Kimberly Horn

Delay discounting and probability discounting as related to cigarette smoking status in adults.

This study examined relations between adult smokers and non-smokers and the devaluation of monetary rewards as a function of delay (delay discounting, DD) or probability (probability discounting, PD). The extent to which individuals discount value, either as a function of a reward being delayed or probabilistic, has been taken to reflect individual differences in impulsivity. Those who discount most are considered most impulsive. Previous research has shown that adult smokers discount the value of delayed rewards more than adult non-smokers. However, in the one published study that examined probability discounting in adult smokers and non-smokers, the smokers did not discount the value of probabilistic rewards more than the non-smoker controls. From this past research, it was hypothesized that measures of delay discounting would differentiate between smokers and non-smokers but that probability discounting would not. Participants were 54 (25 female) adult smokers (n = 25) and non-smokers (n = 29). The smokers all reported smoking at least 20 cigarettes per day, and the non-smokers reported having never smoked. The results indicated that the smokers discounted significantly more than the non-smokers by both delay and probability. Unlike past findings, these results suggest that both delay and probability discounting are related to adult cigarette smoking; however, it also was determined that DD was a significantly stronger predictor of smoking than PD.

Association of active and passive smoking with risk of breast cancer among postmenopausal women: a prospective cohort study

Objective To examine the association between smoking and risk of invasive breast cancer using quantitative measures of lifetime passive and active smoking exposure among postmenopausal women. Design Prospective cohort study. Setting 40 clinical centres in the United States. Participants 79 990 women aged 50–79 enrolled in the Women’s Health Initiative Observational Study during 1993–8. Main outcome measures Self reported active and passive smoking, pathologically confirmed invasive breast cancer. Results In total, 3520 incident cases of invasive breast cancer were identified during an average of 10.3 years of follow-up. Compared with women who had never smoked, breast cancer risk was elevated by 9% among former smokers (hazard ratio 1.09 (95% CI 1.02 to 1.17)) and by 16% among current smokers (hazard ratio 1.16 (1.00 to 1.34)). Significantly higher breast cancer risk was observed in active smokers with high intensity and duration of smoking, as well as with initiation of smoking in the teenage years. The highest breast cancer risk was found among women who had smoked for ≥50 years or more (hazard ratio 1.35 (1.03 to1.77) compared with all lifetime non-smokers, hazard ratio 1.45 (1.06 to 1.98) compared with lifetime non-smokers with no exposure to passive smoking). An increased risk of breast cancer persisted for up to 20 years after smoking cessation. Among women who had never smoked, after adjustment for potential confounders, those with the most extensive exposure to passive smoking (≥10 years’ exposure in childhood, ≥20 years’ exposure as an adult at home, and ≥10 years’ exposure as an adult at work) had a 32% excess risk of breast cancer compared with those who had never been exposed to passive smoking (hazard ratio 1.32 (1.04 to 1.67)). However, there was no significant association in the other groups with lower exposure and no clear dose response to cumulative passive smoking exposure. Conclusions Active smoking was associated with an increase in breast cancer risk among postmenopausal women. There was also a suggestion of an association between passive smoking and increased risk of breast cancer.

A systematic review of the aetiology of tobacco disparities for sexual minorities

Objective To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations. Methods Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria. Results Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation. Conclusions This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.

Lung cancer mortality is elevated in coal-mining areas of Appalachia

Previous research has documented increased lung cancer incidence and mortality in Appalachia. The current study tests whether residence in coal-mining areas of Appalachia is a contributing factor. We conducted a national county-level analysis to identify contributions of smoking rates, socioeconomic variables, coal-mining intensity and other variables to age-adjusted lung cancer mortality. Results demonstrate that lung cancer mortality for the years 2000-2004 is higher in areas of heavy Appalachian coal mining after adjustments for smoking, poverty, education, age, sex, race and other covariates. Higher mortality may be the result of exposure to environmental contaminates associated with the coal-mining industry, although smoking and poverty are also contributing factors. The knowledge of the geographic areas within Appalachia where lung cancer mortality is higher can be used to target programmatic and policy interventions. The set of socioeconomic and health inequalities characteristic of coal-mining areas of Appalachia highlights the need to develop more diverse, alternative local economies.

Adolescent nicotine dependence and smoking cessation outcomes.

