Search Results (77)

Background: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is known about how consistently such policies are implemented across schools within urban school districts. Objectives: This study aimed to examine the existence and enforcement of school-level tobacco control policies in an urban public school system, using Baltimore City schools as a case example. Methods: We conducted a survey of school personnel from 20 high schools in Baltimore City in 2024. The survey instrument assessed the presence and enforcement of policies related to tobacco use prevention, communication, signage, disciplinary actions, and institutional support. Descriptive statistics (frequencies and percentages) were used to summarize responses. Spearman correlations were also used for bivariate correlations. Additional school-level and neighborhood-level contextual data were collected from the internet (neighborhood socioeconomic status and school performance). Results: While many policies existed across the 20 participating schools, their enforcement was widely inconsistent. Most schools reported the existence of policies prohibiting tobacco use in school buildings (60%) and vehicles (55%). However, few schools had visible tobacco-free signage (35%) or offered cessation programs (15%). Communication of policies to students (70%) and staff (65%) was the most commonly enforced aspect of tobacco control policies. Conclusions: Findings suggest that while tobacco control policies may be adopted across urban school systems, their enforcement at the school level remains uneven. Greater attention may be needed to support policy implementation and to reduce variability in school-level practices. Baltimore City serves as a useful case study to understand these challenges and identify opportunities for strengthening school-based tobacco prevention efforts. Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

Despite a general decline in smoking rates among the U.S. population, smoking among low-income populations remains disproportionately high, likely due to the social determinants of health. To inform tailored approaches and responsive public health policies, the aim of this study was to qualitatively explore the sociocultural contexts, attitudes, and behaviors regarding smoking and quitting in a sample of low-income adults who smoke. In-depth, semi-structured qualitative interviews were conducted with 20 adults. Participants were recruited through local safety-net primary care clinics and community sites. A thematic analytic approach was utilized to analyze transcribed interviews. In exploring smoking and quitting within the context of low-income individuals, the following six themes were identified: caught between health and tobacco use; the nuances of context; roadblocks to quitting; motivation without movement; a temporary escape; and one size does not fit all. Insights into sociocultural and environmental contexts that shape smoking and quitting among low-income individuals revealed a complex interplay of factors that perpetuate smoking behavior and make it difficult to achieve sustained cessation. The study findings point to the importance of patient-centered and collaborative approaches that tailor smoking cessation efforts to the unique needs and lived experiences of low-income people who smoke. Full article

Background: Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use—including e-cigarettes—and mental health among high school students is essential for guiding equitable prevention and cessation strategies. The CEASE (Communities Engaged and Advocating for a Smoke-free Environment) program, in collaboration with the American Lung Association’s Not On Tobacco (N-O-T) initiative, developed an online school-based survey to inform community-responsive interventions. Aims: This study aimed to examine the associations between cigarette use, including conventional cigarette use, and self-rated mental health among high school students in Baltimore City. Methods: High school students in Baltimore City completed an anonymous online survey that assessed demographic characteristics, tobacco knowledge and use, mental health, and related behaviors. Self-rated mental health was dichotomized as poor versus fair/good. Tobacco use categories included current use of e-cigarettes and conventional cigarettes. Logistic regression models were used to examine associations between tobacco use and self-rated mental health, adjusting for age, gender, race, and parental education. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: No statistically significant associations were found between self-rated mental health and e-cigarette use and conventional tobacco use after adjusting for covariates. Conclusions: The absence of a significant association may reflect unique aspects of the social context in Baltimore City, where youth may not use tobacco products as a coping mechanism for mental health challenges. Alternatively, it may be due to limitations in measurement, particularly the use of a single-item mental health assessment. These findings should be considered preliminary. Future research using more comprehensive mental health measures and larger samples is warranted to further explore these complex relationships. Full article

