Julie E. Maher

Smoking-related knowledge, attitudes and behaviors in the lesbian, gay and bisexual community: A population-based study from the U.S. Pacific Northwest ☆

OBJECTIVE Several studies have shown that lesbian, gay and bisexual (LGB) persons have higher smoking prevalence than heterosexuals. However, few population-based studies have explored whether smoking-related knowledge, attitudes and behaviors also differ between the communities. METHODS We used Behavioral Risk Factor Surveillance System data for 2003 to 2005 from two states (Washington and Oregon) to compare smoking-related indicators between the self-identified LGB population and their heterosexual counterparts. RESULTS Lesbians, gays and bisexuals were more likely to be current or ever smokers than their heterosexual counterparts. All except bisexual men and had lower quit ratios than heterosexuals. Among successful quitters, bisexual men were less likely to be long-term quitters than heterosexuals. For all groups, attitudes and behaviors regarding secondhand smoke (SHS) were similar to those of heterosexuals, except for bisexual women, who were more likely to be exposed to SHS. CONCLUSIONS Despite a disparity in smoking prevalence, the LGB population in these two states appeared to have similar levels of knowledge and attitudes toward tobacco control as their heterosexual counterparts. Nevertheless, tobacco control programs should continue to focus on this population to prevent smoking initiation, promote cessation, and reduce secondhand smoke exposure.

Implementation of a Smoke-free Policy in Subsidized Multiunit Housing: Effects on Smoking Cessation and Secondhand Smoke Exposure

INTRODUCTION We studied the impact of implementing a comprehensive smoke-free policy in multiunit housing in the Portland, Oregon metropolitan area. Among low-income tenants living in a subset of subsidized multiunit buildings, we evaluated cessation-related behaviors, policy knowledge and compliance, and secondhand smoke (SHS) exposure. METHODS We mailed a self-administered questionnaire to a random sample of 839 current tenants of 17 subsidized buildings 4 months after policy implementation in January 2008 and sent another questionnaire to participants 1 year later. Results are based on 440 tenants who completed both surveys. RESULTS We observed a self-reported annualized quit rate of 14.7% over the study period (95% CI = 7.9%-21.6%) compared with a historical quit rate in this population of 2.6% (95% CI = 0.6%-4.5%). Almost half of ongoing smokers reduced their cigarette consumption. More smokers correctly reported policy rules for indoor settings than for outdoor settings; self-reported indoor smoking decreased significantly from 59% to 17%. Among nonsmokers, frequent indoor SHS exposure (multiple times per week) decreased significantly from 41% prepolicy to 17% postpolicy. CONCLUSIONS The implementation of a smoke-free policy was associated with positive changes in cessation-related behaviors and reduced SHS exposure in this population of low-income adults.

Is a statewide tobacco quitline an appropriate service for specific populations

Objective: To assess whether smoking quit rates and satisfaction with the Washington State tobacco quitline (QL) services varied by race/ethnicity, socioeconomic status, area of residence (that is, urban versus non-urban), or sex of Washington QL callers. Methods: From October 2004 into October 2005, we conducted telephone surveys of Washington QL callers about three months after their initial call to the QL. Analyses compared 7-day quit rates and satisfaction measures by race/ethnicity, education level, area of residence and sex (using α = 0.05). Results: We surveyed half (n = 1312) of the 2638 adult smokers we attempted to contact. The 7-day quit rate among survey participants at the 3-month follow-up was 31% (CI: 27.1% to 34.2%), 92% (CI: 89.9% to 94.1%) were somewhat/very satisfied overall with the QL programme, 97% (CI: 95.5% to 98.2%) indicated that they would probably/for sure suggest the QL to others and 95% (CI: 92.9% to 96.4%) were somewhat/very satisfied with the QL specialist. Quit rate did not vary significantly by race/ethnicity, education level, area of residence or sex. Satisfaction levels were high across subpopulations. Almost all participants (99%) agreed that they were always treated respectfully during interactions with QL staff. Conclusions: The Washington QL appeared effective and well received by callers from the specific populations studied. States choosing to promote their QL more aggressively should feel confident that a tobacco QL can be an effective and well received cessation service for smokers who call from a broad range of communities.

The Impact of Clean Indoor Air Exemptions and Preemption Policies on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers

OBJECTIVES We studied the impact of clean indoor air law exemptions and preemption policies on the prevalence of a tobacco-specific lung carcinogen-4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)--among nonsmoking bar and restaurant workers. METHODS secondhand smoke were compared with results from participants who were exposed to it. RESULTS Participants exposed to workplace secondhand smoke were more likely to have any detectable level of NNAL (P=.005) and higher mean levels of NNAL (P < .001) compared with nonexposed participants. Increased levels of NNAL were also associated with hours of a single workplace exposure (P=.005). CONCLUSIONS Nonsmoking employees left unprotected from workplace secondhand smoke exposure had elevated levels of a tobacco-specific carcinogen in their bodies. All workers--including bar and restaurant workers--should be protected from indoor workplace exposure to cancer-causing secondhand smoke.

