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Women's health, and what we know about it, is influenced by social factors. From the exclusion of women's bodies in medical research, to the silence and stigma of menstruation and menopause, to the racism reflected in maternal mortality, the relevance of social factors is paramount. After a brief history of research on women's health, we review selected patterns, trends, and inequalities in US women's health. These patterns reveal US women's poor and declining longevity relative to those in other high-income countries, gaps in knowledge about painful and debilitating conditions that affect millions of women, and deep inequalities that underscore the need to redress political and structural features of US society that enhance health for some and diminish it for others. We close by describing the challenges and opportunities for future research, and the promise of a social determinants of health approach for advancing a multilevel, intersectional, and biosocial understanding of women's health.

Objectives The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education. Methods We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation. Results The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South. Discussion The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place.

Natural disasters adversely impact children's mental health, with increased parent or child exposure and subsequent parental distress predicting poorer outcomes. It remains unknown, however, whether the psychological consequences of disasters for children persist long-term, and if so, why and for whom. We therefore examined the effects of mothers' exposure to Hurricane Katrina on adolescent children's mental health 12 years later, distinguishing between direct effects of disaster exposure and effects mediated by maternal distress, and evaluating moderation by child age and gender. Data were from a 2003-2018 study of young, low-income, primarily African American mothers living in New Orleans when Hurricane Katrina occurred in 2005 (n = 328). Mothers rated their mental health about one year pre-Katrina and one, four, and 12 years afterwards. They reported on an adolescent child's (ages 10-17, mean = 14.46) internalizing and externalizing symptoms 12 years post-Katrina using the Strengths and Difficulties Questionnaire. Path analytic models adjusting for mothers' pre-disaster distress showed that, whereas the direct effects of maternal hurricane exposures on child mental health were not significant, the indirect effects were. Specifically, mothers who experienced more Katrina-related stressors had higher distress thereafter, which predicted poorer child outcomes. Results did not differ significantly by child age. Gender differences are discussed. Findings suggest that disasters can affect child mental health for many years, even for those who were very young or not yet born at the time, due to parents' disaster-related distress. Addressing parents' mental health needs in the aftermath of disasters may improve child well-being long-term.

Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina. Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or “developing” headaches or migraines, back problems, and digestive problems, and of experiencing remission or “recovery” from previously reported symptoms, across surveys. Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm. Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.

Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters' health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (2003-2018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.

Prior research has provided robust evidence that exposure to potentially traumatic events (PTEs) during a disaster is predictive of adverse postdisaster mental health outcomes, including posttraumatic stress symptoms (PTSS) and nonspecific psychological distress (PD). However, few studies have explored the role exposure to other PTEs over the life-course has in shaping postdisaster mental health. Based on the broader literature on trauma exposure and mental health, we hypothesized a path analytic model linking predisaster PTEs to long-term postdisaster PTSS and PD via predisaster PD, short-term postdisaster symptoms, and disaster-related and postdisaster PTEs. We tested this model using data from the Resilience in Survivors of Katrina study, a longitudinal study of low-income, primarily non-Hispanic Black mothers exposed to Hurricane Katrina and assessed before the disaster and at time points 1, 4, and 12 years thereafter. The models evidenced a good fit with the data, RMSEA < .01–.04, CFIs > .99. In addition, 44.1%–67.4% of the effect of predisaster PTEs on long-term postdisaster symptoms was indirect. Descriptive differences were observed across models that included PTSS versus PD, as well as models that included all pre- and postdisaster PTEs versus only those that involved assaultive violence. The results suggest the importance of incorporating disaster preparedness in clinical work with trauma survivors and the value in attending to other lifetime PTEs when working in postdisaster contexts.

Exposure to disasters has a range of adverse mental-health consequences. This Commentary argues that to understand variation in post-disaster mental health, we must look beyond the disaster itself to other sources of vulnerability throughout the life course, as well as the developmental stage at which the disaster was experienced.

