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Aims: To estimate the relationships of tobacco outlet density, cigarette sales without ID checks and local enforcement of underage tobacco laws with youth's life-time cigarette smoking, perceived availability of tobacco and perceived enforcement of underage tobacco laws and changes over time., Design: The study involved: (a) three annual telephone surveys, (b) two annual purchase surveys in 2000 tobacco outlets and (c) interviews with key informants from local law enforcement agencies. Analyses were multi-level models (city, individual, time)., Setting: A sample of 50 mid-sized non-contiguous cities in California, USA., Participants: A total of 1478 youths (aged 13-16 at wave 1, 52.2% male); 1061 participated in all waves., Measurements: Measures at the individual level included life-time cigarette smoking, perceived availability and perceived enforcement. City-level measures included tobacco outlet density, cigarette sales without ID checks and compliance checks., Findings: Outlet density was associated positively with life-time smoking [OR = 1.12, P < 0.01]. An interaction between outlet density and wave (OR = 0.96, P < 0.05) suggested that higher density was associated more closely with life-time smoking at the earlier waves when respondents were younger. Greater density was associated positively with perceived availability (β = 0.02, P < 0.05) and negatively with perceived enforcement (β = -0.02, P < 0.01). Sales rate without checking IDs was related to greater perceived availability (β = 0.01, P < 0.01) and less perceived enforcement (β = -0.01, P < 0.01). Enforcement of underage tobacco laws was related positively to perceived enforcement (β = 0.06, P < 0.05)., Conclusions: Higher tobacco outlet density may contribute to life-time smoking among youths. Density, sales without ID checks and enforcement levels may influence beliefs about access to cigarettes and enforcement of underage tobacco sales laws., (© 2015 Society for the Study of Addiction.)

This study investigated the associations of youth cigarette smoking with tobacco outlet densities and proximity of tobacco outlets to youth homes and schools across different buffers in 45 midsized California communities. The sample comprised 832 youths who were surveyed about their smoking behaviors. Inclusion criteria included both home and school addresses within city boundaries. Observations in the 45 cities were conducted to document addresses of tobacco outlets. City- and buffer-level demographics were obtained and negative binomial regression analyses with cluster robust standard errors were conducted. All models were adjusted for youth gender, age, and race. Greater densities of tobacco outlets within both a 0.75 and 1-mile buffer of youth homes were associated with higher smoking frequency. Neither tobacco outlet densities around schools nor distance to the nearest tobacco outlet from home or school were associated with youths past-30-day smoking frequency. Lower population density and percent of African Americans in areas around homes and lower percent of unemployed in areas around schools were associated with greater smoking frequency. Results of this study suggest that restricting outlet density within at least 1-mile surrounding residential areas will help to reduce youth smoking.

Few studies have investigated the complex interactions among the individual- and community-level social risk factors that underlie adolescents' smoking behaviors. This study investigated whether community-level adult daily smoking prevalence is associated with adolescents' smoking and whether it moderates the associations between perceived friends' smoking approval and smoking behavior and adolescents' own smoking. Self-reported data from 1,190 youths (50.3% female; 13-18 years old) in 50 midsized Californian cities were obtained through telephone interviews. Community characteristics were obtained from 2010 GeoLytics data. Community adult daily smoking prevalence was ascertained from telephone interviews with 8,918 adults conducted in the same 50 cities. Multilevel analyses, controlling for individual and city characteristics, were used to predict adolescents' past 12-month smoking from perceived friends' smoking approval and smoking behavior and from community adult daily smoking prevalence. Results showed that perceived friends' smoking approval and behavior were associated positively with adolescents' smoking, as was the community-level prevalence of adult daily smoking. Furthermore, the association between perceived friends' smoking behavior and adolescents' own smoking was moderated by the prevalence of adult daily smokers in the community. Specifically, the association was stronger in cities with higher prevalence of adult smokers. These results suggest that adult community norms that are more supportive of smoking may enhance the influence of friends' smoking behavior. Therefore, interventions designed to prevent or reduce youths' smoking should also focus on reducing smoking by adults.

