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Open Access Publications from the University of California

Scholarly Works (45 results)

  • Thesis
  • Peer Reviewed
UC Davis Electronic Theses and Dissertations (2021)

The dissertation focus is on the tobacco use behaviors in California’s health care and school settings, with an emphasis on Latinos and the context of location. Chapter one used data from the California Health Interview Survey to examine the association between race/ethnicity (Latino and Non-Latino white) and provider cessation advice and assistance among smokers with California Medicaid in the post-Affordable Care Act period. Logistic regression was used to examine the association between race/ethnicity and each outcome, adjusted for sociodemographic, tobacco behavior, health care factors, and acculturation measures. Chapter two was a pragmatic randomized trial to examine the impact of a local area code with a proactive outreach strategy among unassisted patients who smoke on the outcome of consenting to an e-referral to evidence-based tobacco treatment with the state quitline. Log-binomial regression was used to examine the association between area code and patient consent to a Helpline e-referral among self-reported smokers, adjusted for age, gender, and preferred language (English and Spanish). Chapter three used data from the California Department of Public Health to examine the association of urbanicity and school staff reports of e-cigarettes on high school grounds. Data were linked from the California Department of Education and California Healthy Kids Survey to include school-level factors, such as student demographics and student past 30-day e-cigarette use prevalence. Logistic regression was performed to assess the association between urbanicity and school staff observation of e-cigarettes on school grounds, adjusted for both individual-level school staff and school-level characteristics. Altogether, two of the chapters contribute to the gap in knowledge around why Latino smokers are advised less by providers, while the last study aims to contribute to the limited research around school staff perspectives and e-cigarettes at high schools.

    Cover page: Understanding Tobacco Use Behaviors in California Health Care and School Settings: Latinos and the Context of Location
    • Thesis
    • Peer Reviewed
    UC Davis Electronic Theses and Dissertations (2024)

    Tobacco use is a significant public health issue in the United States. This dissertation focuses on tobacco use behaviors from different populations, including young adults, smokers with California Medicaid, and patients in cancer centers.

    Chapter one used data from the American College Health Association-National College Health Assessment (ACHA-NCHA) to examine the association between tobacco and/or cannabis use and serious psychological distress (SPD) among college students. Logistic regression was used to examine the association between single/dual/multiple use of tobacco as well as cannabis and SPD.

    Chapter two used the California Health Interview Survey (CHIS) to explore the association between individuals with/without chronic diseases and providers smoking cessation advice and assistance among smokers with California Medicaid. Two logistic regression models were estimated to examine the associations between having at least one chronic disease and receipt of advice and assistance.

    Chapter three used Electronic Health Records from UC Davis Comprehensive Cancer Center to evaluate the effectiveness of a tobacco treatment program to increase access to smoking cessation treatment for cancer patients at UC Davis Comprehensive Cancer Center, comparing patients with and without internal PCPs from January 2017 to December 2022. To examine whether the association between PCPs and assistance differs over time, a logistic regression model with an interaction term between PCPs and study year on assistance was estimated using generalized estimating equations (GEE) to account for within-patient correlation. By exploring tobacco behaviors across diverse populations, this dissertation seeks to inform targeted interventions, policies, and healthcare delivery models to reduce smoking-related disparities, promote cessation, and ultimately improve population health outcomes.

      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2018)

      Background

      Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population.

      Methods

      California Asian Indian Tobacco Use Survey data from 2004 (n = 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use.

      Results

      The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for ≥$100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5).

      Conclusions

      The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such determinants for targeted interventions. Cancer 2018;124:1607-13. © 2018 American Cancer Society.
        Cover page: Moving toward a true depiction of tobacco behavior among Asian Indians in California: Prevalence and factors associated with cultural smokeless tobacco product use
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2024)

        Introduction

        Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area.

        Aims and methods

        We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile.

        Results

        Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87).

        Conclusions

        Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups.

        Implications

        In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.
          Cover page: Flavored Tobacco Sales Restrictions and Youth E-cigarette Behavior: Impact by Tobacco Retailer Density in Diverse Communities in California
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2023)

          Introduction

          Flavored tobacco sales restrictions (FTSRs) are implemented to reduce access to flavored tobacco products. We examined the association between seven cities with local FTSRs implemented in 2018/2019 and e-cigarette use among high school students in the California Bay Area.