The purpose of the present study was to examine adolescent nicotine dependence and its impact on smoking cessation outcomes with two treatments of varying intensity: a brief, self-help intervention and an intensive, multisession, school-based cessation curriculum called Not On Tobacco (N-O-T). A majority (80%) of adolescent smokers in this study were moderately to highly nicotine-dependent, using the Fagerstrom Tolerance Questionnaire. Further, nicotine dependence was positively correlated with duration of smoking and number of cigarettes smoked daily (P<.05). Data showed that the more cigarettes teens smoked daily and the longer they had smoked, the more dependent they were. Some teens (20%), however, had low nicotine dependence despite years of smoking and high smoking rates. Results showed that the relationship between nicotine dependence and cessation outcomes varied by treatment intensity. The brief intervention was successful with only low-dependent smokers, whereas the intensive, multisession, N-O-T intervention was effective with smokers possessing a range of nicotine dependence, including high-dependent smokers.

Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department.

Abstract The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

Statewide Demonstration of Not On Tobacco: A Gender-Sensitive Teen Smoking Cessation Program

This study represented the largest statewide demonstration (n = 346) of the teen smoking cessation program Not On Tobacco (N-O-T) to date and one of the few systematically controlled teen smoking cessation trials reported in the literature. Results showed that N-O-T female teens were 4 times more likely to quit smoking almost 6 months after the program ended than female teens who received a brief intervention (BI). The quit rate for the N-O-T female groups was significantly higher than that for female brief intervention comparison groups. The study demonstrated that 2 times more N-O-T than BI teens quit smoking overall. Differences in the biochemically validated quit rate between the N-O-T groups and the brief intervention groups overall and for male participants were not statistically different, however. Furthermore, findings showed that N-O-T was more effective than the brief intervention in assisting youth with cigarette reduction. There was a significant difference in the reduction rate between the N-O-T and the BI groups on weekdays and weekends 6 months after the program ended. Overall, approximately 84% of N-O-T teens either quit or reduced smoking, compared with approximately 55% of BI teens. This study is 1 phase of an ongoing multiphase evaluation of N-O-T This study resulted in several important findings that will help guide future teen cessation studies and tobacco cessation efforts of school health professionals.

Racial and Ethnic Differences in Current Use of Cigarettes, Cigars, and Hookahs Among Lesbian, Gay, and Bisexual Young Adults

INTRODUCTION Research demonstrates that lesbians, gays, and bisexuals (i.e., LGBs or sexual minorities) smoke more than their heterosexual peers, but relatively less is known about the heterogeneity within LGB populations, namely racial/ethnic differences. Moreover, smoking research on sexual minorities has focused mainly on cigarette smoking, with little attention to other forms of smoking, such as hookahs/water pipes. METHODS Using a large national sample of college students, we examined differences by race and sexual orientation in prevalence of smoking cigarettes, cigars/cigarillos/clove cigarettes, and hookahs. RESULTS All LGB racial groups had higher cigarette smoking prevalence than their heterosexual racial group counterparts. Significantly more White and Hispanic LGBs smoked hookahs when compared, respectively, with White and Hispanic heterosexuals. CONCLUSIONS Given the higher prevalence of multiple forms of smoking among sexual minorities, the heterogeneity within sexual minority populations and the nuances of multiple identities (i.e., racial, ethnic, and sexual minority), targeted-if not tailored-prevention and cessation efforts are needed to address smoking disparities in these diverse communities. Prevention, intervention, and epidemiological research on smoking behaviors among college attending young adults should take into account other forms of smoking, such as hookah use.

The Impact of Not on Tobacco on Teen Smoking Cessation: End-of-Program Evaluation Results, 1998 to 2003

This review summarizes end-of-program quit rates from 6 controlled and 10 field-based Not on Tobacco (NOT) evaluations. Approximately 6,130 youth from 5 states and 489 schools participated. Intent-to-treat and compliant quit rates were calculated at 3 months postbaseline (end-of-program). Results from controlled evaluations revealed an aggregate quit rate of 15% and 19%, respectively. The field-based evaluations revealed an aggregate quit rate of 27% and 31%, respectively. NOT youth were two times more likely to quit than comparison youth (OR = 1.94; p = .002; 95% CI 1.267-2.966). This is the first multiyear, multisite review of a teen smoking cessation program reported in the literature and the first longitudinal review of NOT. NOT participants showed consistent, significant positive smoking behavior change across evaluations.

Associations of Discrimination and Violence With Smoking Among Emerging Adults: Differences by Gender and Sexual Orientation

INTRODUCTION Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups. METHODS Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups. RESULTS Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors. CONCLUSIONS When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.