Objectives: This study examines contextual and community-level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities., Methods: The study is based on data from access surveys conducted by four confederate buyers (two men and two women) in 997 tobacco outlets. City demographics, adult smoking prevalence, and measures of tobacco outlet density, local tobacco retailer licencing and cigarette tax were included., Results: Multilevel regression analyses indicated that buyer's actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer's actual age and minimum age signs increased the likelihood that clerks will request an identification (ID). At the community level, a higher percentage of minors, higher education, and a greater percentage of African-Americans were associated with an increased likelihood of a successful purchase. Lower percentage of minors, lower education, lower percentage of African-Americans, and having a local tobacco retailer licencing were associated with the retailer asking for an ID. Additionally, supermarkets charged significantly more for a pack of cigarettes than small markets, whereas, smoke/tobacco shops and drug stores/pharmacies charged less. Higher prices were associated with higher median household income and greater percentage of Hispanics. Findings about community characteristics, however, differed by cigarette brand., Conclusions: This study enhances our understanding of the associations between contextual and community characteristics and youth access to tobacco through commercial sources which can help policymakers to identify and target at-risk communities and outlets to decrease youth access to tobacco.

Despite reports of high rates of smoking among Southeast Asian refugees in the United States, few studies have described the environmental aspects of tobacco use among this population, particularly for the second-generation youths. This absence is notable because the social environment within which second-generation youths are exposed to tobacco products differs radically from the natal environment of their parents. We describe results of a youth-led community participatory research project for Southeast Asians in Northern California. Using multiple data sources, second-generation youths documented the salience of tobacco products in their social environment, notably products such as blunts and mentholated cigarettes.

Purpose: This study investigates the associations between local tobacco policy, tobacco outlet density, and youth smoking. A primary focus is on whether local tobacco policy moderates the relation between outlet density and youth smoking., Methods: In all, 1,491 youth (51.9% male, mean age = 14.7 years, standard deviation = 1.05) in 50 midsized California cities were surveyed through a computer-assisted telephone interview. Measures of local clean air policy and youth access policy were created based on a review of tobacco policies in these cities. Outlet density was calculated as the number of retail tobacco outlets per 10,000 persons, and city characteristics were obtained from 2000 U.S. Census data., Results: Using multilevel regression analyses and controlling for city characteristics, tobacco outlet density was positively associated with youth smoking. No significant main effects were found for the two tobacco policy types on any of the smoking outcomes after controlling for interactions and covariates. However, statistically significant interactions were found between local clean air policy and tobacco outlet density for ever smoked and past 12-month cigarette smoking. Comparisons of simple slopes indicated that the positive associations between tobacco outlet density and youth smoking behaviors were stronger at the lowest level of local clean air policy compared with the moderate and high levels., Conclusions: Our results suggest that tobacco outlet density is related to youth smoking. In addition, local clean air policy may act as a moderator of relationship between tobacco outlet density and youth smoking, such that density is less important at moderate and high levels of this tobacco policy., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: School tobacco use policies are part of a comprehensive strategy for preventing or reducing adolescent cigarette smoking. This study examines the relationship between perceived tobacco policy enforcement at the school level and smoking behaviors among students., Methods: 21,281 middle and high school students of 255 schools participated in the 2006 Oregon Health Teens Survey. Multilevel logistic regression was conducted, using a school-level policy enforcement measure based on aggregated student reports, and individual-level characteristics (e.g., age, gender, cigarette smoking before age 12, personal beliefs about smoking) as predictors of past-30-day cigarette smoking behaviors (e.g., any smoking, daily smoking, heavy episodic smoking, smoking on school property)., Results: Higher levels of perceived enforcement of anti-smoking policy at the school level were inversely associated with the prevalence of past-30-day smoking behaviors, independent of individual-level predictors., Conclusions: Stricter enforcement of school policies against tobacco use may help prevent or reduce adolescents' cigarette smoking on and outside of school property.

Introduction: School tobacco use policies are often considered to be part of a comprehensive approach to preventing or reducing adolescent cigarette smoking. However, little is known about the relationships between such policies and adolescents' smoking behaviors or the mechanisms by which any such influence may occur. The present study tested a conceptual model that specifies possible direct and indirect relationships among community norms, school antismoking policies, adolescents' personal smoking beliefs, and cigarette smoking behaviors., Methods: This study used data from 17,256 middle and high school students who participated in the 2006 Oregon Health Teens Survey., Results: Structural equation modeling indicated that perceived enforcement of school policy was directly and positively related to perceived community norms. In addition, adolescents' personal beliefs appeared to mediate the relationship between perceived enforcement of school antismoking policies and past-30-day cigarette smoking. School policies, in turn, partially mediated the relationship between community norms and smoking beliefs., Discussion: The results of this study provide a better understanding of how community norms and school antismoking policies may affect adolescents' cigarette smoking.

