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Background: The prevalence of electronic cigarette use grows. Amid increased e-cigarette use nationwide, this paper attempts to identify underlying risk factors for the most vulnerable populations., Objective: The purpose of the study was to assess predictors of e-cigarette use among female current and former tobacco users of childbearing age-specifically to determine whether demographic factors, pregnancy status, conventional cigarette smoking, and perceived e-cigarette harm are associated with e-cigarette use. Reasons for using e-cigarettes were also measured., Methods: A cross-sectional, correlational design was used; 194 current and former female tobacco users, 18-45 years of age, from two university-affiliated prenatal clinics and one women's health clinic in Kentucky took part. Slightly more than half were pregnant. Age, race/ethnicity, education, pregnancy status, use history for cigarettes and e-cigarettes, and perception of health hazard from e-cigarettes were measured, and associations with e-cigarette use were made with Mann-Whitney U-tests or Spearman's rank correlations. Predictors of e-cigarette use were determined using proportional odds modeling., Results: Most current e-cigarette users were also current cigarette smokers (88%). Nearly half of current and former e-cigarette users were pregnant. Most women perceived e-cigarettes as a minor (38%) or moderate (31%) health hazard. In the proportional odds model, younger women were at greater risk for e-cigarette use, whereas minority women and those who were pregnant were less likely to be e-cigarette users., Discussion: Pregnant women were less likely to be more recent e-cigarette users, compared with nonpregnant women. However, nearly all current e-cigarette users were dual tobacco users, including pregnant women. It is both imperative and timely to determine the impact of e-cigarette use on maternal and infant health, thus improving healthcare provider confidence to discuss the health implications of e-cigarette use with their patients.

Introduction: Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students., Methods: Of 10,000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users were included in this study (n = 662, or 41.6% of survey completers)., Results: About 15% of ever users reported current polytobacco use, and more than 70% of polytobacco users smoked cigars, little cigars, or clove cigarettes in combination with one or more products. Cigarettes were the most commonly-used product among single users, followed by hookah. Males, underclassmen, and students with greater acceptance of cigarette use were more likely to be polytobacco users. Race/ethnicity was marginally related to polyuse status, with white/non-Hispanics 28% less likely to be polytobacco users versus single product users., Conclusions: Polytobacco users were more likely than single users to consume emerging tobacco products, (ie, hookah and electronic cigarettes). Males, underclassmen, and racial/ethnic minorities were more at risk for polytobacco use. As young people are particularly prone to nicotine addiction, there is a need to further investigate polytobacco use among college students., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To examine the association of secondhand smoke (SHS) exposure with susceptibility to smoking, perceived addiction, and psychobehavioral effects of exposure among never- and ever-smoking college students., Participants: Participants were 665 college students at a large, southeastern university in the United States., Methods: This study is a secondary analysis of online cross-sectional survey data from randomly selected students in April 2013., Results: Thirty-eight percent of the sample had moderate to high SHS exposure. Among never-smokers, SHS exposure was associated with increased susceptibility to initiating smoking. Among ever-smokers, SHS exposure was not associated with their perceived addiction to tobacco. In the total sample, SHS exposure was associated with greater psychobehavioral symptoms of exposure., Conclusions: SHS exposure may the increase risk of smoking, especially among never-smoking college students. This study strengthens the need for prevention strategies that limit SHS exposure in college environments.

Introduction: Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics., Methods: An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law., Results: Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers., Conclusions: Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.

