Marshall K. Cheney

Point-of-Sale Marketing of Tobacco Products: Taking Advantage of the Socially Disadvantaged?

With increasing regulation of tobacco industry marketing practices, point-of-sale advertising has become an important channel for promoting tobacco products. One hundred and ten convenience stores in Oklahoma County were surveyed for tobacco-related advertising. There were significantly more point-of-sale tobacco advertisements in low-income and minority neighborhoods than in better educated, higher-income, predominantly White neighborhoods. Storeowners or managers were also interviewed to determine who has decision-making power regarding store signage and placement, and to elicit perceptions of industry tactics. Contracts with tobacco companies leave storeowners with little or no control over promotion of tobacco products within their store, and many are unaware of the implications of the tobacco industry point-of-sale practices. Local ordinances that regulated outdoor signage reduced outdoor tobacco advertisements, as well as tobacco signage and promotions within the store. Policy change, rather than education targeting storeowners, is recommended as the most effective strategy for reducing point-of-sale tobacco advertising.

Marketing Practices of Vapor Store Owners

OBJECTIVES We examined the marketing strategies for local vapor stores in a large metropolitan area in Oklahoma. METHODS Vapor store owners or managers (n = 33) participated in individual interviews regarding marketing practices in 2014. We asked owners about their marketing strategies and the groups they targeted. We transcribed the interviews and analyzed them for themes. RESULTS Store owners used a variety of marketing strategies to bring new customers to their stores and keep current customers coming back. These marketing strategies showed many parallels to tobacco industry strategies. Most owners engaged in some form of traditional marketing practices (e.g., print media), but only a few used radio or television advertising because of budget constraints. Owners used social media and other forms of electronic communication, pricing discounts and specials, and loyalty programs. Owners also had booths at local events, sponsored community events, and hosted them in their stores. Owners attempted to target different groups of users, such as college students and long-term smokers. CONCLUSIONS Local vapor store marketing practices closely resemble current and former tobacco industry marketing strategies. Surveillance of marketing practices should include local and Web-based strategies.

Health and Fitness App Use in College Students: A Qualitative Study

Background: College students experience weight gain that can contribute to serious health issues. Health education efforts with college students are increasingly utilizing new technologies. Smartphone applications (apps) in particular are growing in popularity and use in all young adults. Purpose: Formative research was conducted to describe how college students in the southwestern United States use health/fitness apps to change behavior. Method: College students (n = 27) ages 18-30 reporting use of health/fitness apps were recruited on a large public university campus and participated in interviews about app choice, behavioral goals, features, and reasons for continued use. Interviews were recorded, transcribed, and analyzed for themes using a 4-person coding team and the qualitative research software NVivo. Results: Most participants downloaded an app to meet a goal and felt that the app helped them meet it. Two distinct groups emerged, those who used apps to support an established behavior and those who used them to adopt a new behavior. The majority of participants reported that acceptable apps were free, easy to use, provided visual/auditory cues, and had game-like rewards. Most participants strongly opposed linking their social media with apps and did not use those features. Discussion: College students use apps to meet different goals such as developing an exercise routine or improving eating habits. Examining what influences health/fitness app choices among college students may provide important insights for future interventions developed to promote app use over long periods of time. Translation to Health Education Practice: Health education programming may benefit from the use of apps, because college students are already adopting these technologies. Features that are important such as ease of use and game-like rewards can help health educators choose appropriate apps for college student programs.

