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Introduction: During the 2000s the number of adolescents who became new smokers in the United States declined while the number of young adults who did so increased. However, we do not know among which demographic groups these changes occurred.Methods: We analyzed data from the 2006 to 2013 National Survey of Drug Use and Health (n = 180 079). Multivariate linear regression models were used to assess annual trends in smoking onset and log-binomial regression models to assess changes over time in the risk of smoking onset among young adults (18- to 25-years-old) relative adolescents (12- to 17-years-old).Results: From 2006 to 2013, the rate of onset among young adults (6.3%) was greater than among adolescents (1.9%). Time trends demonstrated that annual declines in smoking onset occurred among white young adult males and females. Rates of smoking onset increased among black and Hispanic young adult males with a lower rate of decline among black and Hispanic young adult females. There was a greater risk of smoking onset among young adults relative to adolescents that did not change over time.Conclusions: Smoking onset is becoming more concentrated in the young adult than adolescent years. Despite this trend, there were annual declines in young adult smoking onset but not uniformly across racial/ethnic groups. More effective strategies to prevent young adult smoking onset may contribute to a further decline in adult smoking and a reduction in tobacco-related health disparities.Implications: Smoking onset is becoming more concentrated in the young adult years across sex and racial/ethnic groups. The United States may be experiencing a period of increasing age of smoking onset and must develop tobacco control policies and practices informed by these changes. [ABSTRACT FROM AUTHOR]

Introduction: Smoking-related disparities continue to be a public health problem among American Indian/Alaska Native (AI/AN) population groups and data documenting the health burden of smoking in this population are sparse. The purpose of this study was to assess mortality attributable to cigarette smoking among AI/AN adults relative to non-Hispanic white adults (whites) by calculating and comparing smoking-attributable fractions and mortality.Methods: Smoking-attributable fractions and mortality among AI/ANs (n=1.63 million AI/ANs) and whites were calculated for people living in 637 Indian Health Service Contract Health Service Delivery Area counties in the U.S., from mortality data collected during 2001-2009. Differences in smoking-attributable mortality between AI/ANs and whites for five major causes of smoking-related deaths were examined. All data analyses were carried out in 2013-2014.Results: Overall, from 2001 to 2009, age-adjusted death rates, smoking-attributable fractions, and smoking-attributable mortality for all-cause mortality were higher among AI/ANs than among whites for adult men and women aged ≥35 years. Smoking caused 21% of ischemic heart disease, 15% of other heart disease, and 17% of stroke deaths in AI/AN men, compared with 15%, 10%, and 9%, respectively, for white men. Among AI/AN women, smoking caused 18% of ischemic heart disease deaths, 13% of other heart diseases deaths, and 20% of stroke deaths, compared with 9%, 7%, and 10%, respectively, among white women.Conclusions: These findings underscore the need for comprehensive tobacco control and prevention efforts that can effectively reach and impact the AI/AN population to prevent and reduce smoking. [ABSTRACT FROM AUTHOR]

Introduction. Preemption is a legislative or judicial arrangement in which a higher level of government precludes lower levels of government from exercising authority over a topic. In the area of smoke-free policy, preemption typically takes the form of a state law that prevents communities from adopting local smoking restrictions. Background. A broad consensus exists among tobacco control practitioners that preemption adversely impacts tobacco control efforts. This paper examines the effect of state provisions preempting local smoking restrictions in enclosed public places and workplaces. Methods. Multiple data sources were used to assess the impact of state preemptive laws on the proportion of indoor workers covered by smoke-free workplace policies and public support for smoke-free policies. We controlled for potential confounding variables. Results. State preemptive laws were associated with fewer local ordinances restricting smoking, a reduced level of worker protection from secondhand smoke, and reduced support for smoke-free policies among current smokers. Discussion. State preemptive laws have several effects that could impede progress in secondhand smoke protections and broader tobacco control efforts. Conclusion. Practitioners and advocates working on other public health issues should familiarize themselves with the benefits of local policy making and the potential impact of preemption. [ABSTRACT FROM AUTHOR]

This paper reports on the measurement properties of a scale intended to measure nicotine dependence in adolescents using data from the American Legacy Longitudinal Tobacco Use Reduction Study. The Nicotine Dependence Scale for Adolescents (NDSA) is a simple linear sum of items associated with behaviors to avoid withdrawal and items associated with experiences of craving. An exploratory factor analysis indicated that the items formed a single scale. The reliability of the scale was assessed by estimating Cronbach's alpha for the scale items. The estimated alpha reliability was .81. The scale's validity was assessed by estimating the correlation between the scale and measures of smoking and quitting behaviors. As hypothesized, the scale was positively correlated with lifetime number of cigarettes smoked (r = .44, p < .001), days smoked in the past 30 days (r = .66, p < .001), cigarettes smoked per day on days smoked (r = .61, p <.001), and number of quit attempts (r = .10, p <.001) and negatively correlated with the length of the quit attempt (r = - .22, p <.001). We also examined the measurement properties of the NDSA separately for middle and high school students and by gender and race or ethnicity. We found no meaningful differences in the measurement properties of the NDSA across these groups. The six-item self-report NDSA had good measurement properties in our sample. [ABSTRACT FROM AUTHOR]

