Tobacco-Related Disease Research Program

BACKGROUND: Safe passage interventions aim to enhance public safety and improve access to community resources, including public parks, in underserved communities. However, no studies have directly compared community- and police-led safety interventions with respect to park-based moderate to vigorous physical activity (MVPA). To address this gap, we compared associations between Community-led Safe Passage Services (SPS) and the Los Angeles Police Department Community Safety Partnership (CSP) program with MVPA in South Los Angeles public parks. METHODS: We conducted structured observations of 3997 park users across 8 SPS and 9 CSP parks in South Los Angeles using the System for Observing Play and Recreation in Communities and the Physical Activity Resource Assessment. We applied t tests, analysis of variance, and hierarchical linear models to examine MVPA across park intervention types. RESULTS: Overall, MVPA was higher in SPS parks (P < .001). Black, male, teen, and adult park users exhibited significantly higher MVPA in SPS parks (P < .001). A hierarchical linear model controlling for sex, age, race, and park conditions indicated that Black park users were significantly less physically active in CSP parks (P = .05). Conversely, Black park users had significantly higher MVPA in SPS parks (P = .034). Intervention type was a stronger predictor of MVPA than park features and amenities, whereas incivilities were negatively associated with MVPA (P < .001). CONCLUSIONS: Community-led safety interventions may promote physical activity among Black park users. These findings suggest that community-led public park safety models are a promising approach for advancing health equity.

BackgroundVeterans have a unique health profile and risk for substance use, but few studies compare cannabis use patterns among US military Veterans and non-veteran civilians.ObjectiveTo examine differences in age-specific patterns, modes of use, and sociodemographic correlates of cannabis use between Veterans and non-Veterans.Design, Participants, MeasuresWe conducted a cross-sectional analysis of Behavioral Risk Factor Surveillance System data from 2016 to 2023. The analytic sample included 907,136 adults aged 18 to 80 years with complete data on self-reported veteran status and cannabis use. Primary outcomes were past 30-day cannabis use (yes/no), frequency of use in the past 30 days, and inhalational vs. non-inhalational use methods. Multivariable logistic regressions were used to assess sociodemographic and behavioral correlates of cannabis use. Analyses were conducted from March to June 2025.ResultsAmong participants, 114,193 (12.6%) were Veterans. Although overall cannabis use was lower among Veterans than non-Veterans, age-specific patterns differed. Veterans aged 50–64 years were 43% (95% CI, 28–59%) more likely to report cannabis use than non-Veterans, and those aged 65–80 were 22% (95% CI, 9–37%) more likely. Older Veterans also reported more frequent cannabis use in the past 30 days (mean 18.4 versus 15.8 days among those aged 50–64 years; 17.3 vs. 14.5 days among those aged 65–80 years). Inhalational use was more common among Veterans than non-Veterans (90.0%; 95% CI, 87.8–91.9% vs. 83.7%; 95% CI, 82.5–84.9%). Some correlates of cannabis use were shared across groups; however, educational attainment was differentially associated with cannabis use by veteran status.ConclusionsVeterans aged ≥ 50 years were more likely to report cannabis use and used it more frequently than their non-veteran peers, suggesting they may need tailored interventions to address cannabis use.

OBJECTIVE: Nicotine and cannabis vaping are increasingly prevalent among young adults, and aiding sleep is a common reason for cannabis use. This study examined relationships between daily nicotine/cannabis vaping patterns and sleep. METHODS: From 2023 to 2024, 111 California young adults (aged 18-29; mean age = 23.9±3.0; 64% female; 31.5% non-Hispanic White) who vaped nicotine/cannabis ≥20 days/month completed 30 consecutive days of smartphone-based surveys. Self-reported sleep outcomes included 1) sleep duration (inadequate <7 versus adequate ≥7 hours) and 2) sleep quality (0=terrible to 10=excellent). Daily vaping patterns were non-vaping, nicotine-only vaping, cannabis-only vaping, or same-day co-vaping. Generalized mixed-effects models examined day-level associations between vaping patterns and sleep that night, adjusting for other substance use and baseline covariates. RESULTS: Of 2147 daily assessments, 51.7% reported inadequate sleep; mean sleep quality was 6.1±2.1. Nicotine-only vaping was most frequently reported (42.5% of the days), followed by same-day co-vaping (32.1%), non-vaping (16.1%), and cannabis-only vaping (9.3%). Nicotine-only vaping days had greater odds of inadequate sleep versus non-vaping (OR=1.40, 95%CI: 1.01-1.94) and versus cannabis-only days (1.93 [1.31-2.85]). Days with same-day co-vaping had greater odds of inadequate sleep compared with cannabis-only vaping (1.50 [1.01-2.23]). Associations between sleep quality and daily vaping patterns were not statistically significant. CONCLUSIONS: Nicotine vaping was associated with inadequate sleep duration compared to non-vaping or cannabis-only vaping. Despite perceptions of cannabis as a sleep aid, cannabis vaping did not improve sleep quality compared to non-vaping. These findings highlight the need for educational efforts or interventions addressing sleep health among young adults who vape nicotine and/or cannabis.