Are Latinos Really Less Likely to be Smokers? Lessons from Oregon

Our objective was to identify factors associated with current cigarette smoking among Latino adults in Oregon. We used data from 1,356 Latino participants and, for comparison, 18,593 non-Latino White participants in the 2000-2002 Oregon Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a random-digit-dialed, cross-sectional survey of noninstitutionalized, English- or Spanish-speaking adults who live in Oregon households with a telephone. We examined relationships between current smoking and gender, age, education, and survey language (a measure of acculturation) among Latinos and used the .05 level of significance. The prevalence of current smoking was significantly lower among Latinos (18.1%) than non-Latino Whites (20.8%). Latino men were significantly more likely than Latina women to be smokers (23.1% vs. 11.4%), and some evidence indicated that less education was associated with smoking among Latino men. Taking the survey in English was strongly and significantly associated with smoking among Latina women: Smoking prevalence was 20.5% among those taking the survey in English and 3.3% for those taking it in Spanish. Our results suggest that the lower smoking prevalence among Latinos was driven by Latina women taking the survey in Spanish. Hence, it is essential for tobacco control programs to examine their local Latino smoking prevalence by gender and acculturation to avoid incorrectly concluding that Latinos are at decreased risk. Although programs for Latinos should reinforce protective aspects of Latino culture, decreasing the smoking prevalence in the U.S. mainstream culture might mitigate the negative impact of acculturation on smoking behaviors.

Who continues using the diaphragm and who doesn't: implications for the acceptability of female-controlled HIV prevention methods

OBJECTIVES This study examines the acceptability of the diaphragm with the aim of facilitating the development of female-controlled human immunodeficiency virus (HIV) prevention methods. More specifically, we assess associations between being a current (vs. former) diaphragm user and characteristics that are hypothesized to influence the acceptability of contraceptive methods; and explore reasons for discontinuing use of the diaphragm among former diaphragm users. DESIGN The study involved a cross-sectional telephone survey with women who were members of a nonprofit health maintenance organization and who were either a current (n = 215) or former (n = 172) diaphragm user. METHODS Participants were interviewed about the importance of contraceptive attributes; perceptions for the diaphragm; diaphragm use self-efficacy; perceived risk of and motivation to avoid pregnancy, HIV, and other sexually transmitted infections; and demographic characteristics, sexual, and contraceptive behavior. RESULTS The likelihood of being a current diaphragm user (vs. former) increased with age, greater confidence in being able to use the diaphragm, greater perceived risk of pregnancy and more positive perceptions of the diaphragm. Women who valued attributes of hormonal contraceptives were less likely to be current users. Former diaphragm users reported that the following reasons were moderately to extremely important in their decision to stop using the diaphragm: difficulty inserting or removing the diaphragm (50.8%), dislike of leaving the diaphragm inside the vagina (46.8%), and wanting a more effective method for preventing pregnancy (44.2%). CONCLUSIONS The findings suggest that specific characteristics of a product influence continued use and have implications for improving the acceptability of existing and new female-controlled HIV prevention methods.

USING TEXT MESSAGING TO CONTACT DIFFICULT-TO-REACH STUDY PARTICIPANTS

Kharbanda et al.1 recently discussed the potential use of text messaging for immunization reminders. In addition to investigating how text messaging could improve this and other health-related outcomes,2 we recommend researchers consider using it for contacting study participants expected to be difficult to reach. In our study “Safe Point,” we pilot-tested a program that trained secondary exchangers—methamphetamine injectors who frequent our syringe exchange program and regularly provide syringes to others—to be peer educators who delivered HIV risk reduction messages to methamphetamine-injecting recipients who do not regularly attend syringe exchange programs. Our evaluation involved baseline and 3-month follow-up interviews with recipients identified by secondary exchangers. Forty-eight (75%) of 64 recipients who were eligible completed a baseline interview. All of these participants reported having injected methamphetamine within the past 60 days. Their drug use and other characteristics suggested that they would be difficult to reach (Table 1). TABLE 1 Characteristics of Methamphetamine Injectors (n = 48) Who Completed a Baseline Interview, Overall and by Text Message Preference: Safe Point Study, Portland, OR, 2008–2009 Text messaging was an important way to reach enrolled participants during the study. Thirty-five (73%) indicated text messaging was a way to reach them—these participants appeared similar to the others (Table 1). Generally, study staff first tried to reach participants by calling them, and then tried text messaging, if possible. Staff attempted to reach 15 (31%) of the 48 enrolled participants by text messaging, and 8 of them (53%) responded to the text. Text messaging was the only way for staff to contact 3 participants at at least 1 point during the study. Overall, 43 (90%) of the 48 enrolled participants completed 3-month follow-up interviews. Five were not interviewed at follow-up: 3 were incarcerated, we had safety concerns in regard to 1 participant, and we were unable to reach the fifth participant. Based on staff reports, participants who were reached by text messaging found it acceptable. Indeed, some seemed to prefer it, possibly because text messaging requires less of a time commitment, can be more private when others are present, and can feel less personal. Text messages also seemed easier to retrieve than did voice mail, and participants who responded to text messages did so within a day but often responded to phone messages less quickly. Last, study staff kept text messages sent to participants generic to maintain confidentiality (e.g., “Please contact Susie at [phone number]”), and participants did not report confidentiality concerns. Text messaging was an acceptable means of communication for study participants and much cheaper than in-person field visits to participants. Given our success with text messaging and its extensive use,3 we recommend other studies consider using it as part of their comprehensive tracking protocol4 for contacting populations expected to be difficult to reach.

