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Bandiera F.C.,University of Miami | Kalaydjian Richardson A.,Legacy | Lee D.J.,University of Miami | He J.-P.,U.S. National Institutes of Health | Merikangas K.R.,U.S. National Institutes of Health
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objective: To examine a potential association between biologically confirmed secondhand smoke exposure and symptoms of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) major depressive disorder, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, and conduct disorder using a nationally representative sample of US children and adolescents. Design: Nationally representative cross-sectional survey of the United States. Setting: Continental United States. Participants: Children and adolescents aged 8 to 15 years who participated in the National Health and Nutrition Examination Survey from 2001 to 2004. Intervention: Measurement of serum cotinine level to assess secondhand smoke exposure among nonsmokers. Main Outcome Measures: The DSM-IV symptoms were derived from selected modules of the National Institute of Mental Health's Diagnostic Interview Schedule for Children Version IV, a structured diagnostic interview administered by trained lay interviewers. Results: Among nonsmokers, serum cotinine level was positively associated with symptoms of DSM-IV major depressive disorder, generalized anxiety disorder, attention-deficit/ hyperactivity disorder, and conduct disorder after adjusting for survey design, age, sex, race/ethnicity, poverty, migraine, asthma, hay fever, maternal smoking during pregnancy, and allostatic load. Associations with serum cotinine level were more apparent for boys and for participants of non-Hispanic white race/ethnicity. Conclusions: Our results are consistent with a growing body of research documenting an association between secondhand smoke exposure and mental health outcomes. Future research is warranted to establish the biological or psychological mechanisms of association. ©2011 American Medical Association. All rights reserved.

Richardson A.,Legacy
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco | Year: 2011

Although awareness of mass-media smoking cessation campaigns is hypothesized to affect quit behavior through changes in cessation-related attitudes, intentions, and motivation (cognitions), this has yet to be formally tested. Structural equation modeling was used to examine whether changes in cessation-related cognitions mediate the relationship between awareness of a national mass-media smoking cessation campaign, the EX campaign, and quit attempts in a cohort of 3,571 current smokers drawn from eight U.S. Designated Market Areas and followed over an approximate six-month period. Models were examined in the total sample and within racial/ethnic, gender, age, and educational strata. Data suggest that there are both a direct effect of confirmed awareness of EX on quit attempts as well as an indirect effect mediated by positive changes in cessation-related cognitions. Results are not uniform across subgroups; stratified analyses reveal that awareness of EX is significantly associated with positive changes in cessation-related cognitions and quit attempts only in Blacks, males, and those with less than a high-school education. Those developing health communication mass-media campaigns need to consider how media messages might differentially impact U.S. subpopulations in order to elicit desired behavioral change across target subgroups.

Cantrell J.,Legacy | Anesetti-Rothermel A.,The Schroeder Institute for Tobacco Research and Policy Studies | Anesetti-Rothermel A.,West Virginia University | Pearson J.L.,Behavior and Society | And 5 more authors.
Addiction | Year: 2015

Aims: This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors. Design: Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home. Setting: Eight large Designated Media Areas across the United States. Participants: A total of 2377 baseline smokers followed over three waves from 2008 to 2010. Measurements: Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes. Findings: Smokers in high poverty census tracts living between 500m and 1.9km from an outlet were over two times more likely to be abstinent than those living fewer than 500m from an outlet (P<0.05). Density within 500m of home was associated with reduced abstinence [odds ratio (OR)=0.94; confidence interval (CI)=0.90, 0.98) and lower pro-cessation attitudes (Coeff=-0.07, CI=-0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500m was associated with greater pro-cessation attitudes (OR=0.06; CI=0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes. Conclusions: In the United States, density of tobacco outlets within 500m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas. © 2014 Society for the Study of Addiction.

Curry L.E.,Rti International | Richardson A.,Legacy | Xiao H.,Legacy | Niaura R.S.,Schroeder Institute for Tobacco Research and Policy Studies
Health Education and Behavior | Year: 2013

An unintended consequence of tobacco control's success in marginalizing smoking is that smokers may conceal their smoking from those who are best positioned to help them quit: health care providers (HCPs). The purpose of this study was to identify the prevalence of, and factors related to, nondisclosure of smoking to HCPs. Data were obtained from a cross-sectional survey of adults from a nationally representative Knowledge Networks online panel in March to April 2011. Current and former smokers (n = 2,803) were asked questions about nondisclosure, tobacco use, cessation behavior, and perceived social unacceptability of smoking. All variables significantly related (p<.05) to nondisclosure in bivariate logistic regression were included in the multivariate logistic regression model, which also adjusted for gender, age, race, marital status, and education. Approximately 1 in 10 smokers (12.9%) and 5.8% of former smokers has withheld their smoking status from HCPs. Ever smokers who were 18 to 34 years, those who had used a prescription medication or behavioral therapy in their last quit attempt, and those who were uncomfortable discussing smoking with their HCP were more likely to report nondisclosure than those in their respective comparison groups. Respondents who perceived either medium or high smoker-related stigma (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.05, 2.77 and OR = 2.60, 95% CI = 1.51, 4.48, respectively) and those who reported concealing smoking to gain benefits from health insurance were also significantly more likely to have kept smoking a secret from an HCP (OR = 5.66, 95% CI = 1.88, 17.02). Smokers should be encouraged to be forthright about their smoking in order for practitioners to offer treatment and services that increase their chances of quitting. © 2012 Society for Public Health Education.

Richardson A.,Legacy | He J.-P.,National Health Research Institute | Curry L.,Legacy | Merikangas K.,National Health Research Institute
Journal of Psychosomatic Research | Year: 2012

Objective: To report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents. Methods: Data on two samples were drawn from the 1999-2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n=1884 12-15. year-olds) and anxiety (n=6336 12-19. year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling. Results: Rates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR=3.9, 95% CI: 1.3-11.3 and OR=10.6, 95% CI: 3.1-37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services. Conclusions: Smoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services. © 2012 Elsevier Inc.

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