Environmental tobacco smoke (ETS) exposure is a public health concern linked to neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD). Prior studies link ETS to ADHD, but gaps remain regarding gender differences, critical exposure windows, and dose–response relationships. This study assessed ETS exposure’s association with ADHD-like behaviors in Chinese preschoolers, evaluating overall risk, critical periods, dose–response relationships, and gender differences. Analyzing data from 64,472 preschoolers, ETS exposure (prenatal; infancy, 0–1; and early childhood, 1–3 years) was assessed via parent questionnaires, and ADHD-like behaviors were measured using the Conners’ Parent Rating Scale-Revised, with associations examined via logistic regression. ETS-exposed children had a 49% higher ADHD-like behavior risk (AOR = 1.49, 95% CI: 1.38–1.62, p < 0.001), with dose–response effects: The risk increased from AOR = 1.25 (95% CI: 1.10–1.40) at low exposure to 2.24 (95% CI: 1.63–3.01) at high exposure. Prenatal (AOR = 1.42, 95% CI: 1.17–1.71) and infancy exposures (AOR = 1.43, 95% CI: 1.05–1.90) showed the strongest associations, while early childhood exposure (1–3 years) was non-significant (AOR = 1.04, 95% CI: 0.82–1.29). No gender-specific differences were observed. Early-life ETS exposure, particularly prenatally and in infancy, elevates ADHD-like behavior risk in preschoolers, demonstrating dose–response trends without gender disparity, highlighting the need for universal strategies to reduce such exposures. Full article

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

Objective: To examine trends in perinatal smoking across rural and urban areas and investigate whether structural and intermediary health factors explain rural-urban disparities. Methods: This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) collected between 2009 and 2021 in the United States. Perinatal smoking patterns were based on self-reported smoking before, during, and after pregnancy. Weighted prevalence estimates with 95% confidence intervals (CIs) were calculated for persistent smoking and cessation, stratified by rural–urban residence. Temporal trends were analyzed using logistic regression. Multivariable weighted logistic regression was performed on Phase 8 data (2016–2021) to examine associations between rural–urban status and perinatal smoking patterns, adjusting for maternal age, year of delivery, region, and structural (e.g., education, Tobacco 21 policy) and intermediary (e.g., perinatal stressors) health determinants. All analyses accounted for the complex survey design. Results: Although perinatal smoking declined over time, prevalence remained consistently higher among rural mothers. From 2009 to 2021, persistent smoking decreased significantly in both rural and urban areas (p < 0.001). Smoking cessation rates remained stable (p = 0.087), with no significant difference by rural–urban status (p = 0.475). After adjustment, rural women were 45% more likely to smoke persistently than urban women (OR = 1.45, 95% CI: 1.35–1.56) and 26% less likely to quit smoking. Conclusions: While perinatal smoking declined overall, rural mothers remained more likely to smoke throughout pregnancy. Structural and intermediary determinants partially explained this persistent rural–urban disparity. Full article

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and facilitators of tobacco cessation interventions at both the population and healthcare system levels in the U.S. Understanding these determinants is critical for narrowing health disparities, optimizing resource allocation, and ultimately, enhancing tobacco cessation success rates across all demographic groups. Methods: A comprehensive literature search was conducted across the PubMed, Embase, and Web of Science databases, guided by the population, intervention, comparison, and outcome framework and quality assessment guided by PRISMA guidelines. Data extraction focused on study characteristics, intervention types, barriers, facilitators, and cessation outcomes at both the population and health system levels. The random effects forest plots were graphed to estimate pooled effect sizes for both medical and non-medical interventions. Results: A total of 35 studies met the inclusion criteria from an initial pool of 1555 identified records. Socioeconomic disadvantages, digital inequities, and low motivation constitute primary barriers at the individual level, while systemic factors such as healthcare access limitations, inadequate provider engagement, and lack of financial support further hinder cessation efforts. Financial incentives, culturally tailored interventions, and digital engagement strategies significantly improve tobacco cessation outcomes. Public health implications: as identified by the study, tailored interventions, the expansion of health coverage policies to include intervention, digital solutions, and healthcare resource workforce training will help improve tobacco cessation intervention outcomes. Full article

