Kristen Rohde

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.

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.

Smoking patterns in Oregon youth: effects of funding and defunding of a comprehensive state tobacco control program.

PURPOSE Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated. METHODS We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding. RESULTS Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period (p=.04) and was not significantly different from schools that were never-funded (p=.79). CONCLUSIONS In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment.

Does free nicotine replacement therapy for young adults prompt them to call a quitline

A recent paper by An et al found that offering free nicotine replacement therapy (NRT) through Minnesota’s state tobacco quitline (QL) was associated with large increases in calls and quit rates.1 Other state programmes might not be able to afford NRT for all QL callers, and instead could target specific at-risk populations. Washington State’s tobacco QL had a free NRT service enhancement targeted at young adults—a population whose smoking prevalence has recently increased in the United States.2 In this letter, we describe Washington’s QL service enhancement for young adults, and the associated changes in call volume and quit rates. From January 2005 through January 2006, the Washington QL offered a five-call proactive counselling service that included free NRT for 8 weeks (that is, “Washington Benefit”) to all …

Is smokeless tobacco use becoming more common among U.S. male smokers? Trends in Alaska

INTRODUCTION The tobacco industry has promoted the use of smokeless tobacco (SLT) to smokers as a substitution for cigarettes when smoking is not possible, and some smokers are using SLT this way. However, few publications have examined recent trends in dual cigarette and SLT use (dual use) over time in the U.S. MATERIALS AND METHODS We examined trends in the use of SLT among current, former and never cigarette smokers using data on adult (aged 18+ years) males (n=16,590) from the 1996-2008 Alaska Behavioral Risk Factor Surveillance System (BRFSS). We also examined trends from 2004 to 2008 in cigarette consumption among dual users. RESULTS Between 1996 and 2008, the overall prevalence of current SLT use and prevalence of current smoking among Alaskan men did not significantly change over time (p-value from age-adjusted models p=.63, p=.09, respectively). When we examined trends in SLT use by smoking status, we found that the prevalence of current SLT use remained unchanged between 1996 and 2008 among former and never smokers, but almost doubled among current smokers (age-adjusted p=.004). Between 2004 and 2008, cigarette consumption remained steady among current smokers who did not use SLT, but significantly decreased among dual users (age-adjusted p<.001). CONCLUSIONS Our findings suggest that male smokers in Alaska are increasingly likely to use SLT, but do not appear to be switching to SLT use exclusively. We recommend that other state tobacco control programs examine trends in dual use to confirm our findings, and for programs to continue encouraging cessation of all tobacco products.

Smoking-related knowledge, attitudes, and behaviours among Alaska Native people: a population-based study

Background Several studies have shown that Alaska Native people have higher smoking prevalence than non-Natives. However, no population-based studies have explored whether smoking-related knowledge, attitudes, and behaviours also differ among Alaska Native people and non-Natives. Objective We compared current smoking prevalence and smoking-related knowledge, attitudes, and behaviour of Alaska Native adults living in the state of Alaska with non-Natives. Methods We used Alaska Behavioral Risk Factor Surveillance System data for 1996 to 2010 to compare smoking prevalence, consumption, and cessation- and second-hand smoke-related knowledge, attitudes, and behaviours among self-identified Alaska Native people and non-Natives. Results Current smoking prevalence was 41% (95% CI: 37.9%–44.4%) among Alaska Native people compared with 17.1% (95% CI: 15.9%–18.4%) among non-Natives. Among current every day smokers, Alaska Natives were much more likely to smoke less than 10 cigarettes per day (OR=5.0, 95% CI: 2.6–9.6) than non-Natives. Compared with non-Native smokers, Alaska Native smokers were as likely to have made a past year quit attempt (OR=1.4, 95% CI: 0.9–2.1), but the attempt was less likely to be successful (OR=0.5, 95% CI: 0.2–0.9). Among current smokers, Alaska Natives were more likely to believe second-hand smoke (SHS) was very harmful (OR=4.5, 95% CI: 2.8–7.2), to believe that smoking should not be allowed in indoor work areas (OR=1.9, 95% CI: 1.1–3.1) or in restaurants (OR=4.2, 95% CI: 2.5–6.9), to have a home smoking ban (OR=2.5, 95% CI: 1.6–3.9), and to have no home exposure to SHS in the past 30 days (OR=2.3, 95% CI: 1.5–3.6) than non-Natives. Conclusion Although a disparity in current smoking exists, Alaska Native people have smoking-related knowledge, attitudes, and behaviours that are encouraging for reducing the burden of smoking in this population. Programs should support efforts to promote cessation, prevent relapse, and establish smoke-free environments.