Objective: Tobacco use is the leading preventable cause of death, resulting in 443,000 US deaths per year. Rural adults have higher smoking prevalence and less access to tobacco dependence treatment than their urban counterparts. This study examined exposure to a culturally specific smoking cessation outreach intervention, assessing whether exposure was associated with cessation behaviors., Design and Sample: Post-test only quasi-experimental study. Targeted adult smokers (N = 251) living in a rural, economically distressed southeastern US county for at least 6 months., Measurements: Five outreach elements (brochures/pushcards, posters, print and radio advertisements, quilt made by local artisans) based on themes from focus groups with current and former smokers and paired with brief tobacco cessation counseling, and were delivered over 6 months in 2009-2010. Exposure and cessation behavior indicators were collected via cross-sectional random-digit dial survey. The total intervention exposure score was 4.8 (SD = 4.3, range 0-19)., Results: Intervention exposure was associated with having talked to a health care provider about quitting smoking in the past 6 months and planning to quit smoking in the next 6 months., Conclusions: Culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation., (© 2013 Wiley Periodicals, Inc.)

Objectives: The purpose of this study was to assess attitudes and behaviors related to smoke-free policy among undergraduate student alcohol drinkers on a campus in a community with smoke-free bars., Design and Sample: This was a secondary data analysis of a study in which participants completed mailed surveys assessing demographic characteristics, attitudes and behaviors related to alcohol and tobacco use and smoke-free policy (n = 337). Opinion and behavior items were summarized descriptively; associations were examined using Kruskal Wallis tests and chi-square tests of association. Logistic regression tested for predictors of importance of smoke-free policy., Results: Respondents were predominantly female and Caucasian; mean age 20.3 years. One fourth were current smokers. Seventy-nine percent said the community smoke-free law had no effect on frequency of visiting bars. Eighty-seven percent said smoke-free policy in campus buildings was "somewhat" or "very important." Predictors of perceived importance of smoke-free policy included gender and smoking status., Conclusions: Most smokers in this sample did not experience a change in their motivation to quit smoking or in number of cigarettes smoked daily. Implementation of a community smoke-free law did not reduce the likelihood of visiting bars. Women and nonsmokers were more likely to rate smoke-free campus policy as very important., (© 2011 Wiley Periodicals, Inc.)

Objective: The purpose of this study was to determine the factors related to motivation to quit among smoking family members of lung cancer patients., Design and Sample: Relatives of multidisciplinary lung cancer clinic patients were recruited during family members' treatment. Participants (N=29) were primarily female and Caucasian., Measures: The items assessed included the effect of their relative's disease on motivation to quit, intent to quit in the next 6 months, stage of change, perceived risk from smoking, and attitudes about being approached about cessation., Results: Most indicated that their relative's disease had increased motivation to quit smoking (71%); 72% planned to quit within 6 months. One fourth (28%) were in precontemplation stage of change; 65% in contemplation; and 7% in preparation. The average perceived risk of developing lung cancer was 6.3. Two thirds were glad or very glad that someone had talked with them about quitting; 91% thought it was somewhat or very appropriate to talk about cessation with family members of lung cancer patients. Motivation to quit smoking was positively correlated with stage of change and perceived lung cancer risk., Conclusions: Public health nurses who interact with families of lung cancer patients may be able to promote cessation in an at-risk group that is motivated to quit smoking., (© 2010 Wiley Periodicals, Inc.)

Little is known about the impact of smoke-free legislation on smoking and drinking alcohol among college students. The purpose was to examine whether strength and duration of municipal smoke-free laws are associated with cigarette and alcohol use among college students. Full-time undergraduates from two Southeastern universities participated in mailed (Site A) or electronic (Site B) surveys assessing tobacco and alcohol use and other risk behaviors pre and post comprehensive municipal smoke-free laws (Site A, N = 1,366. Site B, N = 1,404). The first cohort at each site participated prior to a municipal smoke-free law in the community. The second survey was conducted post-law (Site A, 3.5 years, Site B, 8 months). Past 30-day cigarette and alcohol use and other demographic and personal characteristics were assessed. At Site A, controlling for demographic differences and current alcohol use, the odds of being a current smoker were 32% lower post-law (28% pre-law vs. 19% post-law; odds ratio = 0.68, P = 0.02). At Site B, with demographics and drinking status in the model, the decrease in smoking rate from pre- to post-law was not significant. At both sites, controlling for demographics and current smoking status, change in the likelihood of drinking was not significant. Comprehensive smoke-free laws in the surrounding community may reduce smoking rates among college students who live, work and recreate there, particularly after the laws are well-established. While alcohol prevalence is very high among college students, enacting smoke-free legislation was not associated with alcohol use.