Across the United States, residents of lower income neighborhoods evince poorer health, on average, than residents of more affluent areas. Studies aiming to explain this pattern have focused largely on the effects of neighborhood characteristics on residents' health, often overlooking the possibility that the reverse causal process-that a person's health impacts where they live, or "health selection into neighborhoods"-also plays a role. We investigated processes of health selection using the Panel Study of Income Dynamics, a longitudinal survey of U.S. households. Using ordinary least squares linear regression, we estimated the effect of householders' self-rated health on their neighborhood socioeconomic status (SES, the Census tract-level family poverty rate) in 2013, adjusting for neighborhood SES and health in 2001 as well as sociodemographic characteristics and residential mobility. Poorer health was associated with residence in higher poverty neighborhoods overall. Stratified models indicated that while health selection was observed across both race/ethnicity and class boundaries, the relationship between poor health and neighborhood poverty was stronger among non-Hispanic Black respondents, those with low income, and respondents who either moved moderate distances or did not move at all during the study period. We conclude with a call for future work exploring the mechanisms leading those in worse health to reside in higher poverty neighborhoods, and for public health policies that seek not only to improve health supporting conditions in economically disadvantaged neighborhoods, but that also support the economic and social needs of residents struggling with health problems.

Objectives High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults’ beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age. Methods In a representative sample of U.S. adults aged 50–89 from the 2006–2014 Health and Retirement Study (n = 18,979 respondents), we analyze SLE using generalized linear regression. Results Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about 1 in 10 older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled. Discussion Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring.

Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters’ health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (2003–2018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.

Beyond their immediate effects on mortality, disasters have widespread, indirect impacts on mental and physical well-being by exposing survivors to stress and potential trauma. Identifying the disaster-related stressors that predict health adversity will help officials prepare for the coronavirus disease 2019 (COVID-19) pandemic. Using data from a prospective study of young, low-income mothers who survived Hurricane Katrina, we find that bereavement, fearing for loved ones’ well-being, and lacking access to medical care and medications predict adverse mental and physical health 1 y postdisaster, and some effects persist 12 y later. Adjusting for preexisting health and socioeconomic conditions attenuates, but does not eliminate, these associations. The findings, while drawn from a demographically unique sample, suggest that, to mitigate the indirect effects of COVID-19, lapses in medical care and medication use must be minimized, and public health resources should be directed to those with preexisting medical conditions, their social networks, and the bereaved.

Sociologists interested in the effects of genes on complex social outcomes claim environmental conditions structure when and how genes matter, but they have only studied environmental moderation of genetic effects on single traits at a time (gene-by-environment interactions). In this article, we propose that the social environment can also transform the genetic link between two traits. Taking the relationship between educational attainment and smoking as an exemplary case, we use genome-wide methods to examine whether genetic variants linked to education are also linked to smoking, and whether the strength of this relationship varies across birth cohorts. Results suggest that the genetic relationship between education and smoking is stronger among U.S. adults born between 1974 and 1983 than among those born between 1920 and 1959. These results are supported by replication in additional data from the United Kingdom. Environmental conditions that differ across birth cohorts may result in the bundling of genetic effects on multiple outcomes, as anticipated by classic cohort theory. We introduce genetic correlation-by-environment interaction [(rG)xE] as a sociologically-informed model that will become especially useful as data for more well-powered analyses become available.

Background Implementation of tobacco plain packaging (PP) in Australia in December 2012 was associated with significant reductions in the percentage of patrons at outdoor cafes observed to be displaying tobacco packs and actively smoking, immediately post-implementation and 1 year later. This study examines whether these positive effects were sustained through to 2 years post-PP. Methods An observational study conducted at cafes, restaurants and bars with outdoor seating in Melbourne, Australia documented the number of: patrons; patrons actively smoking; tobacco packs on display; orientation and type of displayed packs and whether or not children were present. Data were collected pre-PP (2012), early post-PP (2013), 1 year post-PP (2014) and 2 years post-PP (2015). Multilevel Poisson regressions analyzed changes in each outcome, adjusting for important covariates. Results Overall, positive effects of PP implementation on tobacco pack display and active smoking were not fully sustained through to 2 years post-PP for the total sample. Interactions between phase and the presence of children indicated that pack display and active smoking were lower in all post-implementation phases (compared with pre-PP) at venues where children were present but not at venues where children were not present. Conclusions Children at outdoor cafes were still being exposed to less tobacco packaging and active smoking, 2 years after implementation of the packaging changes. More regular refreshment of graphic health warnings is likely to be required to sustain these effects, and to reduce pack display behaviour at venues with no children.

