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Peer Reviewed

Age of Escalation, Educational Attainment, and Smoking Abstinence among 25-34 Years Old US Respondents in PATH Wave 4 Study

Yang, Tingyi
Advisor(s): Trinidad, Dennis R

UC San Diego Electronic Theses and Dissertations (2021)

Early smoking onset is associated with higher nicotine dependence and increased difficulty to quit smoking. The highest level of education one attains links to both the age of regular smoking escalation and cessation, but whether education is a confounder between the age of escalation and cessation is unknown.

We analyzed a cross-sectional survey from the wave 4 nationally representative Population Assessment of Tobacco and Health (PATH) study and restricted the sample to respondents who had smoked at least 100 cigarettes, escalated to regular smoking before the age of 24, and were under 34 years old at the time of the 2017 survey. Logistical regression analysis was used to investigate the association between the age of smoking escalation (<18 years versus 18-24 years), educational attainment (college degree, some college, and no college), and smoking abstinence (1+ day abstinence and 12+ month abstinence).

We discovered a gradient between the age of escalation and educational attainment: The lower the educational attainment respondents held, the higher the proportion of early onset of smoking escalation observed in this population. Similarly, as the level of education increased, the proportion of respondents who was abstinent 1+ day also increased. However, educational attainment was not associated with successful long-term cessation. We found no evidence that educational attainment predicts 12+ month abstinence in the respondents.

In summary, educational attainment, instead of age of escalation, predicted cigarette abstinence in youth. Future studies should further investigate education and related socioeconomic factors to improve smoking prevention and cessation programs

Cover page: Age of Escalation, Educational Attainment, and Smoking Abstinence among 25-34 Years Old US Respondents in PATH Wave 4 Study

Article
Peer Reviewed

E-Cigarette Use Among Never-Smoking California Students.

UC San Diego Previously Published Works (2015)

We determined the extent to which adolescents who have never used tobacco try e-cigarettes. Data on the prevalence and correlates of e-cigarette use among 482,179 California middle and high school students are from the 2013-2014 California Healthy Kids Survey. Overall, 24.4% had ever used e-cigarettes (13.4% have never used tobacco and 11.0% have used tobacco), and 12.9% were current e-cigarette users (5.9% have never used tobacco). Among those who have never used tobacco, males and older students were more likely to use e-cigarettes than females and younger students. Hispanics (odds ratio [OR] = 1.60; confidence interval [CI] = 1.53, 1.67) and those of other races (OR = 1.24; CI = 1.19, 1.29) were more likely than Whites to have ever used e-cigarettes, but only among those who had never used smokeless tobacco and never smoked a whole cigarette. E-cigarette use is very prevalent among California students who have never smoked tobacco, especially among Hispanic and other race students, males, and older students.

Cover page: E-Cigarette Use Among Never-Smoking California Students.

Creative Commons 'BY-NC-SA' version 4.0 license

Article
Peer Reviewed

Bostean et al. Respond.

UC San Diego Previously Published Works (2016)

Article
Peer Reviewed

Has there been a delay in the age of regular smoking onset among African Americans?

UC San Diego Previously Published Works (2004)

Background: It is not clear whether the decline in African American adolescent smoking in the 1980s reflected a delay in age of onset of regular smoking initiation rather than success in preventing initiation completely. Purpose: The purpose of this study is to identify whether the marked reductions in African American adolescent smoking in the 1980s were offset by increased initiation in young adults. Methods: We combined data from the Tobacco Use Supplements of the 1992-1993, 1995-1996, and 1998-1999 Current Population Surveys (n = 512,258), and reconstructed year of smoking initiation and calculated age-specific incidence of initiation from 1970 to 1992. We then compared detailed age-specific rates of initiation for two 5-year periods selected to be before and after the documented large declines in African American adolescent smoking. Results: In the time period after marked declines in African American adolescent smoking (1987-1991), the incidence of initiation of regular smoking decreased for African Americans ages 14 to 16 and increased for ages 18 to 20. Such a delay was not as evident among non-Hispanic Whites. The delay that was slight in regular smoking initiation among African Americans relative to non-Hispanic Whites in 1975-79 had increased substantially by 1987-91. Conclusions: Reductions in African American adolescent smoking in the 1980s were offset by increased initiation among young adults ages 18 to 20 during this time period and suggest that the window for uptake of regular smoking shifted to older ages for African Americans more so than non-Hispanic Whites. Efforts to combat smoking should remain aggressive into young adulthood, when the tobacco industry's efforts to gain new smokers intensify.

Cover page: Has there been a delay in the age of regular smoking onset among African Americans?

Article
Peer Reviewed

Associations Between Cigarette Print Advertising and Smoking Initiation Among African Americans

UC San Diego Previously Published Works (2017)

Objectives

The objective of this study was to examine changes in the annual number of cigarette advertisements in magazines with a predominantly African-American audience following the broadcast ban on tobacco, and whether fluctuations in cigarette print advertising targeting African Americans during the late-1970s until the mid-1980s were associated with declines in smoking initiation.

