004, Pargament et al. 2004). This has been especially visible in relation to the global HIV epidemic, and has expanded significantly over the past decade as part of the global scale-up of HIV programmes (Shelp and Sunderland 1992, Global Health Council 2005). Agencies such as the World Health Organisation, Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) programme have all called for increased involvement of and partnerships with community-based organisations (CBOs) and faith-based organisations (FBOs) as part of the expanded global response to AIDS (Global Health Council 2005, United Nations Population Fund [UNFPA] 2008a, 2008b, UNAIDS 2009). With the assistance of international donor agencies, millions of dollars are now spent annually to support interventions by religious institutions and FBOs for HIV prevention and treatment in the developing world, and the WHO estimates that at least one in five organisations involved in HIV/AIDS programming is now faith-based (WHO 2004, Agadjanian 2005, Global Health Council 2005, Agadjanian and Sen 2007, Akintola 2010). However, concerns have been raised that

Smoking Cessation Advantage Among Adult Initiators: Does It Apply to Black Women?

INTRODUCTION Smokers who initiate as adults are more likely to quit than those who initiate as adolescents. Black women are more likely than White women to initiate smoking in adulthood and are less likely to quit. There is a paucity of research examining whether the smoking cessation advantage among adult initiators applies to Black women. The study objective is to examine race differences in the effect of developmental stage of smoking initiation on number of years until cessation among Black and White women. METHODS Data were extracted from the National Longitudinal Survey of Young Women, a national cohort of women between the ages of 49 and 61 years in 2003. The analytic sample comprised 1,008 White women and 271 Black women with a history of smoking. Survival analysis procedures were utilized to address the study objective. RESULTS Racial disparities in smoking cessation were most evident among women who initiated smoking as adults. White young adult initiators had a 31% increased hazard of smoking cessation advantage (adjusted hazards ratio [HR]: 1.31, 95% CI: 1.04-1.65) over adolescent initiators, whereas Black young adult initiators had no smoking cessation advantage (adjusted HR: 0.85, CI: 95% 0.55-1.30) over adolescent initiators. CONCLUSIONS Prior observations that smoking initiation in adulthood is associated with high rates of cessation do not apply to black women. To contribute to the reduction of disparities in womens cessation efforts to prevent initiation should target young adult women, particularly Black young adult women.

Translating public health knowledge into practice: Development of a lay health advisor perinatal tobacco cessation program

The value of lay health advisor (LHA) interventions as an effective approach toward ameliorating racial, ethnic and/socioeconomic health disparities has been noted by researchers and policy makers. Translating scientific knowledge to bring state-of-the-art health promotion/disease prevention innovation to underserved populations is critical for addressing these health disparities. This article examines the experiences of a community-academic partnership in designing, developing, and implementing an evidence-based, LHA-driven perinatal tobacco cessation program for low-income, predominately African American and Hispanic women. A multimethod process evaluation was conducted to analyze three essential domains of program implementation: (1) fit of the tobacco cessation program into the broader project context, (2) feasibility of program implementation, and (3) fidelity to program implementation protocols. Findings indicate that project partners have largely succeeded in integrating an evidence-based tobacco cessation program into a community-based maternal and infant health project. The successful implementation of this intervention appears to be attributable to the following two predominant factors: (1) the utilization of a scientifically validated tobacco cessation intervention model and (2) the emphasis on continuous LHA training and capacity development.