Objectives To assess whether following standardisation of tobacco packaging in Australia, smokers were, as predicted by the tobacco industry, more likely to use illicit tobacco. Methods National cross-sectional telephone surveys conducted continuously from April 2012 (6 months before implementation of plain packaging (PP)) to March 2014 (15 months after) using responses from current cigarette smokers (n=8679). Changes between pre-PP, the transition to PP and PP phase were examined using logistic regression models. Results Among those whose factory-made cigarettes were purchased in Australia, compared with pre-PP, there were no significant increases in the PP phase in use of: ‘cheap whites’ (

Background We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms. Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April–September 2012, pre-PP) with n=759 surveyed in the transition period (October–November 2012) and n=4240 during the first year of implementation (December 2012–November 2013, PP year 1), using multivariate logistic regression analyses. Results From pre-PP to PP year 1, more smokers disliked their pack (p

Objectives To describe changes among smokers in use of various types of tobacco products, reported prices paid and cigarette consumption following the standardisation of tobacco packaging in Australia. Methods National cross-sectional telephone surveys of adult smokers were conducted from April 2012 (6 months before transition to plain packaging (PP)) to March 2014 (15 months afterwards). Multivariable logistic regression assessed changes in products, brands and pack types/sizes; multivariable linear regression examined changes in inflation-adjusted prices paid and reported cigarette consumption between the pre-PP and three subsequent periods—the transition phase, PP year 1 and PP post-tax (post a 12.5% tax increase in December 2013). Results The proportion of current smokers using roll-your-own (RYO) products fluctuated over the study period. Proportions using value brands of factory-made (FM) cigarettes increased from pre-PP (21.4%) to PP year 1 (25.5%; p=0.002) and PP post-tax (27.8%; p

Background Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours. Methods We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates. Results Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed significantly greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed-up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)). Conclusions These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers.

Background Implementation of tobacco plain packaging (PP) with larger graphic health warnings (GHWs) in Australia had positive effects on responses reflecting the specific objectives of the PP policy and on follow-up quitting-related cognitions and behaviours. The aim of this study was to examine predictive relationships between these proximal and distal outcomes. Methods A nationally representative sample of Australian adult cigarette smokers completed a baseline survey and a 1-month follow-up survey within the first year of policy implementation (n(weighted)=3125). Logistic regression analyses tested whether baseline measures of cigarette appeal, GHW effectiveness, perceived harm and concern/enjoyment predicted each of seven follow-up measures of quitting-related cognitions and behaviours, adjusting for baseline levels of the outcome and covariates. Results In multivariable models, we found consistent evidence that several baseline measures of GHW effectiveness positively and significantly predicted the likelihood that smokers at follow-up reported thinking about quitting at least daily, intending to quit, having a firm date to quit, stubbing out cigarettes prematurely, stopping oneself from smoking and having attempted to quit. Two of the quitting-related outcomes were also predicted by feeling more smoking-related concern than enjoyment. A smaller number of the appeal variables were prospectively associated with quitting-related outcomes, while believing that brands do not differ in harmfulness did not positively predict any outcomes. Conclusions These findings provide an initial insight into the pathways through which PP with larger GHWs may lead to changes in smoking behaviour. Future research should examine whether the effects are conditional on individual demographic and smoking characteristics.

Aims We observed tobacco pack display and smoking at outdoor venues over three summers to assess changes in their prevalence following Australia9s introduction of plain tobacco packaging with larger pictorial health warnings. Methods Between January and April 2012 (preplain packaging (PP)), 2013 (early post-PP) and 2014 (1 year post-PP), we counted patrons, smokers and tobacco packs at cafes, restaurants and bars with outdoor seating. Pack type (branded, plain or unknown) and orientation were noted. Rates of active smoking, pack display and pack orientation were analysed using multilevel Poisson regression. Results Prevalence of pack display among patrons declined from pre-PP (1 pack per 8.7 patrons) to early post-PP (1 pack per 10.4), and remained low 1 year post-PP (1 pack per 10.3). This appeared to be driven by a sustained decline in active smoking post-PP (pre-PP: 8.4% of patrons were smoking; early post-PP: 6.4%; 1 year post-PP: 6.8%). Notably, active smoking declined more in venues with children present than in those without. While early post-PP, plain packs were less often displayed face-up (74.0%) and more often concealed (8.9%) than branded packs pre-PP (face-up: 85.2%; concealed: 4.0%), this was not sustained 1 year post-PP (face-up: 85.7%; concealed: 4.4%). Also, external case use increased from pre-PP (1.2%) to early post-PP (3.5%), but returned to pre-PP levels 1 year post-PP (1.9%). Conclusions This study demonstrated a sustained reduction in visibility of tobacco products and smoking in public, particularly in the presence of children, from pre-PP to 1 year post-PP. This effect is likely to reduce smoking-related social norms, thereby weakening an important influence on smoking uptake and better supporting quit attempts.