Objectives. Our study presents national estimates of the proportion of youths in each of 7 stages of smoking and investigates the associations between risk/protective factors and progression to established smoking. Methods. We analyzed data from the 1999 and 2000 National Youth Tobacco Surveys. Results. In 1999 and 2000, 48.6% of US adolescents had at least experimented with tobacco, and 7.8% were established smokers. Important correlates of progression to established smoking included parental advice not to smoke, antismoking lessons in school, susceptibility to tobacco industry advertising and promotion, peer smoking, and exposure to smoking at home. Conclusions. Interventions to stop adolescent progression to established smoking should target susceptible never smokers and early experimenters as well as those in later stages of smoking. (Am J Public Health. 2004;94:331-337) [ABSTRACT FROM AUTHOR]

Objectives. This study compared trends in adult cigarette smoking prevalence in California and the remainder of the United States between 1978 and 1994. Methods. We used data from National Health Interview Surveys and Behavioral Risk Factor Surveillance System surveys to compare trends in smoking prevalence among persons 18 years and older. Results. In both California and the remainder of the United States, the estimated annual rate of decline in adult smoking prevalence accelerated significantly from 1985 to 1990: to --1.22 percentage points per year (95% confidence interval [CI] = 1.51, - 0.93) in California and to -0.93 percentage points per year (95% CI = -1.13, -0.73) in the remainder of the nation. The rate of decline slowed significantly from 1990 to 1994: to -0.39 percentage points per year (95% CI = -0.76. -0.03) in California and to -0.05 percentage points per year (95% CI = -0.34, 0.24) in the remainder of the United States. Conclusions. The presence of an aggressive tobacco control intervention has supported a significant decline in adult smoking prevalence in California from 1985 to 1990 and a slower but still significant decline from 1990 to 1994. a period in which there was no significant decline in the remainder of the nation. To restore nationwide progress in reducing smoking prevalence, other states should consider similar interventions. (Am J Public Health. 2000:90:372-379) [ABSTRACT FROM AUTHOR]

Introduction Mentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over time. Methods We estimated menthol cigarette use during 2004-2010 using annual data on persons ≥12 years old from the National Surveys on Drug Use and Health. We adjusted self-reported menthol status for selected brands that were either exclusively menthol or nonmenthol, based on sales data. Data were weighted to provide national estimates. Results Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7%) and 18-25 year olds (45.0%) than among older persons (range 30.5% to 34.7%). In a multivariable analysis, menthol use was associated with being younger, female and of non-Caucasian race/ethnicity. Among all adolescents, the percentage who smoked non-menthol cigarettes decreased from 2004-2010, while menthol smoking rates remained constant; among all young adults, the percentage who smoked non-menthol cigarettes also declined, while menthol smoking rates increased. The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic Caucasians, during the study period. Conclusions Young people are heavy consumers of mentholated cigarettes. Progress in reducing youth smoking has likely been attenuated by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. This study should inform the Food and Drug Administration regarding the potential public health impact of a menthol ban. [ABSTRACT FROM AUTHOR]

Abstract: This study assesses whether a national anti-tobacco campaign for youth could create a social context that would elevate social desirability response bias on surveys, as measured by an increase in under-reporting of smoking. This could give rise to data that falsely suggest a campaign-induced decline in youth smoking, or it could exaggerate campaign effects. Data were obtained from a national sample of 5511 students from 48 high schools that were matched to schools sampled for the 2002 National Youth Tobacco Survey (NYTS). Self-reported smoking was compared with biochemical indicators of smoking, measured using saliva cotinine. The rate of under-reporting detected was 1.3%. Level of truth® exposure was not related to under-reporting. This study suggests that for high school students, anti-tobacco campaigns are not an important cause of social desirability responses on surveys, and that in general under-reporting smoking is not a major source of error in school-based surveys. [Copyright &y& Elsevier]

Conclusions. A change in questionnaire wording in the BRFSS caused demographic-specific effects in population-based estimates of mammography use. (Am J Public Health. 2001;91: 817-820) [ABSTRACT FROM AUTHOR]