Vapor Store Owner Beliefs and Messages to Customers

INTRODUCTION Electronic cigarette (e-cigarette) use is becoming increasingly popular but little is known about the role of the local vapor store in promoting use and influencing customer attitudes and beliefs about vaping. METHODS Thirty-three vapor store owners were interviewed about their personal beliefs and attitudes about e-cigarettes and what they told customers about the health impact of using e-cigarettes. Interviews were recorded then transcribed, coded, and analyzed for themes. RESULTS Vapor store owners used the internet to obtain information about vaping, most often from YouTube and industry sources. Owners often did not have the training to critically evaluate research studies posted on the internet. Owners promoted vaping as a healthier alternative to smoking and often compared it to a medical treatment. Owners considered ingredients in the e-liquid as safe to use if it was safe to eat and discussed other foods vapor ingredients were found in. Owners also discussed the safety of secondhand vapor. Owners described the health impact of nicotine in e-liquid by comparing nicotine to caffeine and promoted the nicotine in e-liquid as coming from vegetables rather than tobacco. Finally, owners talked about vaping as a habit rather than a continued addiction to nicotine. CONCLUSIONS Local store owners are an important source of health information for current and potential e-cigarette users but their messages to customers may be based on incomplete or misinterpreted information. Understanding local store owner messages to customers in addition to internet-based messages is an important area for future public health research.

Smoking and membership in a fraternity or sorority: A systematic review of the literature

Abstract Objective: Fraternity and sorority members have higher rates of smoking than other college students. This systematic review examines studies that included fraternity/sorority membership in their investigation of smoking behaviors. Participants/Methods: Studies identified in MEDLINE, PsychInfo, JSTOR, CINAHL, ERIC, and Google Scholar published between 2003 and 2013 were included if they included fraternity and/or sorority membership, were written in English, published in a peer-reviewed journal, and had smoking as an outcome variable. Nineteen studies were identified for the review. Results: Fraternity/sorority members were more likely to be nondaily smokers. Members who lived in the fraternity/sorority house had higher rates of smoking than members who lived elsewhere. Fraternity/sorority member smoking was associated with alcohol and other substance use. The influence of no-smoking policies on fraternity/sorority member smoking was also examined. Conclusions: Fraternity/sorority membership was associated with higher rates of smoking, but this association was influenced by other substance use and environmental factors.

African American Young Adult Smoking Initiation: Identifying Intervention Points and Prevention Opportunities

Background African Americans have one of the lowest smoking rates as teens yet have one of the highest smoking rates as adults. Approximately 40% of African Americans who have ever smoked started smoking between the ages of 18 and 21. Purpose This study aimed to identify why African American young adults began smoking in young adulthood and what personal, social, and environmental influences promoted the transition to regular smoking. Methods Twelve focus groups were conducted with African American young adults (n = 99) between the ages of 18 and 29 who began smoking regularly after the age of 18. Results Participants did not smoke while they were younger because of strong maternal antismoking messages, out of respect for elders, or because they smoked marijuana instead. Factors influencing smoking initiation were perceived smoking social norms, changing parental messages about smoking, believing that smoking was an adult coping strategy, and extending a marijuana high. Discussion African American young adult smokers described multiple levels of influences on smoking initiation and the transition to regular smoking. Translation to Health Education Practice Recommendations include continuing strong parental messages against smoking, preparing youth for the transition to young adulthood, targeting normative smoking beliefs, and delinking smoking from marijuana use.

Underutilization of Influenza Vaccine: A Test of the Health Belief Model

Yearly influenza vaccination continues to be underutilized by those who would most benefit from it. The Health Belief Model was used to explain differences in beliefs about influenza vaccination among at-risk individuals resistant to influenza vaccination. Survey data were collected from 74 members of at-risk groups who were not vaccinated for influenza during the previous flu season. Accepting individuals were more likely to perceive flu as a threat to health and perceive access barriers, and cues to action were the most important influence on whether they plan to get vaccinated. In comparison, resistant individuals did not feel threatened by the flu, access barriers were not a problem, and they did not respond favorably to cues to action. Perceived threat, perceived access barriers, and cues to action were significantly associated with plans to be vaccinated for influenza in the next flu season. Participants who saw influenza as a threat to their health had 5.4 times the odds of planning to be vaccinated than those who did not. Participants reporting barriers to accessing influenza vaccination had 7.5 times the odds of reporting plans to be vaccinated. Those responding positively to cues to action had 12.2 times the odds of planning to be vaccinated in the next flu season than those who did not. Accepting and resistant individuals have significant differences in their beliefs, which require different intervention strategies to increase vaccination rates. These findings provide important information to researchers and practitioners working to increase influenza vaccination rates.