Effectiveness of a tobacco quitline in an indigenous population: a comparison between Alaska Native people and other first-time quitline callers who set a quit date

Abstract Objectives. To conduct a descriptive, comparative study of the acceptability and effectiveness of a tobacco cessation quitline (QL) among Alaska Native people and non-Alaska Native people. Study design. From January 2006 to January 2007, we conducted telephone surveys of first-time Alaska QL callers who set a quit date. We attempted to reach them by phone about 3 months after their call to the QL. Methods. Analyses compared 7-day point prevalence quit rates, satisfaction measures, experiences and general perceptions of QLs by Alaska Native and non-Alaska Native callers. Results. We surveyed 39.8% (n=772) of the 1,941 adult tobacco users we attempted to contact. The 7-day point prevalence quit rate among Alaska Native survey participants at the 3-month follow-up was 22.2% (CI: 14.8% –32.0%), compared to 40.7% (CI: 36.7% –44.9%) for non-Alaska Native survey participants. Eighty-three percent (CI: 74.6% –89.3%) were somewhat/very satisfied overall with the QL program compared to 90.3% (CI: 87.6% –92.4%) for non-Alaska Native participants. Conclusions. Although the QL was less effective for Alaska Native callers than other QL callers, Alaska Native peoples’ quit rates and satisfaction were still quite good. Despite this, more effort should be made to address specific Alaska Native values and social and cultural barriers to quitting tobacco.

Acceptability of the Vaginal Diaphragm Among Current Users

CONTEXT Interest in the diaphragm has been growing, in part because it is a female-controlled method that might protect against HIV and other sexually transmitted diseases (STDs). A better understanding of diaphragm acceptability is needed. METHODS In 2001-2002, female members of a managed care organization were interviewed by telephone. The 215 participants, aged 19-49, who reported diaphragm use during the past three months were asked about their experience with the method and background characteristics. Characteristics associated with womens satisfaction with and consistent use of the diaphragm were identified through multiple logistic regression analysis. RESULTS Most participants had a low risk for HIV and other STDs. The mean duration of diaphragm use was 8.5 years. Although only 42% of participants reported consistent use in the past three months, most were satisfied with the method (79%) and planned to use it at next vaginal intercourse (85%). Satisfied users had significantly higher diaphragm use self-efficacy and more positive perceptions of the method than those not satisfied. Consistent use was significantly associated with older age and having had some college education rather than none. More than half of women cited dissatisfaction with previous methods (72%) and provider recommendation (61%) as moderately to extremely important in their decision to begin diaphragm use. When asked what they would change about the diaphragm, 32% mentioned concerns related to inserting or removing it. CONCLUSIONS From an acceptability point of view, the diaphragm appears to be a viable candidate for a female-controlled method for prevention of HIV and other STDs. Our findings have important implications for the reintroduction of the traditional diaphragm and development of new diaphragm-like products.

Consequences of clean indoor air exemptions in Oregon: the hookah story

The WHO Framework Convention on Tobacco Control has stimulated the passage of comprehensive clean indoor air laws throughout the world.1 Although WHO guidelines stress the importance of universal protection from secondhand smoke in such laws,2 many states in the USA exempt certain locations such as tobacco retail establishments and tobacco bars/cigar lounges.3 ,4 Tobacco waterpipe (ie, hookah) establishments are often exempt from these laws, are growing in popularity and may change social norms regarding hookah use.3 ,4 Indeed, hookah use among young people in the USA appears to be increasing,5 as it is elsewhere,6 and the limited research available suggests it may be associated with negative health effects (eg, nicotine dependence, cancer).5 In this letter, we describe the exemptions in Oregons Indoor Clean Air Act (ICAA), subsequent proliferation of hookah lounges and associated monetary costs, as well as patterns in youth hookah use. To our knowledge, this is the first such published study in the …