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Background: Although higher socioeconomic status (SES) indicators such as educational attainment are linked with health behaviors, the Blacks’ Diminished Return theory posits that the protective effects of SES are systemically smaller for Blacks than Whites. Aims: To explore the Black/White differences in the association between education and smoking. Methods: This cross-sectional study used the Health Information National Trends Survey (HINTS) 2017 (n = 3217). HINTS is a national survey of American adults. The current analysis included 2277 adults who were either Whites (n = 1868; 82%) or Blacks (n = 409; 18%). The independent variable was educational attainment, and the dependent variables were ever and current (past 30-day) smoking. Demographic factors (age and gender) were covariates. Race was the focal moderator. Results: In the pooled sample, higher educational attainment was associated with lower odds of ever and current smoking. Race interacted with the effects of higher educational attainment on current smoking, suggesting a stronger protective effect of higher education against current smoking for Whites than Blacks. Race did not interact with the effect of educational attainment on odds of ever smoking. Conclusions: In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks. Smaller protective effects of education on health behaviors may be due to the existing racism across institutions such as the education system and labor market.

According to the Minorities' Diminished Return (MDR) theory, socioeconomic status (SES) indicators such as employment status produce smaller tangible outcomes for racial and ethnic minority groups, however, very limited information exists on such diminished returns for Hispanics. To test whether MDR also holds for the social patterning of smoking behaviors among white adults, this study explored ethnic differences in the association between employment status and ever smoking in a representative sample of adults in Los Angeles. Los Angeles Family and Neighborhood Survey 2001 included 907 non-Hispanic white and 2117 Hispanic white adults (ages 18 or older). Ethnicity, gender, age, employment status, marital status, immigration status, and ever smoking were measured. Logistic regression models were used for data analysis. In the pooled sample that included both non-Hispanic whites and Hispanic whites, being employed was associated with lower odds of ever smoking, net of covariates. A significant interaction was found between ethnicity and employment status on odds of ever smoking, suggesting a stronger inverse association between employment status and ever smoking for non-Hispanic whites than Hispanic whites. Ethnic specific models showed an inverse association between being employed and ever smoking status for non-Hispanic whites, but not for Hispanic whites. Even among whites, whether or not employment reduces the risk of ever smoking may depend on ethnicity, with Hispanics being at a disadvantage relative to non-Hispanic whites in terms of lower odds of ever smoking from their employment status.

Background The United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; however, mentholated tobacco products were exempt. Since 2009, over 20 US jurisdictions and numerous countries around the world have extended this restriction to menthol. Currently, the FDA is reconsidering its position on a nation-wide menthol cigarette ban. However, the effects of such a ban remain unclear. We conducted a scoping review to explore the impact of a menthol cigarette ban on individual behaviors (initiation, cessation, and product switching), sales, and compliance. Methods We conducted a search of the international literature using PubMed, EBSCO, and Web of Science (to November 25, 2019). We retrieved articles relevant to the impacts of an implemented or hypothetical menthol ban. We also included studies of flavored tobacco product bans due to their potential relevance in gauging compliance and product substitutability. Results The search identified 493 articles, of which 24 were included. Studies examined the effects of implemented menthol bans ( n  = 6), hypothetical menthol bans ( n  = 12) and implemented flavor bans that exclude menthol ( n  = 6). Menthol bans were found to reduce sales and increase smoking cessation with only partial substitution for non-menthol cigarettes. US smokers’ reactions to a hypothetical ban indicate that about 25–64% would attempt to quit smoking and 11–46% would consider switching to other tobacco products, including 15–30% to e-cigarettes. Flavor ban studies indicate reductions in initiation of 6%. Ban compliance was high, but studies indicate that the tobacco industry and retailers have attempted to circumvent their impact via packaging changes and online sales. Conclusion Our review finds that extending the US cigarette flavor ban to menthol products would promote smoking cessation and reduce initiation. This evidence supports further action by the FDA towards mentholated tobacco products. However, few studies have been conducted in the vaping era.

According to the minorities’ diminished returns (MDR) theory, socioeconomic status (SES) indicators such as education attainment have smaller protective effects on health risk behaviors for racial and ethnic minority groups in comparison to the ‘dominant’ social group. However, most studies of MDR theory have been on comparison of Blacks versus Whites. Much less is known about diminished returns of SES in ethnic subpopulations (i.e., Hispanics versus non-Hispanic Whites). To test whether MDR also holds for the social patterning of problematic alcohol use among Hispanic and non-Hispanic Whites, this study investigated ethnic variations in the association between education attainment and alcohol binge drinking frequency in a population-based sample of adults. Los Angeles Family and Neighborhood Survey, 2001, included 907 non-Hispanic White and 2117 Hispanic White adults (≥18 years old). Hispanic ethnicity (moderator), education attainment (independent variable), alcohol binge drinking frequency (dependent variable), and gender, age, immigration status, employment status, self-rated health, and history of depression (confounders) were included in four linear regressions. In the overall sample that included both non-Hispanic and Hispanic Whites, higher education attainment was correlated with lower alcohol binge drinking frequency (b = −0.05, 95% CI = −0.09–−0.02), net of covariates. A significant interaction was found between ethnicity and education attainment (b = 0.09; 95% CI = 0.00–0.17), indicating a stronger protective effect of high education attainment against alcohol binge drinking frequency for non-Hispanic than Hispanic Whites. In ethnic-stratified models, higher level of education attainment was associated with lower binge drinking frequency among non-Hispanic Whites (b = −0.11, 95% CI = −0.19–−0.03), but not among Hispanic Whites (b = −0.01, 95% CI = −0.04–0.03). While, overall, higher education attainment is associated with lower frequency of alcohol binge drinking, this protective effect of education attainment seems to be weaker among Hispanic Whites compared to non-Hispanic Whites, a phenomenon consistent with the MDR theory.

