Michael J. Stark

Demonstrating the Importance and Feasibility of Including Sexual Orientation in Public Health Surveys: Health Disparities in the Pacific Northwest

OBJECTIVES We identified health disparities for a statewide population of lesbian, gay, and bisexual (LGB) men and women compared with their heterosexual counterparts. METHODS We used data from the 2003-2006 Washington State Behavioral Risk Factor Surveillance System to examine associations between sexual orientation and chronic health conditions, health risk behaviors, access to care, and preventive services. RESULTS Lesbian and bisexual women were more likely than were heterosexual women to have poor physical and mental health, asthma, and diabetes (bisexuals only), to be overweight, to smoke, and to drink excess alcohol. They were also less likely to have access to care and to use preventive services. Gay and bisexual men were more likely than were heterosexual men to have poor mental health, poor health-limited activities, and to smoke. Bisexuals of both genders had the greatest number and magnitude of disparities compared with heterosexuals. CONCLUSIONS Important health disparities exist for LGB adults. Sexual orientation can be effectively included as a standard demographic variable in public health surveillance systems to provide data that support planning interventions and progress toward improving LGB health.

The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline

Objectives: State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. Methods: This 3×2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. Results: Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was

A prospective study of household smoking bans and subsequent cessation related behaviour: the role of stage of change

2467 for brief NRT,

Randomised controlled trial of a postpartum relapse prevention intervention

1912 for moderate no NRT,

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

2109 for moderate NRT,

The association between advertising and calls to a tobacco quitline

2641 for intensive no NRT, and

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

2112 for intensive NRT. Conclusion: Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.

Is a statewide tobacco quitline an appropriate service for specific populations

Objective: To assess the degree to which smokers living with a full household ban on smoking change their cessation related behaviour. Design, setting, and participants: Prospective cohort study; follow up of a population based cohort of 1133 smokers, identified from a 1997 telephone survey of adult Oregonians. After a median of 21 months, 565 were located and reinterviewed. Main outcome measures: Quit attempts, time until relapse, and smoking cessation, defined as seven day and 90 day sustained abstinence at follow up. Results: A full ban at baseline was associated with a doubling of the odds of a subsequent quit attempt (odds ratio (OR)  =  2.0, 95% confidence interval (CI), 1.0 to 3.9). Among respondents in the preparation stage at baseline (intention to quit in the next month with a quit attempt in the previous year), a full ban was associated with a lower relapse rate (hazard ratio  =  0.5 (95% CI, 0.2 to 0.9)), while for those in precontemplation/contemplation (no intention to quit or intention to quit within the next six months, respectively), there was no significant association between full ban and relapse rate. For respondents in preparation, those with a full ban had over four times the odds of being in cessation for seven or more days before the follow up call (OR  =  4.4 (1.1 to 18.7)), but for those in precontemplation/contemplation, full bans were unrelated to cessation. Conclusions: Full household bans may facilitate cessation among smokers who are preparing to quit by increasing quit attempts. They may also prolong time to relapse among those smokers.

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

Many women quit smoking during pregnancy but postnatal relapse rates are high, averaging 50–80% in the first year after delivery.1 2 Previous work suggests that provider based relapse intervention in the context of well-baby visits may lead to a decrease in postnatal relapse rates.3 However, prior research also suggests that the majority of postnatal providers do not take a systematic approach to obtaining a smoking history from all new mothers, and thus may miss opportunities for cessation and relapse counselling.3 4 In the present study we examined whether: (1) a relapse prevention intervention, implemented during the hospital stay during the period soon after delivery and at well-baby visits, would reduce the rate of relapse to smoking six months postpartum; (2) the time of delivery was an opportune moment to obtain a smoking history; (3) the history could be transmitted quickly to the infants pediatric provider; and (4) transmission would lead to increased rates of relapse advice. All women delivering babies at six participating Portland, Oregon, metropolitan area hospitals received an in-hospital screening and were deemed eligible for the study if they reported smoking during the 30 days before the pregnancy and quitting during pregnancy, and were willing to speak with a Visiting Nurse Association (VNA) nurse about having quit smoking. Women were not eligible to be screened if there was a maternal or child illness that would prevent them from attending the paediatric well-baby visits; if the baby was being adopted; or if the woman did not speak English. When an eligible woman agreed to participate in the study, the delivery nurse or the birth certificate clerk contacted the VNA. A VNA nurse informed the woman about the study, obtained informed consent, collected a saliva sample for cotinine verification of non-smoking status, and conducted the baseline assessment …

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

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.