Introduction: To address gaps in existing research, the current study used a mixed‐methods approach to describe, contextualise and understand harm perceptions of vaping nicotine relative to cigarette smoking and associations with nicotine and tobacco (NT) use among young adults who identify their genders and sexualities in ways that classify them as sexual and gender minorities (SGM). Methods: Results are based on cross‐sectional surveys and online qualitative interviews with 98 SGM young adults (18–25 years old) in California's San Francisco Bay Area who currently or formerly used combustible tobacco. We generated a measure assessing participants' relative harm perceptions of e‐cigarette use versus cigarette smoking and identified those who perceived cigarette smoking as more harmful than e‐cigarette use compared to those who perceived it to be equally or less harmful. Results: We found that relative harm perceptions of cigarette smoking versus e‐cigarette use are likely related to much uncertainty and confusion about the harms of e‐cigarette use. Moreover, findings illustrate that public health messages regarding the risks of e‐cigarette use may have unintended consequences of increasing cigarette use to replace e‐cigarette use for some SGM young adults, a practice that is incongruent with scientific evidence demonstrating that cigarettes and other combustible tobacco products are riskier than e‐cigarettes and other forms of NT use. Discussion and Conclusions: Results suggest the need for evidence‐based, clear, and direct messaging about the relative harms of cigarettes versus e‐cigarettes to reduce NT‐related inequities in SGM populations. [ABSTRACT FROM AUTHOR]

Introduction Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use. Aims and Methods Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March–May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress. Results Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status. Conclusions The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes. Implications The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

We investigated the perceived impact of COVID-19 on changes in tobacco and nicotine (NT) use among sexual and gender minority (SGM) young adults. We used a mixed methods approach that included closed- and open-ended survey questions and in-depth interviews. Participants were 53 SGM young adults in California who reported current or past cigarette smoking. Of study participants, 63% (n = 33) reported any changes in their NT use, and of those, 60% reported initial increase of NT use. Content analysis of an open-ended survey question revealed three reported reasons for changes in NT use: (1) changes in routine activities (27%), (2) stress (46%), and (3) health (24%). Thematic analysis of qualitative interviews identified several related themes: (1) in discussions of increased NT use, stress and boredom/free time were important aspects of changes to daily routines, (2) fluctuations in NT use behaviors occurred over time, (3) reasons for NT changes were multiple and intertwined, and (4) NT use changes were shaped by experiences related to intersectional forms of structural and social stigmatization. Results reveal the dynamic and complex ways in which participants described their pandemic-related changes in NT use—nuance that is crucial for compassionate and participant-centered approaches to tobacco prevention and cessation. [ABSTRACT FROM AUTHOR]

Aims: To examine whether daily exposure to tobacco outlets within activity spaces is associated with cigarette smoking and with the number of cigarettes smoked by youth that day. Design The study used geographic ecological momentary assessment (GEMA) data that combined daily surveys with ecological momentary assessment of global positioning systems (GPS) using geographic information systems (GIS) to allow for real‐time data collection of participants' environments and behaviors. Setting: Eight mid‐sized California (USA) city areas. Participants: The analytical sample included 1065 days, which were clustered within 100 smoker and non‐smoker participants (aged 16–20 years, 60% female). Measurements Any cigarette smoking and number of cigarettes smoked on a given day, the number of tobacco outlets within 100 m of activity space polylines each day, the number of minutes participants spent within 100 m of tobacco outlets each day and demographic characteristics (age, sex, race/ethnicity and perceived socio‐economic status). Findings Controlling for demographic characteristics, the findings of multi‐level mixed effects logistic models were inconclusive, whether or not the number of tobacco outlets within 100 m of youths' activity space polylines or the number of minutes spent within 100 m of tobacco outlets were associated with whether the participant smoked cigarettes on a given day [odds ratio (OR) = 1.05, P = 0.24; OR = 0.99, P = 0.81, respectively]. However, in multi‐level zero‐inflated negative binomial models, the risk of smoking an additional cigarette on a given day increased with each additional tobacco outlet [incidence rate ratio (IRR) = 1.04, P < 0.05] and each additional minute spent within 100 m of tobacco outlets (IRR = 1.01, P < 0.001) each day. Conclusions: Among young people in urban California, differences in day‐to‐day exposure to tobacco outlets within activity spaces does not seem to be significantly associated with whether a person smokes a cigarette on a given day, but higher exposure to tobacco outlets appears to be positively associated with the number of cigarettes smoked on that day. [ABSTRACT FROM AUTHOR]

Introduction Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. Methods We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. Results The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. Conclusion Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. Implications This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation. [ABSTRACT FROM AUTHOR]