Background Religiosity and school connectedness have been shown to protect adolescents from tobacco use initiation in the U.S. and Europe but have not been examined in India. A population-based in-home survey of 1,982 adolescents’ susceptibility to tobacco use in India was examined in relation to several adolescent prosocial factors: connectedness with school, and three indicators of religiosity. Methods Religiosity measures included participant frequency of attendance at places of worship (e.g., mosque, temple), frequency of prayer, and importance of prayer. School connectedness measures included feeling like you are a part of the school, you are happy at your school, and you feel safe at your school. Primary outcome was susceptibility to tobacco use defined as intention to or openness to using tobacco during next 12 months. Results More in Mumbai than in Kolkata, adolescent prosocial factors were associated with reduced susceptibility to tobacco use. Adolescents’ sex-at-birth also influenced these associations. Conclusion Encouraging religiosity and school connectedness may help reduce adolescent susceptibility to tobacco use in India.

IntroductionThe use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the lung injuries outbreak, flavour bans, Tobacco 21 and the COVID-19 pandemic.MethodsUsing the Population Assessment of Tobacco and Health Study, we applied a multistate transition model to 28 061 adults in waves 4–5 (2017–2019) and 24 584 adults in waves 5–6 (2019–2021), estimating transition rates for initiation, cessation and switching products for each period overall and by age group.ResultsCigarette initiation among adults who never used either product decreased from 2017–2019 to 2019–2021, but ENDS initiation did not significantly change. The persistence of ENDS-only use remained high (75%–80% after 1 year). Cigarette-only use transitions remained similar (88% remaining, 7% to non-current use and 5% to dual or ENDS-only use). In contrast, dual use to ENDS-only transitions increased from 9.5% (95% CI 7.3% to 11.7%) to 20.0% (95% CI 17.4% to 22.6%) per year, decreasing the persistence of dual use. The dual to cigarette-only use transition remained at about 25%. These changes were qualitatively similar across adult age groups, though adults ages 18–24 years exhibited the highest probability of switching from cigarette-only use to dual use and from dual use to ENDS-only use.ConclusionsThe persistence of ENDS use among adults remained high in 2019–2021, but a larger fraction of dual users transitioned to ENDS-only use compared with 2017–2019. Because the fraction of cigarette-only users switching to dual use remained low, especially among older adults, the public health implications of this change are minimal.

Objectives. We examined the relationship between students' tobacco use and the density and proximity of tobacco retailers near their schools. Methods. We used data from the 2003–2004 California Student Tobacco Survey and California retail licensing data. Measures included students' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors. Results. Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources. Conclusions. Our results support the plausibility of reducing rates of students' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.

Although perceived discrimination in Black youth is a risk factor for a wide range of negative mental health outcomes, recent research has suggested some gender differences in these associations. Gender differences in vulnerability to perceived discrimination among Caribbean Black youth is, however, still unknown. The current cross-sectional study investigated gender variations in the association between perceived discrimination and substance use (SU) in a national sample of Caribbean Black youth. Data came from the National Survey of American Life-Adolescents (NSAL-A), 2003–2004. This analysis included 360 Caribbean Black youth (165 males and 195 females) who were between 13 and 17 years old. Sociodemographic factors, perceived discrimination, and SU were measured. Logistic regressions were used for data analysis. Among Caribbean Black youth, a positive association was found between perceived discrimination and SU (odds ratio (OR) = 1.15 (95% confidence interval (CI) = 1.02–1.29)). A significant interaction was found between gender and perceived discrimination on smoking (OR = 1.23 (95% CI = 1.07–1.41)) suggesting that the association between perceived discrimination and smoking is larger for male than female Caribbean Black youth. The interaction between gender and perceived discrimination on SU was not statistically significant (OR = 1.32 (95% CI = 0.94–1.86)). While perceived discrimination increases SU in Caribbean Black youth, this effect is stronger for males than females, especially for smoking. While discrimination should be reduced at all levels and for all populations, clinicians may specifically address discrimination for SU prevention and treatment among male Caribbean Black youth.

Background With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. Methods Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group. Results Regardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40 and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold. Conclusion The estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.

Background This project will use a multilevel longitudinal cohort study design to assess whether changes in Community Tobacco Environmental (CTE) factors, measured as community compliance with tobacco control policies and community density of tobacco vendors and tobacco advertisements, are associated with adolescent tobacco use in urban India. India’s tobacco control policies regulate secondhand smoke exposure, access to tobacco products and exposure to tobacco marketing. Research data about the association between community level compliance with tobacco control policies and youth tobacco use are largely unavailable, and are needed to inform policy enforcement, implementation and development. Methods The geographic scope will include Mumbai and Kolkata, India. The study protocol calls for an annual comprehensive longitudinal population-based tobacco use risk and protective factors survey in a cohort of 1820 adolescents ages 12–14 years (and their parent) from baseline (Wave 1) to 36-month follow-up (Wave 4). Geographic Information Systems data collection will be used to map tobacco vendors, tobacco advertisements, availability of e-cigarettes, COTPA defined public places, and compliance with tobacco sale, point-of-sale and smoke-free laws. Finally, we will estimate the longitudinal associations between CTE factors and adolescent tobacco use, and assess whether the associations are moderated by family level factors, and mediated by individual level factors. Discussion India experiences a high burden of disease and mortality from tobacco use. To address this burden, significant long-term prevention and control activities need to include the joint impact of policy, community and family factors on adolescent tobacco use onset. The findings from this study can be used to guide the development and implementation of future tobacco control policy designed to minimize adolescent tobacco use.