          Aims and methods

          We analyzed data from the California Healthy Kids Survey using a difference-in-differences (D-I-D) strategy. We compared pre- and post-policy changes one year after implementation in current and ever e-cigarette use among students attending school in a city with a FTSR (exposed) (n = 20 832) versus without (unexposed) (n = 66 126). Other outcomes included ever marijuana use in an e-cigarette and ease of access to e-cigarettes.

          Results

          Pre- to post-policy, the adjusted odds of current and ever e-cigarette use did not significantly change among students exposed and unexposed to a FTSR. In the adjusted D-I-D analysis, the odds of current (aOR: 1.25, 95% CI: 0.95, 1.65) and ever e-cigarette use (aOR: 1.06, 95% CI: 0.89, 1.26) did not significantly change by exposure group. However, one year post-implementation, the odds of ease of access to e-cigarettes significantly increased among exposed (aOR: 1.57, 95% CI: 1.27, 1.95) and unexposed students (aOR: 1.54, 95% CI: 1.39, 1.70). Similarly, the odds of ever using marijuana in an e-cigarette significantly increased among exposed (aOR: 1.35, 95% CI: 1.19, 1.53) and unexposed students (aOR: 1.29, 95% CI: 1.20, 1.39).

          Conclusions

          Local FTSRs in the California Bay Area were not associated with a change in e-cigarette use one year post-implementation. Increased ease of access and marijuana use may be explanatory factors.

          Implications

          FTSRs were not associated with a decrease in current or ever e-cigarette use among high school students in the California Bay Area one-year post-implementation. Potential explanatory factors are that ease of access to e-cigarettes and using marijuana in an e-cigarette increased. More research is needed to understand the influence of these factors on youth access and behaviors. To address the youth e-cigarette epidemic, a comprehensive approach is needed, including policies, media campaigns, education programs, and cessation tools targeted to youth.
            Cover page: Flavored Tobacco Sales Restrictions and Teen E-cigarette Use: Quasi-experimental Evidence From California
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2024)

            Objective

            To examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students.

            Study design

            We analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n = 287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools.

            Results

            Current co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (β = -0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR 1.19, 95% CI 1.10-1.29) and lower grades (β = -0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis.

            Conclusions

            California youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.
              Creative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2022)

              Background

              Lung cancer screening (LCS) for former and current smokers requires that current smokers are counseled on tobacco treatment. In the USA, over 4 million former smokers are estimated to be eligible for LCS based on self-report for "not smoking now." Tobacco use and exposure can be measured with the biomarker cotinine, a nicotine metabolite reflecting recent exposure.

              Objective

              To examine predictors of tobacco use and exposure among self-reported former smokers eligible for LCS.

              Design

              Cross-sectional study using the 2013-2018 National Health and Nutrition Examination Survey.

              Participants

              Former smokers eligible for LCS (n = 472).

              Main measures

              Recent tobacco use was defined as reported tobacco use in the past 5 days or a cotinine level above the race/ethnic cut points for tobacco use. Recent tobacco exposure was measured among former smokers without recent tobacco use and defined as having a cotinine level above 0.05 ng/mL.

              Key results

              One in five former smokers eligible for LCS, totaling 1,416,485 adults, had recent tobacco use (21.4%, 95% confidence interval (CI) 15.8%, 27.0%), with about a third each using cigarettes, e-cigarettes, or other tobacco products. Among former smokers without recent tobacco use, over half (53.0%, 95% CI: 44.6%, 61.4%) had cotinine levels indicating recent tobacco exposure. Certain subgroups had higher percentages for tobacco use or exposure, especially those having quit within the past 3 years or living with a household smoker.