Objective. This study sought to reassess the relationship between cigarette smoking and education. Methods. Data from the 1983 to 1991 National Health Interview survey for participants aged 25 years and older were used to plot the prevalence of current smoking, ever smoking, heavy smoking and smoking cessation, as well as the adjusted log odds ratios, by years of education. Results. The "less than high school graduate" category consisted of two groups with distinct smoking patterns: persons with 0 to 8 years and persons with 9 to 11 years of education. The latter were the most likely to be current, ever, and heavy smokers and the least likely to have quit smoking, whereas the former were similar to persons having 12 years of education. After 11 years of education, the likelihood of smoking decreased and that of smoking cessation increased with each successive year of education. These results persisted after the statistical adjustment for age, sex, ethnicity, poverty status, employment status, marital status, geographic region, and year of survey. Conclusions. The relationship between smoking and education is not monotonic. Thus, when evaluating smoking in relation to education, researchers should categorize years of education as follows: 0 to 8, 9 to 11, 12, 13 to 15, and 16 or more years. [ABSTRACT FROM AUTHOR]

Online data collection has become an extremely popular survey mode given its reduced cost, ease of administration, and timeliness. Although extensive research exists on the influence of e-mail invitation design characteristics to prompt survey participation, less is known about the effectiveness of e-mail reminders in prompting survey completion among nonresponders. The purpose of this study was to determine whether incorporating humor into e-mail reminders improved survey completion rates. Respondents from the Truth Initiative Young Adult Cohort (n = 2,963) who did not respond to the first standard e-mail invitation to complete their follow-up survey were randomly assigned to one of the three e-mail reminder groups: control (standard), humor only, or humor plus statistics. Those who received an initial humor plus statistics reminder e-mail received the humor only e-mail as their second reminder and vice versa. Logistic regression was used to generate the odds ratios (OR) for the probability of completing the survey after the first reminder. Results of multivariable models showed that, when collapsed together, the humor only and humor plus statistics e-mails were more effective than the control [adjusted OR (AOR) = 1.23, 95% confidence interval (CI) [1.01, 1.49], p = .05]. Receiving the humorous e-mail as the first reminder increased the odds of response to the survey by 24% (AOR = 1.24, 95% CI [1.00, 1.54], p = .04). Those entering the study at an earlier wave, nonsmokers and those living in smaller households were more likely to respond after the first reminder. A humorous reminder tailored to the voice of the audience is an easy, efficient, and effective way to increase response rates among young adults. [ABSTRACT FROM AUTHOR]

Conclusions. Measured compliance rates are strongly influenced by the age of the youths used to purchase tobacco. (Am d Public Health. 2001; 91:1124-1125) [ABSTRACT FROM AUTHOR]

Background: Mass media campaigns can be an effective strategy to increase quitting activity among smokers, particularly when aired in the context of other anti-tobacco efforts. Design: A longitudinal study using data collected from smokers identified in a random-digit-dial survey of adults in Grand Rapids MI, prior to the campaign and approximately 6 months after the launch of the campaign. Setting/participants: Adult smokers who were interviewed in the fall of 2006 and agreed to participate in a follow-up interview approximately 6 months later (n=212). Intervention: A pilot mass media campaign, branded EX®, which used empathy to encourage smokers to “relearn” life without cigarettes, and focused on disassociating smoking from common activities that would otherwise function as smoking cues, such as driving or drinking coffee. The campaign averaged 100 targeted rating points per week on television. Main outcome measures: Primary outcome measures were five campaign-related cognitions and confidence in quitting. Secondary outcome measures were quitting behaviors. Results: This 2007 analysis suggests that the campaign generated a high level of awareness of EX, with 62% of the sample demonstrating confirmed awareness and 79% reporting aided awareness. Awareness of EX was associated with significant change in two of five campaign-related cognitions. Awareness was not associated with confidence in quitting or having made a quit attempt. Conclusions: These findings demonstrate that a branded, empathetic media campaign that offers smokers practical advice on how to approach quitting can change cognitions related to successful cessation over a relatively short time period. [Copyright &y& Elsevier]

Background. On April 1, 2009, the federal cigarette excise tax increased from 39 cents to $1.01 per pack. Methods. This study describes call volumes to 16 state quitlines, characteristics of callers and cessation outcomes before and after the tax. Results. Calls to the quitlines increased by 23.5% in 2009 and more whites, smokers ⩾ 25 years of age, smokers of shorter duration, those with less education, and those who live with smokers called after (versus before) the tax. Quit rates at 7 months did not differ before versus after tax. Conclusions. Descriptive analyses revealed that the federal excise tax on cigarettes was associated with increased calls to quitlines but multivariate analyses revealed no difference in quit rates. However, more callers at the same quit rate indicates an increase in total number of successful quitters. If revenue obtained from increased taxation on cigarettes is put into cessation treatment, then it is likely future excise taxes would have an even greater effect. [ABSTRACT FROM AUTHOR]

Objectives. We examined the effectiveness of a program to increase exposure to national "truth" tobacco countermarketing messages among youths in rural and low-population-density communities. Methods. A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of "truth" messages. Results. Confirmed awareness of "truth" increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign's messages. Conclusions. Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence-based tobacco prevention campaigns. [ABSTRACT FROM AUTHOR]