Tobacco denormalization is a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of widespread beliefs about the effectiveness of tobacco denormalization approaches, concerns about their emphasis on stigmatization have emerged. Social science research on smoking stigma raises questions about the potential iatrogenic consequences of tobacco denormalization approaches. Few studies have considered how smoking stigma may be internalized differently by different people, particularly those who experience stigmatization because of other socially ascribed makers of inequity (e.g. race, ethnicity, gender, sexuality). The intersection of multiple stigmas may work to intensify the ‘social isolation and marginalization’ that some people already experience. This paper presents results from a pattern-level analysis of focus group and interview data from a study investigating smoking-related stigma and perceptions of tobacco denormalization approaches among 15 low income Black women who smoke in the San Francisco Bay Area. Our analysis revealed a cycle where Black women’s experiences with structural oppression resulted in stress and the use of cigarettes to cope with that stress. Though the connection between smoking and stress is well documented in previous research, our analysis further revealed the additional contribution of the stigmatization of smoking and how it intensifies inequity for Black women who smoke. Implications of these findings for tobacco control and prevention are discussed. [ABSTRACT FROM PUBLISHER]

Although the population-level success of tobacco denormalization is widely accepted, it remains unclear whether these strategies alleviate health inequities for sexual and gender minorities. The high risk of smoking among sexual and gender minorities together with research that documents a relationship between stigma-related processes and smoking prevalence for these groups raises questions about whether tobacco-related stigma intensifies the disadvantages associated with the stigmas of other social identities. We have not adequately considered how tobacco-related stigma overlaps with other social identity stigmas. Given concerns about the intensification of inequality, this type of inquiry has important implications for understanding both the effectiveness and limitations of tobacco denormalization strategies for sexual and gender minorities and identifying those tobacco prevention, treatment, and public health policies that work to ameliorate health inequities. [ABSTRACT FROM AUTHOR]

Background Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. Methods We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. Results Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. Conclusions The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts. [ABSTRACT FROM AUTHOR]

This study examined: 1) whether using cigarettes to enhance the effects of other drugs (here referred to as "boosting") is a unique practice related to blunts (i.e., small cheap cigars hollowed out and filled with cannabis) or marijuana use only; 2) the prevalence of boosting among drug-using young people; and 3) the relationship between boosting and other drug-related risk behaviors. Data collected from 89 Southeast Asian American young people in Northern California. Seventy-two percent reported any lifetime boosting. Results of linear regression analyses show a positive relationship between frequency of boosting to enhance alcohol high and number of drinks per occasion. Boosting was also associated with use of blunts and with the number of blunts on a typical day. Boosting may be common among drug-using Southeast Asian youths and our findings indicate a need for further research on boosting as an aspect of cigarette uptake and maintenance among drug- and alcohol-involved youths. [ABSTRACT FROM AUTHOR]

Introduction: Shelter-in-place orders altered facilitators and barriers to tobacco use (e.g., outlet closures, restricted social gatherings). This study examined whether the duration of time in shelter in place and compliance with different shelter-in-place orders influenced adolescent cigarette and E-cigarette use and how the use may differ by demographic characteristics.Methods: Shelter-in-place policy data obtained from government websites were merged with cross-sectional 2020 survey data on adolescents in California. Treatment variables included the proportion of time in shelter in place and self-reported compliance with shelter-in-place orders (for essential businesses and retail spaces and social and outdoor contexts). Multilevel logit models for dichotomous past 6-month cigarette and E-cigarette use and multilevel negative binomial regression models for past 6-month frequency of use were used. Moderation analyses were conducted on demographic measures. The sample included 1,196 adolescents (mean age=15.8 years, age range=13-19 years, 49.2% female, 50.0% White). Analyses were conducted in 2022.Results: No associations were found between the proportion of time in shelter in place and outcomes. Shelter-in-place compliance with essential business and retail space orders was associated with lower odds of using cigarettes and E-cigarettes in the past 6 months. Compliance with social and outdoor context-related orders were associated with lower odds of using E-cigarettes and fewer days using cigarettes and E-cigarettes. Being aged ≥18 years moderated the associations between essential business/retail space and social/outdoor context-related shelter-in-place compliance orders and past 6-month frequency of cigarette smoking.Conclusions: Findings support tailored interventions for less compliant and older adolescents for future pandemic mitigation measures. [ABSTRACT FROM AUTHOR]

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants' narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases. [ABSTRACT FROM AUTHOR]