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Richardson A.,Legacy | Ganz O.,Legacy | Vallone D.,Legacy
Tobacco Control | Year: 2015

Background Despite the internet’s broad reach and potential to influence consumer behaviour, there has been little examination of the volume, characteristics, and target audience of online tobacco and e-cigarette advertisements. Methods A full-service advertising firm was used to  collect all online banner/video advertisements occurring in the USA and Canada between 1 April 2012 and 1 April 2013. The advertisement and associated meta-data on brand, date range observed, first market, and spendwere downloaded and summarised. Characteristics and themes of advertisements, as well as topic area and target demographics of websites on which advertisements appeared, were also examined.Results Over a 1-year period, almost $2 million werespent by the e-cigarette and tobacco industries on the placement of their online product advertisements in the USA and Canada. Most was spent promoting two brands: NJOY e-cigarettes and Swedish Snus. There was almost no advertising of cigarettes. About 30% of all advertisements mentioned a price promotion, discount coupon or price break. e-Cigarette advertisements weremost likely to feature messages of harm reduction (38%) or use for cessation (21%). Certain brands advertised onwebsites that contained up to 35% of youth (<18 years) as their audience. Conclusions Online banner/video advertising is a tactic used mainly to advertise e-cigarettes and cigars ratherthan cigarettes, some with unproven claims about benefits to health. Given the reach and accessibility of online advertising to vulnerable populations such asyouth and the potential for health claims to bemisinterpreted, online advertisements need to be closely monitored. © 2015, BMJ Publishing Group. All rights resereved.

Cantrell J.,Legacy | Anesetti-Rothermel A.,The Schroeder Institute for Tobacco Research and Policy Studies | Anesetti-Rothermel A.,West Virginia University | Pearson J.L.,The Schroeder Institute for Tobacco Research and Policy Studies | And 3 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.

Rath J.M.,Legacy | Villanti A.C.,Schroeder Institute for Tobacco Research and Policy Studies | Rubenstein R.A.,Legacy | Vallone D.M.,Legacy | Vallone D.M.,Schroeder Institute for Tobacco Research and Policy Studies
Nicotine and Tobacco Research | Year: 2013

Introduction: National surveillance data are needed for the lesbian, gay, bisexual, and transgender population, a group which has been shown to have unique health needs. Methods: This study uses data from Legacy's Young Adult Cohort Study, a nationally representative sample collected in the summer of 2011 to examine patterns of tobacco use by sexual identity. Results: Homosexual and bisexual past 30-day cigarette use (35% and 27%, respectively) was higher than heterosexual past 30-day cigarette use (18%; p = .004). The prevalence of any current tobacco use among heterosexuals was 22% compared with 35% in homosexuals and 31% in bisexuals (p = .04). Prevalence of dual use was 30% among heterosexuals, 43% among homosexuals, and 35% among bisexuals. High school education (OR = 4.27), current alcohol use (OR = 12.64), and current other drug use (OR = 9.67) were significant predictors of current cigarette use among lesbian, gay, and bisexual respondents. Strong predictors of other tobacco product use were Black race (OR = 6.95), current alcohol use (OR = 11.70), and current other drug use (OR = 7.42). Conclusions: Prevalence estimates for tobacco use were higher among young adults who self-identify as sexual minorities compared with those who identify as heterosexuals. Tobacco use is strongly associated with alcohol and other drug use in this population. This study highlights the significant disparities in tobacco use behaviors among sexual minority populations and the critical need to conduct surveillance among these groups. © The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Richardson A.,Schroeder Institute for Tobacco Research and Policy Studies | Ganz O.,LEGACY | Stalgaitis C.,LEGACY | Abrams D.,Schroeder Institute for Tobacco Research and Policy Studies | Abrams D.,Georgetown University
Nicotine and Tobacco Research | Year: 2014

Background: With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. Methods: Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. Results: Over 3 months, almost $20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (̃$8 million) and snus (̃$10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. Conclusions: Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Richardson A.,Legacy | Rath J.,Legacy | Ganz O.,Legacy | Xiao H.,Legacy | Vallone D.,Legacy
Nicotine and Tobacco Research | Year: 2013

Background: Although cigarettes are regulated through the Family Smoking Prevention and Tobacco Control Act, cigars are currently not regulated and tend to be lower in price. Despite the rising use of cigars in the United States, little is known about the prevalence of use of little cigars/cigarillos (LCCs) versus large cigars (LCs) and the profile of these distinct cigar users. Methods: This study uses data from Legacy's Young Adult Cohort, a nationally representative study of 4,215 young adults, ages 18-34. Cigar use was divided into three groups: ever use of LCCs only, ever use of LCs only, and ever dual users. Multinomial regression was used to determine the differential demographic characteristics and tobacco use behaviors associated with the three cigar-use groups. Results: Ever cigar use was reported by 37.9% (n = 1,596) of the young adult cohort. Of the cigar smokers, 21.5% (n = 344) had used only LCCs, 32.3% (n = 515) had used only LCs, and 46.2% (n = 737) were dual users of both. In comparison with LC-only users, LCC-only users were more like to be younger (relative risk ratio [RRR] = 0.40, p < .001 for 25-34 vs. 18-24 years), female (RRR = 4.92, p < .001), non-Hispanic Black (RRR = 2.91, p < .001), and smoke cigarettes daily. Dual users were more likely than LC-only users to be female (RRR = 1.61, p = .03), non-Hispanic Black (RRR = 2.06, p = .04), and use a higher numbers of tobacco products (RRR = 4.44, p < .001). Conclusions: Cigar use is prevalent among young adults with the highest proportion using both LCCs and LCs. Interventions to curb use should consider the differential demographic and tobacco use patterns of cigar users. © The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

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.

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.

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 | Xiao H.,Legacy | Vallone D.M.,Legacy
Nicotine and Tobacco Research | Year: 2012

Introduction: The Family Smoking Prevention and Tobacco Control Act provides an unprecedented opportunity to regulate tobacco in the United States. However, restrictions on little cigars, cigarillos, and large cigars are notably absent from the Act, which may create a favorable environment for increased dual usage of cigars. The purpose of this study is to examine demographic profiles and tobacco use behaviors of dual, as opposed to primary, users of cigarettes and cigars. Methods: This study used data from a cross-sectional nationally representative survey of 2,649 adult smokers and nonsmokers. Multivariable regression analysis was used to compare the demographic characteristics and tobacco use behaviors of dual users versus cigarette-only smokers. Results: Data indicate that 12.5% of cigarette smokers are dual users of cigars. Dual users are more likely to be male, 18-29 years of age, non-Hispanic Black, of lower educational attainment, and either unemployed or out of the work force. Dual users were less likely than cigarette-only smokers to be daily cigarette smokers (odds ratio [OR] = 0.57, 95% CI: 0.32, 1.02), more likely to have made a recent quit attempt (OR = 2.39, 95% CI: 1.44, 3.97), and more likely to have used at least one other alternative product (OR = 2.26, 95% CI: 1.26, 4.05), including snus, e-cigarettes, dissolvables, and chewing tobacco. Conclusions: As greater restrictions on cigarettes become implemented in the United States, it will be critical to monitor increased dual use of cigars, in order to inform prevention and treatment strategies and guide more comprehensive policy efforts. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. 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.

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