Understanding and reducing health disparities through social and behavioral research

National Institute On Minority Health And Health Disparities

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Abstract

Understanding inter-relationships between social determinants and tobacco use In recent years, the tobacco industry has introduced new tobacco products into the US marketplace in light of the decline in cigarette smoking. The most recent products are heated tobacco products, an electronic device that heat a tobacco stick to generate an inhalable aerosol, and nicotine pouches, a small teabag-like products filled with nicotine salt to be place between gum and cheek. In a national survey of adult current tobacco product users, we found that 23.6% of this population was aware of, 8.9% had ever used, and 3.9% currently used heated tobacco products. Importantly, Black individuals were more likely than White individuals to report ever and current heated tobacco products, which coincided with the target marketing of these products to Black population by the tobacco industry. In the sample population, 46.6% were aware of, 16.4% had ever used, and 3.0% currently used nicotine pouches. Younger individuals (vs. older individuals) and those who currently used smokeless tobacco products (e.g., chewing tobacco) were more likely to report current use of nicotine pouches, indicating the tobacco industry could be targeting different population segments with different new products. Contrary to the decline in cigarette smoking, cigar smoking is increasing in recent years. The prevalence of cigar smoking is the highest among young adults. To understand the beliefs and perceptions about cigars among young adults, we conducted a belief elicitation exercise with a U.S. sample of young adult who never used tobacco products. Through this exercise, we learned that young adults anticipated relaxation and mood regulation with cigar smoking, and perceived cigars to be highly accessible and low cost. These beliefs were more prevalent among those who were interested in using cigars. We also found that these beliefs varied by cigar type (e.g., little cigars, cigarillos, and premium cigars). These findings inform public health communication strategies to prevent cigar smoking initiation among young adults. Investigate mediating and moderating factors associated with tobacco use disparities Tobacco marketing continues to play a role in tobacco use disparities in the US. As a measure to circumvent FDA regulations, the tobacco industry has started marketing their products contain tobacco-free nicotine instead of tobacco-derived nicotine. In an online experiment with young adult who do not use tobacco products, viewing e-cigarette advertisement with tobacco-free nicotine descriptors was associated with higher intention to use the e-cigarette depicted in these advertisements. This suggested that the tobacco-free nicotine descriptor may prompt young adults to start using e-cigarettes. We continue to strengthen the evidence base supporting the causal relationship that tobacco price discounting influences tobacco product use behaviors. For example, using the data from the Population Assessment on Tobacco and Health (PATH) Study, we found that exposure to tobacco price promotion was associated with progression of tobacco products use among adolescents and young adults. Additionally, we observed that such exposure has a dose-response relationship with changes in smoking behaviors. Specifically, we found that among US adults, number of years exposed to cigarette price discounting was associated with higher odds of smoking initiation, progression, and return to use, while with lower odds of cessation. Use marketing research perspective to reduce tobacco use disparities Changing product standard is one of the ways to reduce the marketability of harmful products. In a national survey of adults who used flavored cigars, we explored how they might change their cigar smoking behavior should there be a sales restriction on flavored cigars. We found that 15.1% of them would stop smoking cigars completely, 41.6% would switch to non-flavored cigars, and 33.4% would supplement with other flavored tobacco products. These findings suggest that while cigar flavor restriction can promote cigar smoking cessation, complementary strategies are needed to address other unintended behavioral outcomes. Increasing prices is also a known effective tobacco control strategy. In the same national sample of adult who smoked cigars, we examined how they would change their tobacco product use behaviors if cigar price increases. To our surprise, 77.2% said they would pay more and keep smoking, 44.7% would reduce use, 39.9% would use other tobacco products, and 37.7% would use cannabis. Interestingly, those who smoked cigarillos were more likely than those who smoke other types of cigars to report intention to pay more and keep smoking, potentially because of the low prices of cigarillos. Denormalizing the tobacco industry has been a successful counter-marketing strategy to reduce cigarette smoking. In a national survey of young adults who were interested in e-cigarette use, we found that those who were aware of the Master Settlement Agreement and how cigarette industry have used various tactics to promote a detrimental health behavior had worse perceptions of the e-cigarette industry and high health risk perceptions about e-cigarettes. These data suggest that revealing the predatory tobacco marketing tactic may be a promising approach for e-cigarette use prevention among young adults. Investigate the impact of tobacco use patterns and health outcomes We continue to document health impact of tobacco product use. For example, in a study of US adolescents, we found that tobacco smoke exposure (i.e., secondhand and thirdhand smoking) was associated with sleep deprivation. In another study of California adolescents, we found that e-cigarette use, cigarette use, and cannabis use were all associated with having asthma. In a third study, we examined the association between tobacco smoke exposure and mortality by race/ethnicity and socioeconomic status. We found that tobacco smoking exposure was associated with increased mortality risk across all races/ethnicities, while the association was slightly stronger among Hispanic adults. Lastly, we examined whether receiving a diagnosis of chronic respiratory conditions is related to changes in tobacco product use behaviors. In a longitudinal analysis of a nationally representative sample of adults, we found that receiving such diagnoses was not associated with combustible product cessation or switching to noncombustible tobacco products. These findings suggest that additional support for tobacco product use cessation is needed when tobacco product users are diagnosed with chronic respiratory conditions. COVID-19 and Tobacco Use COVID-19 pandemic has intensified the financial hardship in our society. We examined what strategies adults who use tobacco products employed to reduce their spending on tobacco products, and whether financial hardship during the pandemic was associated with using these strategies. While 22.4% reported cutting back on consumption as a way to save money, 15.6% reported finding cheaper places to purchase the products, and 15.5% reported buying these products in bulks for savings. Individuals who experienced financial hardships during the pandemic were more likely than those who did not experience financial hardships to use these strategies to save money. Additionally, we found that experiencing financial hardship was associated with increased receipt of coupons for all tobacco products. These findings suggest that the tobacco industry targeted financially vulnerable individuals during the pandemic to boost sales, resulting in a reversal in the 20-year decline in cigarette sales during the pandemic.