Design

We tabulated the annual number of cigarette advertisements from magazines with large African-American readerships (Ebony, Essence, and Jet) from 1960 to 1990. Advertisements were coded depending on whether they featured African-American models. We calculated the incidence rate of regular smoking initiation from 1975 to 1990 for African-American 14-25 years old using data from the 1992-1993, 1995-1996, 1998-1999, and 2001-2002 Tobacco Use Supplements of the Current Population Survey. We examined whether trends in smoking initiation coincided with trends in cigarette advertising practices among African Americans.

Results

The annual aggregated number of printed cigarette advertisements in Ebony, Essence, and Jet magazines increased at least five-fold starting in 1971, following the broadcast ban on cigarette advertising. A decrease in the percentage of ads by Brown & Williamson that showed African-American models was positively correlated (r = 0.30) with declines in the incidence rate of smoking initiation among African Americans from the late-1970s to the mid-1980s.

Conclusion

The tobacco industry adapted quickly following the broadcast ban on cigarettes by increasing print advertising in African-American magazines. However, changes in print advertising practices by were associated with declines in smoking initiation among African Americans from the late-1970s to mid-1980s.

Cover page: Associations Between Cigarette Print Advertising and Smoking Initiation Among African Americans

Article
Peer Reviewed

Social Network Characteristics, Social Support, and Cigarette Smoking among Asian/Pacific Islander Young Adults

UC San Diego Previously Published Works (2016)

Cigarette smoking may be one of the factors contributing to the high levels of cancer-related mortality experienced by certain Asian/Pacific Islander (A/PI) subgroups (e.g., Native Hawaiian). Given the collectivist cultural orientation attributed to A/PI groups, social strategies are recommended for substance abuse or smoking cessation treatment among A/PI. However, research examining how social network characteristics and social support relate to smoking across A/PI subgroups has been lacking. This study investigated the associations between social network characteristics (e.g., size, composition), perceived social support, and recent cigarette use across Native Hawaiian, Filipino, and East Asian (e.g., Japanese, Chinese) young adults (18-35 year old). Cross-sectional, self-report data were collected from N = 435 participants (M age = 25.6, SD = 8.3; 61% women). Ethnic differences were found in a number of pathways linking social network characteristics, perceived social support, and cigarette smoking. Larger network size was strongly associated with higher perceived social support and lower recent cigarette smoking among Native Hawaiians but not Filipinos or East Asians. Higher perceived social support was associated with lower recent smoking among East Asians and Filipinos but not Native Hawaiians. Implications are discussed with regard to smoking prevention and cessation among A/PI.

Cover page: Social Network Characteristics, Social Support, and Cigarette Smoking among Asian/Pacific Islander Young Adults

Article
Peer Reviewed

The Potential Influence of Regulatory Environment for E-Cigarettes on the Effectiveness of E-Cigarettes for Smoking Cessation: Different Reasons to Temper the Conclusions From Inadequate Data

UC San Diego Previously Published Works (2018)

Cover page: The Potential Influence of Regulatory Environment for E-Cigarettes on the Effectiveness of E-Cigarettes for Smoking Cessation: Different Reasons to Temper the Conclusions From Inadequate Data

Article
Peer Reviewed

The effect of college attendance on young adult cigarette, e-cigarette, cigarillo, hookah and smokeless tobacco use and its potential for addressing tobacco-related health disparities

UC San Diego Previously Published Works (2020)

The goal of this study was to assess the effect of college attendance on tobacco use among young adults and across subpopulations with disparities in tobacco use. Using a cohort of US youth (<18 years) who aged into young adulthood (18-24 years) in the Population Assessment of Tobacco and Health (2013-14, 2015-16, n = 3619) and propensity score matching we estimated the effect of college attendance on past 30-day use of cigarettes, e-cigarettes, cigarillos, hookah and smokeless tobacco. In unmatched analysis, college attenders (vs. nonattenders) had lower risk of using any form of tobacco (Risk Difference (RD): -10.0; 95% CI: -13.2, -7.0), cigarettes (RD: -13.0; 95% CI: -15.4, -10.5), e-cigarettes (RD: -4.1; 95% CI: -6.8, -1.7), cigarillos (RD: -5.7; 95% CI: -7.6, -3.8), and smokeless tobacco (RD: -2.0; 95% CI: -3.4, -0.6), but not hookah (RD: -0.2; 95% CI: -2.1, 1.6). In matched analysis, these associations were all near-null, with the exception of cigarettes (matched RD: -7.1; 95% CI: -10.3, -3.9). The effect of college attendance on cigarette smoking was stable for all subpopulations we assessed including among those identifying as non-Hispanic Black or Lesbian, Gay or Bisexual as well as among those living in the South, Midwest or whose parents did not attend college. The results suggest that college attendance may reduce young adults' risk of cigarette smoking but may not reduce the risk of using other tobacco products.