INTRODUCTION: Little is known whether cannabis and tobacco use are indicators of suicide-related risks. This longitudinal study examined the associations of cannabis and tobacco use with risks of suicide attempt/death and overdose death over a 2-year follow-up in a cohort of veterans prescribed opioids. METHODS: This study analyzed data in 2024 using a national cohort of 923,291 veterans receiving opioid analgesics in Veterans Health Administration clinics collected during 2014-2019. Cannabis and tobacco use were assessed at cohort entry. Outcomes (suicide attempts, suicide death, overdose death) were obtained at follow-up through 2021. Cause-specific hazard models were used to examine the associations of cannabis and tobacco use with each outcome, adjusting for well-established risk factors for suicide/overdose (e.g., substance use disorders, mental health, sociodemographics). RESULTS: At baseline, 5.4% of the cohort used cannabis, and 39.4% used tobacco. At the end of follow-up (median follow-up time of 6.7-6.8 years), 2.2% of the sample had attempted suicide, 0.4% had died by suicide, and 0.5% had died by overdose. In adjusted models, cannabis use was associated with a higher rate of suicide attempt (hazard ratio=1.11, 95% CI=1.06, 1.15). Current use of tobacco at baseline (versus never use) was associated with a higher rate of suicide attempts (hazard ratio=1.18, 95% CI=1.13, 1.22), suicide deaths (hazard ratio=1.19, 95% CI=1.07, 1.32), and overdose deaths (hazard ratio=1.67, 95% CI=1.51, 1.83). CONCLUSIONS: Cannabis and tobacco use were associated with suicide attempts/deaths and overdose deaths among veterans prescribed opioid analgesics, underscoring a need for monitoring patients who use tobacco and cannabis in this population.

INTRODUCTION: Tobacco control policies aim to limit access, reduce initiation, and mitigate tobacco-related harms, particularly among youth. However, the effectiveness of these policies relies on consistent enforcement to ensure widespread compliance and achieve their intended public health impacts. Socioeconomic vulnerability and neighborhood characteristics have been shown to influence retailer compliance, although existing studies often primarily focus on compliance violations instead of inspections. This study uses Los Angeles (LA) County, California to explore the associations between compliance inspections, violations, and neighborhood social vulnerability. METHODS: We identified inspection and violation data from the Food and Drug Administration (FDA) Tobacco Compliance Check Outcomes database for Los Angeles County, CA (January 1, 2021 to December 31, 2023) and linked these data to census tract level data from the 2022 Centers for Disease Control and Prevention Social Vulnerability Index (SVI). All analyses were conducted at the census-tract level, with separate multivariable models adjusted for tobacco retailer density, and used to examine the relationship between inspections, violations, and neighborhood social vulnerability. FINDINGS: Neighborhood-level social vulnerability significantly predicted the likelihood of tobacco retailer inspections, but not violations. Census tracts with greater socioeconomic vulnerability and housing vulnerability had higher odds of inspections, while census tracts with higher proportions of racial/ethnic minority residents were less likely to undergo compliance inspections. CONCLUSION: The uneven distribution of FDA compliance inspection efforts in socially vulnerable neighborhoods highlights systemic inequities. The results underscore the importance of utilizing equitable enforcement frameworks that leverage tools like SVI to pinpoint high-need areas, optimize resource allocation, and support comprehensive tobacco policy implementation. IMPLICATIONS: This study reveals disparities in Food and Drug Administration compliance inspections with a concentration of inspections identified in socioeconomically vulnerable areas and gaps in predominantly racial/ethnic minority communities. No direct link was found between social vulnerability and violations, suggesting heightened retailer compliance may stem from successful outreach, past regulatory scrutiny, or other factors. Leveraging the Centers for Disease Control and Prevention Social Vulnerability Index can strengthen tobacco control enforcement in high-need areas, ensuring inspections are more equitable and targeted where enforcement gaps and tobacco access remain most pronounced.

There are significant racial and ethnic disparities in head and neck cancer (HNC) survival. Disparities in cancer stage appear to account for some of the disparities in survival. However, the proportion of the survival disparities mediated by cancer stage is unclear. This study aimed to quantify the mediation effects of stage at diagnosis on racial/ethnic disparities in HNC survival using data from the California Cancer Registry. We found that T3-4 disease accounted for 36.3% (95% CI 15.6% to 57.0%) of the association between Black (versus White) and worse OS, and for 44.2% (95% CI 10.9% to 77.4%) of the association between Black (versus White) and worse DSS. This suggests that interventions aimed at improving access to care and early detection of malignancies may have highest impact in reducing racial/ethnic disparities in HNC survival. Future studies are needed to further understand factors that drive racial disparities in HNC stage at diagnosis, and to inform the development of intervention strategies to address these disparities.