Purpose. Document changes from 2000 to 2004 in youth reports of exposure to pro-tobacco messages in the mass media, including images of smoking and tobacco advertising. Design. Comparison of cross-sectional data from three waves of the school-based National Youth Tobacco Surveys conducted in 2000 (N= 33,772), 2002 (N= 23,439), and 2004 (N= 23,540). Setting. Public and private middle schools and high schools across the United States. Subjects. Students in grades 6 through 12. Measures. Smoking status; exposure to images of smoking on television and in movies; exposure to advertisements for tobacco products in stores, on the Internet, and in newspapers and magazines; demographic data. Results. Youth exposure to pro-tobacco messages declined within all media channels studied from 2000 to 2004, except the Internet. Despite these declines, most youth in the United States remain exposed to pro-tobacco messages: 81% saw images of smoking on television or in movies (down from 90%), 85% saw tobacco ads in stores (down from 88%), 50% saw tobacco ads in newspapers and magazines (down from 66%), and 33% saw tobacco ads on the Internet (up from 22%). Conclusion. Despite recent progress in this area, most youth in the United States are still at increased risk of smoking as a result of exposure to pro-tobacco messages in the mass media. [ABSTRACT FROM AUTHOR]

A response by P. Z. Siegal, J. R. Qualters and P. D. Mowery to a letter to the editor about their article "Subgroup-Specific Effects of Questionnaire Wording on Population-Based Estimates of Mammography Prevalence" in the May 2001 issue is presented.

Context: Cotinine, a metabolite of nicotine, is a marker of exposure to tobacco smoke. Previous studies suggest that non-Hispanic blacks have higher levels of serum cotinine than non-Hispanic whites who report similar levels of cigarette smoking.Objective: To investigate differences in levels of serum cotinine in black, white, and Mexican American cigarette smokers in the US adult population.Design: Third National Health and Nutrition Examination Survey, 1988-1991.Participants: A nationally representative sample of persons aged 17 years or older who participated in the survey.Outcome Measures: Serum cotinine levels by reported number of cigarettes smoked per day and by race and ethnicity.Results: A total of 7182 subjects were involved in the study; 2136 subjects reported smoking at least 1 cigarette in the last 5 days. Black smokers had cotinine concentrations substantially higher at all levels of cigarette smoking than did white or Mexican American smokers (P<.001). Serum cotinine levels for blacks were 125 nmol/L (22 ng/mL) (95% confidence interval [CI], 79-176 nmol/L [14-31 ng/mL]) to 539 nmol/L (95 ng/mL) (95% CI, 289-630 nmol/L [51-111 ng/mL]) higher than for whites and 136 nmol/L (24 ng/mL) (95% CI, 85-182 nmol/L [15-32 ng/mL]) to 641 nmol/L (113 ng/mL) (95% CI, 386-897 nmol/L [68-158 ng/mL]) higher than for Mexican Americans. These differences do not appear to be attributable to differences in environmental tobacco smoke exposure or in number of cigarettes smoked.Conclusions: To our knowledge, this study provides the first evidence from a national study that serum cotinine levels are higher among black smokers than among white or Mexican American smokers. If higher cotinine levels among blacks indicate higher nicotine intake or differential pharmacokinetics and possibly serve as a marker of higher exposure to cigarette carcinogenic components, they may help explain why blacks find it harder to quit and are more likely to experience higher rates of lung cancer than white smokers. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was lo determine national trends in adolescent cigarette smoking prevalence. Methods. We conducted trend analyses based on 1974 through 1991 current smoking prevalence data among persons aged 12 through 19 years from the National Household Surveys on Drug Abuse, High School Seniors Surveys, and National Health Interview Surveys. Results. Overall smoking prevalence declined much more rapidly from 1974 through 1980 (1.9 percentage points annually among younger adolescents; the range among surveys of older adolescents was 0.2 to 2.0 percentage points annually) than from 1985 through 1991 (0 to 0.5 percentage points annually among all adolescents). Since 1980, smoking has generally declined at a slightly faster rate among older female adolescents than among male adolescents. Smoking among Black adolescents of all ages declined in nearly every survey population during each study period (range among surveys; 1974-1985 = 1.0 to 2.9 percentage points; 1985-1991 = 0.7 to 1.5 percentage points annually); for White adolescents, only minimal declines in smoking have occurred since 1985. Conclusions. Since 1974, major changes in adolescent smoking patterns have occurred, especially among Blacks. The overall slowing rate of decline in smoking prevalence since 1985 may indicate success of increased tobacco advertising and promotional activities targeted at adolescents or inadequate antitobacco education efforts. [ABSTRACT FROM AUTHOR]

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes;by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes [ABSTRACT FROM AUTHOR]