Background: Cigar smoking poses significant public health challenges due to its rising prevalence and associated health risks. However, research on cigar use in China remains limited. This study investigates the prevalence, demographic characteristics, and key factors associated with cigar use among Chinese adults. Methods: We analyzed data from the 2018–2019 China Health Literacy Survey, including 86,701 participants aged 20–69 years. Multistage stratified sampling was employed, and logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with cigar use. Weighted data were applied to ensure national representation. Results: Of the 86,701 respondents, 1025 participants reported having used cigars, including 248 exclusive cigar users and 777 dual users of cigars and other tobacco products. Cigar use was significantly higher among men (1.93%) than women (0.05%). Most users were aged 50–59, with a mean age of 49.3 years. Factors associated with cigar use among men included higher education (for college and higher, OR: 1.81; 95% CI: 1.42–2.30), lower household income (for income < 20,000, OR: 1.02; 95% CI: 1.08–1.53), poor self-reported health (OR: 1.45; 95% CI: 1.15–1.83), and severe nicotine dependence (FTND ≥ 7 points, OR: 2.09, 95% CI: 1.67–2.61). Cigar use prevalence showed notable regional variation, with the highest rates observed in northern and eastern provinces. Interpretation: The estimated number of cigar users in China is approximately 10.46 million. Male cigar users often represent a unique demographic: “knowledgeable but economically marginalized” individuals, characterized by higher education but lower economic status. Tailored tobacco control measures addressing regional disparities, socioeconomic factors, and marketing-driven misconceptions about cigars are essential to reduce public health impacts. Full article

Displaced populations face an elevated risk for tobacco use, especially smokeless tobacco (SLT), due to its affordability and acceptability in regions like Mizoram State (India) and Chin State (Myanmar). Despite this, limited research exists on tobacco use patterns and contributing factors among displaced populations. This study aimed to examine smoked tobacco and SLT use among displaced communities in Mizoram, India. We collected data across nine villages using mobile health technology. We conducted logistic regression models to examine the cross-sectional associations between sex and tobacco use. Age was explored as a potential moderator. The analytic sample consisted of 2226 participants, with a mean age of 43 (±16.2) years, 63.1% of whom were women. Approximately 70% of the participants reported using tobacco, with SLT being the most common form (46.3%). Women were 57% less likely to use tobacco than men, but women aged 55 and older had twice the odds of using tobacco compared to men in the same age group. Additionally, women had nearly 71 times higher odds of using SLT compared to smoked tobacco than men. The findings underscore the need for culturally sensitive interventions targeting SLT use among women. Future research should explore the drivers of this disparity to guide public health strategies. Full article

Background/Objectives: Rural populations in the US bear a disproportionate burden of cancer mortality, which may be partly due to their elevated tobacco use and the limited receipt of tobacco use interventions in rural healthcare settings. Here, we examine providers’ use of the 5As (Ask, Advise, Assess, Assist, and Arrange), a brief tobacco cessation intervention, with their patients to assess intervention gaps. Methods: Provider practices in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs), each serving rural and/or medically underserved areas (MUAs) of Texas, were compared. In total, 347 providers from 10 SUTCs (n = 174) and 9 MHCs (n = 173) responded to an anonymized survey about their cigarette and non-cigarette screening and intervention delivery, along with their perceived importance and workforce’s preparedness to help patients stop using tobacco. Linear mixed and generalized linear mixed models were used to assess differences between practices at SUTCs and MHCs. Results: More MHC than SUTC providers reported that cigarette and non-cigarette tobacco use cessation intervention were (respectively) important parts of their job (p = 0.0009; p = 0.0023) and that their workforce was prepared to help their patients quit tobacco (p = 0.0275), although less than half of all respondents endorsed preparedness. Relative to those at SUTCs, MHC providers reported higher rates of asking (SUTCs = 59.57% and MHCs = 77.21%; p = 0.0182) and advising (SUTCs = 45.34% and MHCs = 72.35%; p = 0.0017) their patients to quit cigarette smoking and advising them to quit non-cigarette tobacco products (SUTCs = 43.94% and MHCs = 71.76%; p = 0.0016). Conclusions: Overall, providers in both settings may benefit from greater preparation to deliver tobacco cessation care; needs were more prevalent within SUTCs than MHCs. Our findings can inform strategic planning to improve centers’ capacity to comprehensively address their patients’ tobacco use in rural/MUAs of Texas, US. Full article