Cover page: The effect of college attendance on young adult cigarette, e-cigarette, cigarillo, hookah and smokeless tobacco use and its potential for addressing tobacco-related health disparities

Article
Peer Reviewed

Standardised cigarette packaging may reduce the implied safety of Natural American Spirit cigarettes

UC San Diego Previously Published Works (2018)

Background

Over two-thirds of Natural American Spirit (NAS) smokers believe their cigarettes might be 'less harmful', but toxicological evidence does not support this belief. We assessed whether standardised packaging could reduce the possibility of erroneous inferences of 'safety' drawn from NAS cigarette packaging.

Methods

US adult smokers (n=909) were recruited to a between-subject survey experiment (3 brands×3 packaging/labelling styles) through Amazon Mechanical Turk and rated their perception of whether a randomly assigned cigarette package conveyed that the brand was 'safer' on a three-item scale (Cronbach's α=0.92). We assessed whether NAS packs were rated higher on the 'implied safety' scale than two other brands and estimated the effect that plain packaging (ie, all branding replaced with a drab dark brown colour) and Australian-like packaging (ie, all branding replaced with a drab dark brown colour and a graphic image and text on 75% of the pack surface) had on perceptions of the NAS cigarette package.

Results

Smokers' ratings of the standard NAS pack on the implied safety scale (mean=4.6; SD=2.9) were 1.9 times (P <0.001) higher than smokers' ratings of a Marlboro Red pack (mean=2.4; SD=2.3) and 1.7 times (P <0.001) higher than smokers' ratings of a Newport Menthol pack (mean=2.7; SD=2.4). These perceptions of implied safety were lower when plain packaging was used (Cohen's d=0.66; P <0.001) and much lower when Australian-like packaging was used (Cohen's d=1.56; P <0.001).

Conclusion

The results suggest that NAS cigarette packaging conveys that its cigarettes are 'safer' and that such perceptions are lower with standardised packaging, both with and without warning images.

Cover page: Standardised cigarette packaging may reduce the implied safety of Natural American Spirit cigarettes

Article
Peer Reviewed

Lesbian, Gay, Bisexual, and Transgender (LGBT) View it Differently Than Non-LGBT: Exposure to Tobacco-related Couponing, E-cigarette Advertisements, and Anti-tobacco Messages on Social and Traditional Media

UC San Diego Previously Published Works (2019)

Background

LGBT populations use tobacco at disparately higher rates nationwide, compared to national averages. The tobacco industry has a history targeting LGBT with marketing efforts, likely contributing to this disparity. This study explores whether exposure to tobacco content on traditional and social media is associated with tobacco use among LGBT and non-LGBT.

Methods

This study reports results from LGBT (N = 1092) and non-LGBT (N = 16430) respondents to a 2013 nationally representative cross-sectional online survey of US adults (N = 17522). Frequency and weighted prevalence were estimated and adjusted logistic regression analyses were conducted.

Results

LGBT reported significantly higher rates of past 30-day tobacco media exposure compared to non-LGBT, this effect was strongest among LGBT who were smokers (p < .05). LGBT more frequently reported exposure to, searching for, or sharing messages related to tobacco couponing, e-cigarettes, and anti-tobacco on new or social media (eg, Twitter, Facebook, etc.) than did non-LGBT (p < .05). Non-LGBT reported more exposure from traditional media sources such as television, most notably anti-tobacco messages (p = .0088). LGBT had higher odds of past 30-day use of cigarettes, e-cigarettes, and cigars compared to non-LGBT, adjusting for past 30-day media exposure and covariates (p ≤ .0001).

Conclusions

LGBT (particularly LGBT smokers) are more likely to be exposed to and interact with tobacco-related messages on new and social media than their non-LGBT counterparts. Higher levels of tobacco media exposure were significantly associated with higher likelihood of tobacco use. This suggests tobacco control must work toward reaching LGBT across a variety of media platforms, particularly new and social media outlets.

Implications

This study provides important information about LGBT communities tobacco-related disparities in increased exposure to pro-tobacco messages via social media, where the tobacco industry has moved since the MSA. Further, LGBT when assessed as a single population appear to identify having decreased exposure to anti-tobacco messages via traditional media, where we know a large portion of tobacco control and prevention messages are placed. The study points to the need for targeted and tailored approaches by tobacco control to market to LGBT using on-line resources and tools in order to help reduce LGBT tobacco-related health disparities. Although there have been localized campaigns, only just recently have such LGBT-tailored national campaigns been developed by the CDC, FDA, and Legacy, assessment of the content, effectiveness, and reach of both local and national campaigns will be important next steps.