Objective: To evaluate whether the adult smoking rate changed in Lexington-Fayette County, Kentucky, following the enactment of a smoke-free public places ordinance., Methods: Behavioral Risk Factor Surveillance System (BRFSS) data from 2001-2005 were used to test whether smoking rates changed in Fayette County from the pre- to post-law period, relative to the change in 30 Kentucky counties with similar demographics. The sample consisted of 10,413 BRFSS respondents: 7139 pre-law (40 months) and 3274 post-law (20 months)., Results: There was a 31.9% decline in adult smoking in Fayette County (25.7% pre-law to 17.5% post-law). In the group of 30 Control counties, the rate was 28.4% pre-law and 27.6% post-law. Controlling for seasonality, time trend, age, gender, ethnicity, education, marital status, and income, there was a significant Time (pre- vs. post-law) by Group (Fayette vs. Controls) interaction. There were an estimated 16,500 fewer smokers in Fayette County during post-law compared to pre-law., Conclusion: There was a significant effect of smoke-free legislation on adult smoking rates.

Public support for Lexington-Fayette County, Kentucky's smoke-free law, perception of health risks from exposure to secondhand smoke (SHS), smoking behaviors, and frequency of visiting restaurants, bars, and entertainment venues were assessed pre- and post-law. Two cohorts of noninstitutionalized adults (N = 2,146) were randomly selected and invited to participate in a 10- to 15-min telephone survey. Public support for the smoke-free law increased from 56% to 63%, and respondents were 1.3 times more likely to perceive SHS exposure as a health risk after the law took effect. Although adult smoking and home smoking policy did not change post-law, adults frequented public venues at least as much as before the law. Lexington adults favored the smoke-free legislation despite living in a traditionally protobacco climate. The smoke-free law acted as a public health intervention as it increased perception of risk of heart disease and cancer from SHS exposure.

This case study examined the implementation and enforcement of the purchase, use, and possession (PUP) laws for tobacco in four Kentucky communities. Purposive and snowball sampling were used to identify 44 adult key informants. Qualitative, semistructured phone interviews assessed knowledge about PUP laws, enforcement, effects of the laws on teen tobacco use, and perceptions about the laws. Seven themes were identified: enforcement not a priority, unaware of enforcement authority, spotty enforcement, other sources of tobacco, minimum penalties, confusion about compliance checks, and schools as de facto enforcers. One community went beyond the statutory requirements of the law and created more stringent penalties for violating the use and possession law, and it also had low illegal sales rates. These laws may be more effective if they are enforced strictly with a meaningful penalty and a clear enforcement strategy.

Objective: Examine receptivity and motivation to use/quit tobacco among college students after viewing Truth ads. Participants: Random sample of 10,000 college students invited to complete online survey February 2016 (8.5% response rate). Methods: Quasi-experimental. Participants (N = 854) watched four ads and answered survey items for each ad. Results: Students rated ad receptivity and decreased motivation to use tobacco higher for the Catmageddon ad than the others. Regardless of ad, men and current cigarette smokers reported lower receptivity. Younger age was associated with lower motivation to use tobacco for all ads. Tobacco users reported greater motivation to quit with the Catmageddon ad. Conclusions: College students were receptive to the Truth ads, and many indicated lower motivation to use tobacco. Men, older college students, and current cigarette smokers were less receptive to the ads, reinforcing the need to develop tailored campaigns to reach these subgroups.

Background: More radon-related lung cancers occur among those exposed to tobacco smoke. Objectives: To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention. Methods: The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models. Results: The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation. Conclusions: Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.

Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50--0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported "to socialize" as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts.