Designing the Process Evaluation for the Collaborative Planning of a Local Turning Point Partnership

This study describes the design of the process evaluation of a collaborative effort among community partners to address health issues in central Oklahoma. The design is an application of a sound process evaluation planning framework that integrates the components of context, reach, dose delivered, dose received, fidelity, implementation, recruitment, barriers, and maintenance. The planning framework also provides guidance regarding the steps of designing and implementing the process evaluation. This planning process was conducted by utilizing a participatory research approach. At the end of the planning phase, the evaluation team accomplished the following: (a) development of an evaluation plan, (b) development of evaluation instruments (i.e., surveys, interview guides, observation forms), and (c) development of evaluation questions and process objectives. The information derived from this study can be valuable to practitioners and researchers involved in the planning of community partnerships or coalitions and interested in process evaluation that takes place in community settings.

Electronic Cigarette Use in Straight-to-Work Young Adults.

OBJECTIVE We explored beliefs about electronic cigarettes (e-cigarettes) as well as social influences on e-cigarette use in straight-to-work (STW) young adults. METHODS Thirty interviews were conducted with STW young adults ages 19-31 years old. We asked participants about smoking and e-cigarette use, beliefs about e-cigarettes, and influences on decisions to use e-cigarettes. We conducted interviews in community locations and transcribed and coded them using NVivo. RESULTS We identified 4 themes: benefits of e-cigarette use; dual use/continued smoking; social influences; and quitting smoking and e-cigarettes. STW young adults initiated e-cigarette use to quit smoking but most became dual users or reported cycles of smoking and e-cigarette use. Flavors were a primary attraction for e-cigarette users. Family and friends supported e-cigarette use and often provided participants with their first e-cigarette. Most participants who no longer identified as smokers still smoked occasionally. Users felt they were more positively perceived by others when they used e-cigarettes but were still seen as smokers or former smokers. CONCLUSIONS E-cigarette use may bring STW young adults closer to their aspirational identity of non-smoker but many may be vulnerable to smoking relapse or increased dependence on nicotine through dual use.

Knowledge and Beliefs About E-Cigarettes in Straight-to-Work Young Adults.

Introduction: Young adults are a growing segment of electronic cigarette (e-cigarette) users. Young adults who go straight to work (STW) from high school make up a large portion of the young adult population, yet research to date has focused on college-educated young adults. This study explored STW young adult beliefs and knowledge about e-cigarettes. Methods: Semistructured individual interviews were used to elicit in-depth information from STW young adults ages 19–31 from a state in the southwest United States. Thirty interviews were conducted focusing on beliefs about e-cigarettes, current knowledge, and information-seeking practices. Interviews were recorded, transcribed, and analyzed using NVivo. Results: Nine themes were identified falling into three categories: (1) beliefs about e-cigarettes, (2) knowledge about e-cigarettes, and (3) personal rules about e-cigarettes. STW young adults held positive beliefs about the health and safety of e-cigarettes for themselves, others, and the environment. They reported their social networks and the Internet as reliable sources of information about e-cigarettes, but they reported parents as the best source for advice. Participants had rules about e-cigarettes that contradicted some of their beliefs such as using e-cigarettes around children indicating that their beliefs were not as strongly held as they initially reported. Conclusions: Industry marketing and contradictory information may contribute to STW young adult knowledge and beliefs about e-cigarettes. Lack of credible public health information may also contribute to this issue. Ensuring that what is known about the benefits and harms of e-cigarettes is conveyed through multichannel communication and continued monitoring of marketing practices of the e-cigarette industry in light of the soon to be implemented regulations should be top priorities for public health. Implications: Beliefs and knowledge of STW young adults have not been explored even though they are heavily targeted by the e-cigarette industry. This group holds strong positive beliefs about the health and safety of e-cigarettes, despite having little credible knowledge about them. This study indicates a need for efforts focused on educating STW young adults on the potential risks and benefits of e-cigarettes and the communication of credible information or at minimum the acknowledgment of the uncertainty regarding the long-term health effects of e-cigarettes. It also indicates a need for continued monitoring and advocacy related to marketing practices of the e-cigarette industry.