We introduce Multi-Trait Analysis of GWAS (MTAG), a method for joint analysis of summary statistics from GWASs of different traits, possibly from overlapping samples. We apply MTAG to summary statistics for depressive symptoms (Neff = 354,862), neuroticism (N = 168,105), and subjective well-being (N = 388,538). Compared to 32, 9, and 13 genome-wide significant loci in the single-trait GWASs (most of which are themselves novel), MTAG increases the number of loci to 64, 37, and 49, respectively. Moreover, association statistics from MTAG yield more informative bioinformatics analyses and increase variance explained by polygenic scores by approximately 25%, matching theoretical expectations.

Aims We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia. Methods Between October and April 2011–12 (pre-plain packaging, pre-PP) and 2012–13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafes, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression. Results Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79–0.91, P

Nongovernmental organizations (NGOs) have become influential forces in global society. They exert their influence in part by framing issues and thereby suggesting particular courses of action. This article examines how NGOs with distinct missions represent mass violence for the case of Darfur. Content analysis of reports, speeches, and other documents from Amnesty International, Doctors Without Borders, and Save Darfur reveals distinct patterns across organizations. In addition to the organizations' specialized fields, interventions by external actors such as the United Nations and the International Criminal Court affect NGO framing, but they do so in organization-specific ways. Against presumptions of a uniform Western position on Darfur, this analysis documents that depictions of violence by Western NGOs show field-specific patterns and distinct responses to international political and judicial interventions.

In the version of the paper initially published, no competing interests were declared. The ‘Competing interests’ statement should have stated that B.M.N. is on the Scientific Advisory Board of Deep Genomics. The error has been corrected in the HTML and PDF versions of the article.

Among American Indians and Alaska Natives, most aspects of ethnicity are tightly associated with the person's tribal origins. Language, history, foods, land, and traditions differ among the hundreds of tribes indigenous to the United States. With this in mind, we ask why almost one million American Indians failed to respond to the tribal affiliation part of the Census 2000 race question. We investigate four hypotheses about why one-third of multiracial American Indians and one-sixth of single-race American Indians did not write any response to the tribal affiliation question: (1) survey item non-response which undermines all fill-in-the-blank questions, (2) a non-salient tribal identity, (3) a genealogy-based affiliation, and (4) a mestizo identity which does not require a tribe. We use multivariate logistic regression models and high-density restricted-use Census 2000 data. We find support for the first two hypotheses and note that predictors differ substantially for single-race versus multiple-race American Indians.

Opponents of plain packaging (PP) in Australia1–4 and elsewhere5–8 have claimed that the legislation would create confusion for retailers attempting to locate packs of uniform appearance. This, it was claimed, would result in increases in pack retrieval and overall serving times,9 ,10 impatience with queuing among customers, and a consequent shift in patronage, sales and profits from small mixed businesses to large discount outlets such as supermarkets.10 ,11 Surveys of retailers funded by tobacco industry groups reported perceived negative effects among retailers shortly after implementation of the legislation.12 However, studies of retail outlets conducted across Australia over the period of implementation of legislation found no lasting effects on retail serving time13 and a study conducted in the Australian state of Victoria 1 year before (2011) and 1 year after (2013) introduction detected no changes among current smokers in usual place of purchase of tobacco products.14 We aimed to repeat and extend this analysis using a large national data set. We used data from continuous national cross-sectional telephone surveys conducted between 9 April 2012 and 30 March 2014 with about 100 respondents per week aged 18–69 years, described fully in Wakefield et al 15 (this volume). All respondents were asked ‘Do …

Objective We sought to determine the relative frequency and nature of personal display of cigarette packs by smokers in two Australian cities where 30% front-of-pack and 90% back-of-pack health warnings have been used since 2006 and comprehensive tobacco marketing restrictions apply. Methods An observational study counted patrons, active smokers and tobacco packs at cafes, restaurants and bars with outdoor seating. Pack orientation and use of cigarette cases were also noted. Results Overall, 18 954 patrons, 1576 active smokers and 2153 packs were observed, meaning that one out of every 12.0 patrons was actively smoking, and one of every 8.8 patrons displayed a pack. Packs were more frequently observed in lower socio-economic neighbourhoods, reflecting the higher prevalence of smoking in those regions. Packs were displayed less often in venues where children were present, suggesting a greater tendency not to smoke around children. Most packs (81.4%) were oriented face-up, permitting prominent brand display. Only 1.5% of observed packs were cigarette cases, and 4.2% of packs were concealed by another item, such as a phone or wallet. Conclusions Tobacco packs are frequently seen on table-tops in cafe strips, providing many opportunities for other patrons and passers-by to be incidentally exposed to cigarette brand names and imagery. Use of cigarette cases is rare, suggesting that smokers eventually habituate to pictorial warnings on branded packs and/or find repeated decanting of each newly purchased branded pack into a case to be inconvenient.