Background: Tobacco media campaigns are effective, but less is known regarding the impact on college students. Purpose: The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. Methods: A quasi-experimental pre-post design was used to assess the 8-week campaign with 3 Tips ads. Two randomly selected cohorts of college students (N = 1593) from a large public university completed online surveys pre- and postcampaign. Group comparisons using chi-square tests, 2-sample t tests, and logistic regression, controlling for residence or cohort, and predictors of believability using proportional odds modeling were examined. Results: Ads were recalled by significantly more students (68%) postcampaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (P < 0.05). Believability was greater for those who recalled seeing the ads more often (P < 0.05). Discussion: Subgroups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. Translation to Health Education Practice: Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

Objectives: (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences. Participants: Undergraduate students attending a large university in the Southeast United States (N = 511). Methods: An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics. Results: Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco. Conclusion: To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies.

Purpose: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e‐cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time. Methods: We analyzed data from the National Youth Tobacco Survey (2011‐2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics. Findings: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e‐cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time. Conclusions: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e‐cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e‐cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location. [ABSTRACT FROM AUTHOR]

An introduction articles in the issue is presented on topics including the heterogeneity of the rural population as critically important, the use of community health workers to increase access to lung cancer screening for people in low-resourced communities, and the call for nurses to mobilize to level of the tobacco control playing field in rural and urban areas.

Objectives: Objectives were to (1) explore perceived effectiveness of existing smoke‐free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents. Design and Sample: Qualitative methods design. Thirty‐nine rural adults recruited by community partners. Measures: Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke‐free policy. Results: Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials. Conclusions: Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke‐free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke‐free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS. [ABSTRACT FROM AUTHOR]

This study explores youth smokers' (N = 20) knowledge, experience, and perceptions of Kentucky's PUP laws through a series of focus groups. Most adult smokers become addicted to nicotine before high school graduation, revealing the importance of developing and enforcing strong policies related to adolescent smoking. By 2003, 45 U.S. states had passed laws punishing youth for possession, use, and purchase of tobacco products, referred to as PUP laws. Adolescents' understanding of these laws may increase support and compliance with the policy; yet little is known about teens' understanding, perceptions, and consequences of PUP laws. Teen smokers in this study reported easy access to tobacco products, due in part to inconsistent and weak enforcement. They reported a lack of community-wide commitment to reducing access, resulting in mixed messages about the seriousness of youth smoking. Youth perceived the laws were not taken seriously, given weak penalties and inconsistent enforcement. Effective communication strategies are needed to increase adolescents' understanding of PUP laws, thereby increasing support and compliance. Community interventions are also needed to engage all stakeholders including schools in consistent and visible enforcement of these laws. As part of a comprehensive approach, these activities can contribute to reductions in teen smoking. [ABSTRACT FROM AUTHOR]

Purpose: To examine frequency, prominence, and content of local print media after a 4-year policy advocacy intervention.Design: This was a controlled community-based trial.Setting: The study took place in 39 rural counties (22 intervention, 17 comparison).Subjects: Subjects consisted of 2525 newspaper articles monitored over 18 quarters (July 2007 to December 2011).Intervention: One key element of the tailored policy advocacy intervention delivered by community advisors was building demand for smoke-free policy via media advocacy strategies.Measures: Media clips were coded to assess number of articles; percent of tobacco-related articles on the front page or bold heading section; percent of pro-health articles; and percent of articles with secondhand smoke (SHS)-relevant topics or themes.Analysis: Coded data were entered into Atlas.ti software. Article frequencies and attributes were compared between groups and over time using negative binomial regression for longitudinal data, with county-level demographics as covariates.Results: In the last 3 years, there were approximately twice as many articles in intervention than in comparison counties. Media clips from newspapers in intervention counties were between 1.4 and 2 times more likely to have front page placement and percent of relevant topic or theme than were those in comparison counties. There was no difference in rate of pro-health articles by group.Conclusion: The policy advocacy intervention to promote smoke-free policy increased media attention to SHS and may have increased public awareness of issues related to smoke-free policy. [ABSTRACT FROM AUTHOR]