Background: Tobacco use remains a global challenge to public health, accounting for almost eight million deaths per year worldwide, with a significant portion attributable to tobacco-related cancers. Examining the epidemiology of tobacco-related cancers and assessing the trends in the incidence and mortality will allow for more effective prevention, treatment, and targeted strategies. Methods: We assessed the trends in the incidence and mortality of tobacco-related cancers among adults in the United States using data from United States Cancer Statistics (USCS) 2001–2021 and mortality data 1975–2022 from the National Center for Health Statistics (NCHS). The incidence and mortality rates of tobacco-related cancers were calculated as cases per 1,000,000 persons and age-adjusted to the 2000 United States standard population. Results: There was a recent overall decreasing trend in both the incidence (2001–2021) and mortality rate (2001–2022). Among adults 20–49 years old, there was an increasing trend from 2001 to 2021 in the incidence among non-Hispanic American Indians/Alaska Natives (APC 2.6, 95% CI 2.1–3.0) and those in the West (APC 0.2, 95% CI 0.0–0.4); in Hispanics, the incidence rate increased most recently from 2013 to 2021 (APC 1.7, 95% CI 1.0–3.0). The mortality rate first increased from 1975 to 1990 among females 50–64 years old and males 65+ years old and from 1975 to 2000 among females 65+ years old, and then decreased thereafter. Conclusions: The rising incidence in some younger groups highlights the need for targeted public health interventions to address disparities and improve cancer prevention in these vulnerable populations. Full article

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons. Full article

Objectives: In this study, we aimed to investigate (1) the association of tobacco and e-cigarette use with sexual orientation (LGBTQ and heterosexual individuals) and (2) the difference in the association of tobacco and e-cigarette use with self-reported depression by sexual orientation. Methods: The data for this study were obtained from the Health Information National Trends Survey (HINTS 5, Cycle 4). Sample participants included 3583 adults (93.87% heterosexuals). We used multinomial regression to measure the relative risk ratios (RRRs) of being a former and current user versus never a user of tobacco and e-cigarettes and binomial regression to measure the odds ratios of depression between the LGBTQ and heterosexuals. Results: Current smoking prevalence is higher among LGBTQ participants (17.3%) compared to heterosexuals (11.0%). The disparity is even greater for e-cigarette use, with 7.3% of LGBTQ participants being current users versus 2.8% of heterosexuals and 24.5% of LGBTQ participants being former users compared to 9.3% of heterosexuals. Compared to heterosexuals, the relative risk ratio of being a current tobacco user among the LGBTQ participants was about 1.75 times higher [RRR = 1.75, 95%CI = 1.16, 2.64], and that of e-cigarette use was about 2.8 times higher [RRR = 2.81, 95%CI = 1.57, 5.05]. Among current e-cigarette users, heterosexual participants had 1.9 percentage points [risk difference = 1.94, 95%CI = 1.20, 3.13] higher probability of depression, whereas among the LGBTQ participants, the risk was about 3.7 times higher [OR = 3.67, 95%CI = 1.06, 12.74]. Conclusions: Our findings conclude that the LGBTQ are more likely to use tobacco and e-cigarettes compared to heterosexuals and that the risk of depression from e-cigarette smoking is more pronounced among the LGBTQ participants. Full article

Introduction: Non-communicable diseases (NCDs) represent a major global health challenge, particularly in low- and middle-income countries like India, with significant gender disparities in mortality and disease burden. This study aims to investigate these disparities, using data from national health surveys, to inform gender-specific public health strategies and align with global health goals. Methodology: The study uses data from the Longitudinal Aging Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5). Result: The results from the Longitudinal Ageing Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5) indicate significant demographic and health-related variations among 65,562 participants. Key findings show gender disparities in lifestyle habits such as alcohol and tobacco use, and differences in health outcomes across age, education, and socioeconomic status. Notably, an increase in NCD prevalence, particularly hypertension and diabetes, was observed from NFHS-4 to NFHS-5, highlighting evolving health challenges in India. Conclusions: The study emphasizes the importance of gender in the prevalence and management of non-communicable diseases (NCDs) in India, advocating for public health strategies that address gender differences, socio-economic factors, and urban-rural disparities to achieve health equity. Full article