Among American Indians and Alaska Natives, most aspects of ethnicity are tightly associated with the person's tribal origins. Language, history, foods, land, and traditions differ among the hundreds of tribes indigenous to the United States. With this in mind, we ask why almost one million American Indians failed to respond to the tribal affiliation part of the Census 2000 race question. We investigate four hypotheses about why one-third of multiracial American Indians and one-sixth of single-race American Indians did not write any response to the tribal affiliation question: (1) survey item non-response which undermines all fill-in-the-blank questions, (2) a non-salient tribal identity, (3) a genealogy-based affiliation, and (4) a mestizo identity which does not require a tribe. We use multivariate logistic regression models and high-density restricted-use Census 2000 data. We find support for the first two hypotheses and note that predictors differ substantially for single-race versus multiple-race American Indians.

Objectives To test for early evidence whether, following the standardisation of tobacco packaging, smokers in Australia were—as predicted by the tobacco industry—less likely to purchase from small mixed business retailers, more likely to purchase cheap brands imported from Asia and more likely to use illicit tobacco. Design Serial cross-sectional population telephone surveys in November 2011 (a year prior to implementation), 2012 (during roll-out) and 2013 (a year after implementation). Setting/participants Smokers aged 18 years and over identified in an annual population survey in the Australian state of Victoria (2011: n=754; 2012: n=590; 2013: n=601). Main outcome measures Changes between 2011 and 2013 in: proportions of current smokers who purchased their last cigarette from discount outlets such as supermarkets compared with small mixed business retail outlets; prevalence of regular use of low-cost brands imported from Asia and use of unbranded tobacco. Results The proportion of smokers purchasing from supermarkets did not increase between 2011 (65.4%) and 2013 (65.7%; p=0.98), and the percentage purchasing from small mixed business outlets did not decline (2011: 9.2%; 2012: 11.2%; p=0.32). The prevalence of low-cost Asian brands was low and did not increase between 2011 (1.1%) and 2013 (0.9%; p=0.98). The proportion reporting current use of unbranded illicit tobacco was 2.3% in 2011 and 1.9% in 2013 (p=0.46). In 2013, 2.6% of cigarette smokers reported having purchased one or more packets of cigarettes in non-compliant packaging in the past 3 months; 1.7% had purchased one or more packets from an informal seller in the past year. Conclusions One year after implementation, this study found no evidence of the major unintended consequences concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and use of illicit tobacco predicted by opponents of plain packaging in Australia.

Objective: To investigate whether the density of tobacco retail outlets near schools in Victoria, Australia, is associated with adolescent smoking behaviour. Methods: Cross-sectional survey data of 2,044 secondary school students aged 12–17 years was combined with tobacco outlet audit data. Associations between students' self-reported tobacco use and the density of tobacco outlets near schools was examined using multilevel logistic and negative binomial regression models, with cigarette price at local milk bars and key socio-demographic and school-related variables included as covariates. Results: Increased tobacco retail outlet density was associated with a significant increase in the number of cigarettes smoked in the previous seven days among students who smoked in the past month (IRR=1.13; 95% CI 1.02–1.26), but not the odds of smoking in the past month in the larger sample (OR=1.06; 95% CI 0.90–1.24), after controlling for local mean price of cigarettes and socio-demographic and school-related variables. Conclusions and implications: This study suggests there is a positive association between tobacco retail outlet density and cigarette consumption among adolescent smokers, but not smoking prevalence, in the Australian context. There is value in considering policy measures that restrict the supply of tobacco retail outlets in school neighbourhoods as a means of reducing youth cigarette consumption.

We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia.Between October and April 2011-12 (pre-plain packaging, pre-PP) and 2012-13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression.Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79-0.91, P 0.001], driven by a 23% decline in active smoking (IRR = 0.77, 95% CI = 0.71-0.84, P 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status (SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre-PP to 73.6% of plain packs post-PP (IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre-PP and 9.5% of plain packs post-PP; IRR = 2.33, 95% CI = 1.72-3.17, P 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation.Following Australia's 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion.