INTRODUCTION: Prior research indicates that social class is strongly associated with academic outcomes such as GPA. However, little work explores the role that social discrimination plays in this relation. This study examined the link between social class discrimination and academic outcomes among high school students. METHOD: Participants were 956 working class adolescents (ages 13-18; 55% boys, 65% Latine) in the western United States. Using latent profile analysis, we identified four patterns of discrimination from five sources (teachers, classmates, friends, other teenagers, and community members). We also assessed socio-emotional academic outcomes (school isolation, impulsivity) and academic self-reported achievement outcomes (GPA, grades). RESULTS AND DISCUSSION: Two profiles showed high discrimination from either in-school or out-of-school sources, one showed frequent discrimination from all sources, and one reported low levels overall. Adolescents in profiles experiencing in-school discrimination from teachers and classmates had lower academic outcomes than those experiencing infrequent or out-of-school social class discrimination. Findings highlight that in-school social class discrimination may be particularly detrimental to self-reported performance and socio-emotional academic outcomes.

OBJECTIVE: To compare head and neck cancer (HNC) stage at diagnosis and survival outcomes between South Asian, Other Asian, and non-Hispanic white individuals in the United States. STUDY DESIGN: Retrospective population-based cohort study. SETTING: Data from Surveillance, Epidemiology, and End Results Research Plus 17 database. METHODS: Patients diagnosed with squamous HNC from 2006 to 2020 were categorized as South Asian, Other Asian, and non-Hispanic white. Logistic regression assessed the association between race/ethnicity and advanced-stage disease (stage III/IV vs I/II). Overall survival (OS) and disease-specific survival (DSS) outcomes were evaluated using Kaplan-Meier analysis and Cox proportional hazards regression models, respectively. RESULTS: Among 92,664 patients (1066 South Asian, 3260 Other Asian, and 88,338 non-Hispanic white individuals), adjusted logistic regression showed South Asian individuals had a higher risk of advanced stage at diagnosis (odds ratio [OR] 1.48, 95% CI 1.29-1.70) than Other Asian (OR 1.13, 95% CI 1.05-1.22) and non-Hispanic white individuals. Adjusted Cox regression showed Other Asian (hazard ratio [HR] 0.89, 95% CI 0.84-0.94) individuals had improved OS, while South Asian individuals had similar OS (HR 1.09, 95% CI 0.99-1.21) as non-Hispanic white individuals. South Asian individuals had worse DSS (HR 1.30, 95% CI 1.16-1.46) than Other Asian (HR 1.05, 95% CI 0.98-1.12), and non-Hispanic white individuals. CONCLUSION: South Asian individuals with HNC are more likely to present with advanced disease stage and have worse survival compared with Other Asian and non-Hispanic white individuals, highlighting the importance of disaggregating Asian ethnic groups when assessing HNC outcome disparities.

INTRODUCTION: Cigarettes and cannabis are commonly co-used, but little research has examined how cannabis use relates to cigarette price responsiveness. This study compares the price elasticity of cigarette demand between U.S. adults who currently use cannabis and those who do not. METHODS: We analyzed cross-sectional data from the National Survey on Drug Use and Health (2004-2019; annual mean unweighted n = 50 000 adults aged 18+). A two-part econometric model of cigarette demand was estimated separately for adults who currently use cannabis and those who do not, including a multivariable logistic regression for smoking participation and a multivariable linear regression for smoking intensity. RESULTS: From 2004 to 2019, smoking prevalence declined from 24.5% to 16.6%, while cannabis use increased from 5.8% to 11.6%, and co-use rose from 3.6% to 4.5%. Among cannabis users, price elasticity was statistically significant at -0.20 for smoking participation, -0.27 for smoking intensity, and -0.47 for total demand-indicating that a 1% increase in cigarette prices is associated with a 0.20%, 0.27%, and 0.47% decrease in smoking participation, smoking intensity and overall cigarette demand. Among non-cannabis users, price elasticity was also statistically significant at -0.23, -0.13, and -0.36. Those who currently use cannabis were significantly more price-responsive in reducing smoking participation and smoking intensity than those who do not. CONCLUSIONS: Higher cigarette prices are associated with lower smoking prevalence, intensity, and total demand for both subgroups. However, adult smokers who currently use cannabis are more price-sensitive, suggesting that tobacco taxes may be particularly effective in reducing smoking among this subgroup. IMPLICATIONS: Both cannabis-using and non-cannabis-using smokers are significantly responsive to cigarette prices, with higher prices associated with in lower levels of smoking initiation and smoking intensity as well as a higher quit rate. However, the cannabis-using smokers are significantly more price-responsive than non-cannabis-using smokers. These results suggest that increasing cigarette prices, such as through taxation, is effective in reducing cigarette smoking among U.S. adults, especially those who currently use cannabis.