Kevin D. Everett

Baby BEEP: A randomized controlled trial of nurses' individualized social support for poor rural pregnant smokers.

Objectives We tested the effect of nurse-delivered telephone individualized social support (“Baby BEEP”) and eight mailed prenatal smoking cessation booklets singly and in combination (2 × 2 factorial design) on smoking cessation in low-income rural pregnant women (N = 695; 75% participation). Methods Participants randomized to Baby BEEP groups (n = 345) received weekly calls throughout pregnancy plus 24-7 beeper access. Saliva cotinine samples were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery. Primary outcomes were point prevalence abstinence (cotinine < 30 ng/ml) in late pregnancy and post-delivery. Results Only 47 women were lost to follow-up. Intent-to-treat analyses showed no difference across intervention groups (17–22%, late pregnancy; 11–13.5%, postpartum), and no difference from the controls (17%, late pregnancy; 13%, postpartum). Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers. Partner smoking had no effect on late pregnancy abstinence (OR = 1.7, 95% CI = 0.95, 3.2), but post-delivery, the effect was pronounced (OR = 3.2, 95% CI = 1.8, 5.9). Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

An examination of smoking behavior and opinions about smoke-free environments in a large sample of sexual and gender minority community members.

INTRODUCTION The purpose of this study is to more completely quantify smoking rate and support for smoke-free policies in private and public environments from a large sample of self-identified sexual and gender minority (SGM) populations. METHODS A targeted sampling strategy recruited participants from 4 Missouri Pride Festivals and online surveys targeted to SGM populations during the summer of 2008. A 24-item survey gathered information on gender and sexual orientation, smoking status, and questions assessing behaviors and preferences related to smoke-free policies. RESULTS The project recruited participants through Pride Festivals (n = 2,676) and Web-based surveys (n = 231) representing numerous sexual and gender orientations and the racial composite of the state of Missouri. Differences were found between the Pride Festivals sample and the Web-based sample, including smoking rates, with current smoking for the Web-based sample (22%) significantly less than the Pride Festivals sample (37%; p < .0001). The SGM group (n = 2,162) was 1.49 times more likely to be current smokers compared with the studys heterosexual group (n = 436; p = .005). Statistically fewer SGM racial minorities (33%) are current smokers compared with SGM Whites (37%; p = .04). Support and preferences for public and private smoke-free environments were generally low in the SGM population. CONCLUSIONS The strategic targeting method achieved a large and diverse sample. The findings of high rates of smoking coupled with generally low levels of support for smoke-free public policies in the SGM community highlight the need for additional research to inform programmatic attempts to reduce tobacco use and increase support for smoke-free environments.

Smoking initiation, tobacco product use, and secondhand smoke exposure among general population and sexual minority youth, Missouri, 2011-2012.

Introduction Research indicates disparities in risky health behaviors between heterosexual and sexual minority (referred to as LGBQ; also known as lesbian, gay, bisexual, queer, and questioning) youth. Limited data are available for tobacco-use–related behaviors beyond smoking status. We compared data on tobacco age of initiation, product use, and secondhand smoke exposure between general population and LGBQ youth. Methods Data for general population youth were from the statewide, representative 2011 Missouri Youth Tobacco Survey, and data for LGBQ youth were from the 2012 Out, Proud and Healthy survey (collected at Missouri Pride Festivals). Age-adjusted Cochran-Mantel-Haenszel tests were used to examine differences between general population (N = 1,547) and LGBQ (N = 410) youth, aged 14 to 18 years. Logistic regression models identified variables associated with current smoking. Results The 2 groups differed significantly on many tobacco-use–related factors. General population youth initiated smoking at a younger age, and LGBQ youth did not catch up in smoking initiation until age 15 or 16. LGBQ youth (41.0%) soon surpassed general population youth (11.2%) in initiation and proportion of current smokers. LGBQ youth were more likely to use cigars/cigarillos, be poly-tobacco users, and be exposed to secondhand smoke (SHS) in a vehicle (for never smokers). Older age (odds ratio [OR] = 1.39, 95% confidence interval [95% CI] = 1.18–1.62), female sex (OR = 1.64, 95% CI = 1.13–2.37), LGBQ identity (OR = 3.86, 95% CI = 2.50–5.94), other tobacco product use (OR = 8.67, 95% CI = 6.01–12.51), and SHS exposure in a vehicle (OR = 5.97, 95% CI = 3.83–9.31) all significantly increased the odds of being a current smoker. Conclusion This study highlights a need for the collection of data on sexual orientation on youth tobacco surveys to address health disparities among LGBQ youth.

Can Smoke-Free Policies Reduce Tobacco Use Disparities of Sexual and Gender Minorities in Missouri?

Objective The purpose of this study is to explore the associations between smoke-free policies, current and former smoking status, personal smoking restrictions, and intention to quit among sexual and gender minority (SGM) and non-SGM individuals in Missouri. Aims and Methods The current analysis derives from the Out, Proud and Healthy project. Chi-squares examined differences between SGM (N = 2210) and non-SGM (N = 586) respondents and former (N = 836) and current (N = 1960) smokers on smoking-related variables. Odds ratios and 95% confidence intervals from logistic regression identified variables associated with former (vs. current) smoking. Results SGM current smokers (25%) were significantly more likely than SGM former smokers (19%) to live in a community without a smoke-free policy. Among SGM current smokers, significantly greater intention to quit was seen in those living in a smoke-free community with a smoke-free policy of two or more years (94%) compared with those living in a community without a smoke-free policy (76%). Conclusions Living in an area with smoke-free policies is related to greater intention to quit among SGM current smokers, greater support for smoke-free policies, and lower smoking prevalence for this community. The SGM community may collectively accrue greater public health benefits from the adoption of smoke-free policies than the non-SGM community. Implications Prior to this study, no data are available regarding current and former smoking status among SGM individuals following the implementation of a local smoke-free policy. The purpose of this study was to explore the relationship between smoke-free policies, current and former smoking status, and intention to quit among SGM and non-SGM individuals in Missouri. This study finds evidence of lower current smoking prevalence and greater intentions to quit among SGM current smokers who live in communities with smoke-free policies. The SGM community may collectively accrue greater public health benefits from the adoption of smoke-free policies than the non-SGM community.

Newspaper Tobacco Advertising Focuses on Cessation

A content analysis of tobacco and tobacco control advertisements that ran in Missouri newspapers during a five-year period showed that the frequent topic was tobacco cessation, followed by messages about politics, health effects and smoking ordinances and restrictions.

Tobacco Control Policy Adoption Dynamics: A Case Study of Missouri Communities

Tobacco control policies reduce the health and economic burden caused by tobacco. With over half of the United States communities lacking adequate protective policies, an examination of policy adoption factors can provide insights to facilitate policy adoption. A case study approach examines the rate of adoption, prominent media frames, policy leaders’ perceptions and coalition activities for smokefree and Tobacco 21 policies adopted in Missouri. Findings show compared to smokefree policy, Tobacco 21 requires a considerably shorter timeframe and fewer resources for adoption. Tobacco 21 coalitions target a small group of stakeholders compared to smokefree coalitions’ emphasis on broad community engagement. Both policies are formally opposed, but elected officials perceive less political risk supporting Tobacco 21. As a new tobacco control policy tool, Tobacco 21 has relative advantage that should be considered by community health advocates.