              Conclusions

              Former smokers eligible for LCS should be asked about recent tobacco use and exposure and considered for cotinine testing. Nearly 1.5 million "former smokers" eligible for LCS may be current tobacco users who have been missed for counseling. The high percentage of "passive smokers" is at least double that of the general nonsmoking population. Counseling about the harms of tobacco use and exposure and resources is needed.
                Cover page: Assessment and Counseling Gaps Among Former Smokers Eligible for Lung Cancer Screening in US Adults
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2017)
                This qualitative study examines the social environmental influences on smoking and cessation from the perspectives of Chinese smokers and household nonsmokers in California. Seven focus groups were conducted with 63 participants. Three culturally influenced levels of potential intervention emerged from constant comparative analysis. At the individual level, participants focused more on irritating odor than health harms of exposure and had inaccurate beliefs about harms of smoking and cessation. At the relational level, peers kept smokers connected to pro-smoking norms. There was conflict in the home about smoking and failed cessation, but smokers recognized the benefits of cessation for family harmony and children's health. Physicians encouraged cessation but this tended to be insufficient to prompt action unless a smoker felt ill. At the societal level, participants recognized changes in social acceptability and environmental regulation of smoking upon immigration. Better implementation of smokefree policies, plus culturally nuanced strategies for equipping both nonsmokers and smokers to become smokefree, are needed.
                  • Article
                  • Peer Reviewed
                  UC Davis Previously Published Works (2018)
                  Most tobacco users initiate use as youth or young adults. To promote tobacco cessation for this group and encourage non-users' engagement in tobacco control efforts, a community-based organization developed a "Street Team" brief outreach intervention that enlisted youth and young adults to encourage their peers to stop tobacco use through a brief intervention. Street Team members provided education, a Quit Kit, and referrals to cessation resources at a total of 27 community events over a four-year period. Tobacco users (n = 279) completed assessments of tobacco use, quit intention, and quit self-efficacy at baseline. Self-reports of cessation outcomes including past week abstinence were assessed 1-, 3-, and 6-months post-intervention. Perceptions of the intervention were gathered from Street Team members (n = 28) and intervention participants post-intervention. T-tests and χ2-tests were used to compare those who completed at least one follow-up assessment to those lost to follow-up. Time effects were analyzed using fixed effect models. Missing = using analyses indicate 16.1, 18.6, and 12.5% 7-day quit rate at 1-, 3-, and 6-months follow-up. Feedback from intervention participants indicate the intervention was acceptable and that discussions with Street Team members and provision of quit kits motivated tobacco users to consider quitting. All Street Team members responded positively to their participation in the intervention. This Street Team approach for youth and young adults is promising as an effective approach to the promotion of tobacco cessation among users and engagement and empowerment in tobacco control efforts among non-users.
                    Cover page: A Community-Based “Street Team” Tobacco Cessation Intervention by and for Youth and Young Adults
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2018)

                    Background

                    Chinese American men smoke at a high rate, which puts household nonsmokers at risk. The objective of this study was to evaluate the effectiveness of a brief-intensity versus moderate-intensity smoke-free-living educational intervention for household pairs.

                    Methods

                    The authors conducted a randomized controlled trial of Cantonese-speaking Chinese American smoker and household nonsmoker pairs in San Francisco, California. Pairs were randomized to moderate-intensity or brief-intensity group sessions with their household partner. The moderate-intensity group received 2 group sessions, a laboratory report of their baseline smoke exposure, as measured by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3 follow-up calls over 6 months. The brief-intensity group received 1 group session on tobacco-cessation resources. Primary outcomes were biochemically validated, past-month smoking abstinence and elimination of nonsmoker household exposure at 12 months.

                    Results

                    Participant pairs (n = 203) were male smokers, one-half of whom did not intend to quit within 6 months, with mostly female spouses as household nonsmokers. Approximately three-quarters of nonsmokers in both groups already had smoke-free home rules. At 12 months, smokers in both groups had similar biochemically validated 30-day abstinence rates (moderate-intensity group, 0%-20.7%; brief-intensity group, 0%-20.0%; P = .002 over time). More smokers in the moderate-intensity group used subsequent cessation group classes (moderate-intensity group, 50%; brief-intensity group, 24%; P = .004). Household nonsmokers in both groups had similar biochemically validated rates of no home exposure (moderate-intensity group, 24.5%-42.2%; brief-intensity group, 24.8%-33.3%; P = .0001 over time).

                    Conclusions

                    A moderate-intensity smoke-free-living educational intervention for Chinese-speaking household pairs was not more effective than a brief-intensity intervention for smoking abstinence and elimination of household nonsmoker exposure. Abstinence rates were similar to those achieved with standard group counseling. Cancer 2018;124:1590-8. © 2018 American Cancer Society.
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