How is a person's racial self-representation related to the race history of the place in which he or she lives? We use Census Bureau data about race and ancestry to address this research question for two groups of people with mixed racial heritage: those reporting white and American Indian heritages, or reporting black and American Indian heritages. Links between history, place, and self-representation can be seen in geographic clustering for each race/ancestry response combination. We use multinomial logistic regression models to predict individuals' race/ancestry responses (e.g., white with American Indian ancestry versus white and American Indian races) using measures of local race history and the area's contemporary racial composition. Multivariate results highlight the relationship between a person's identity claims and the history of the area, net of contemporary area composition. Future research should attend to the history of the place as a potential contributor to contemporary patterns.

Objective This study aims to explore how cigarette brands are arranged on boards listing tobacco products and/or prices following the 1 January 2011 ban on point-of-sale tobacco displays in Victoria, Australia. Methods An audit undertaken in late 2011 gathered information on the prevalence and contents of tobacco product information displays (‘price boards’). We examined how often all or most of the brands listed at the top of price boards were owned by the same tobacco company, and whether premium, mainstream and value brands were listed in prominent positions more frequently in different store types and socio-economic areas (SES). Results Of the 281 stores audited, 64% (179) had legible price boards. Of the 178 with factory-made products, 11% arranged brands alphabetically, 2% by price and 87% did so in some other way. In 65% of stores where brands were arranged in some other way, at least three of the top four positions were devoted to brands owned by the same tobacco company. Premium brands were given greater prominence than would be expected by market share. Neighbourhood SES was significantly related to the representation in the most prominent price board positions of brands from the most appropriate market segment. Conclusions Price boards are being used to target brands to consumers. Jurisdictions should also prohibit price board display when they ban tobacco product display; prices might instead be itemised in alphabetical order on a list only viewable upon customer request.

INTRODUCTION This study aimed to evaluate compliance with legislation which restricted cigarette displays in retail outlets, and to assess prevalence of pro- and anti-tobacco elements in stores pre- and post-legislation. METHODS Three audits of 302 stores in Melbourne, Australia by trained observers who gathered information on point-of-sale tobacco displays 2-3 months before and 3-4 and 11-12 months after the enactment of new restrictions. RESULTS Between the first and second audits, nine stores stopped selling tobacco and three stores had either shut down or were closed for renovations. Of the remaining 290 stores, 94.1% observed the full ban on cigarette package visibility, while new restrictions on price board size and new requirements for graphic health warnings were followed in 85.9% and 67.2% of stores, respectively. Between the second and third audits, another seven stores ended tobacco sales and two stores closed. In Audit 3, 89.7% of the remaining 281 stores complied with price board restrictions, and 82.2% of stores followed requirements for graphic health warnings. Overall, the prevalence of anti-tobacco signage increased and pro-tobacco features decreased between audits for every store type and neighborhood socio-economic status. CONCLUSIONS Tobacco retailers were almost universally compliant with placing cigarettes out of sight and a substantial majority were compliant with regulations on price board size and display of graphic health warnings, demonstrating that such legislation can be implemented successfully.

Among American Indians and Alaska Natives, most aspects of ethnicity are tightly associated with the person’s tribal origins. Language, history, foods, land, and traditions differ among the hundreds of tribes indigenous to the United States. Why did almost one million of them fail to respond to the tribal affiliation part of the Census 2000 race question? We investigate four hypotheses about why one-third of multiracial American Indians and one-sixth of single-race American Indians did not report a tribe: (1) survey item non-response which undermines all fillin- the-blank questions, (2) a non-salient tribal identity, (3) a genealogy-based affiliation, and (4) mestizo identity which does not require a tribe. We use multivariate logistic regression models and high-density restricted-use Census 2000 data. We find support for the first two hypotheses and note that the predictors and results differ substantially for single race versus multiple race American Indians.

Among American Indians and Alaska Natives, most aspects of ethnicity are tightly associated with the person’s tribal origins. Language, history, foods, land, and traditions differ among the hundreds of tribes indigenous to the United States. Why did almost one million of them fail to respond to the tribal affiliation part of the Census 2000 race question? We investigate four hypotheses about why one-third of multiracial American Indians and one-sixth of single-race American Indians did not report a tribe: (1) survey item non-response which undermines all fill-in-the-blank questions, (2) a non-salient tribal identity, (3) a genealogy-based affiliation, and (4) mestizo identity which does not require a tribe. We use multivariate logistic regression models and high-density restricted-use Census 2000 data. We find support for the first two hypotheses and note that the predictors and results differ substantially for single race versus multiple race American Indians.