Using Photovoice to assess and promote environmental approaches to tobacco control in AAPI communities

Asian American and Pacific Islander (AAPI) communities face enormous health disparities, with tobacco use contributing to high rates of cancer and heart disease. There is growing interest nationwide on the influence of environmental factors on tobacco use. AAPI communities have been found to have higher exposures to tobacco company marketing compared to the general population. The authors describe the use of Photovoice (a qualitative needs assessment technique) to empower AAPI youth to identify and understand environmental characteristics associated with tobacco use in four AAPI communities in California and Washington. Of the six major environmental themes identified from the photos, three themes were found across all four communities. Debrief sessions with youth and community leaders underscore the relevance of Photovoice for identifying community needs and motivating community organization for change. Despite some logistical challenges, Photovoice exemplifies the power and potential of this community-based methodology to capture how the environment influences youth on tobacco use.     

Smoking behaviours in a remote Australian Indigenous community: the influence of family and other factors

In Australia, tobacco smoking is more than twice as common among Indigenous people as non-Indigenous people. Some of the highest smoking rates in the country are in remote Indigenous communities in the Northern Territory of Australia. Owing to this high prevalence, tobacco use today is the single biggest contributing risk factor for excess morbidity and mortality among Indigenous Australians. Despite this, there is a lack of published research which qualitatively explores the social context of Indigenous smoking behaviour or of meanings and perceptions of smoking among Indigenous people. The aim of this study was to understand why Indigenous people start to smoke, the reasons why they persist in smoking and the obstacles and drivers of quitting. We conducted semi-structured interviews with a purposive sample of 25 Indigenous community members in two remote communities in the Northern Territory and 13 health staff. The results indicate that there is a complex interplay of historical, social, cultural, psychological and physiological factors which influence the smoking behaviours of Indigenous adults in these communities. In particular, the results signal the importance of the family and kin relations in determining smoking behaviours. While most community participants were influenced by family to initiate and continue to smoke, the health and well being of the family was also cited as a key driver of quit attempts. The results highlight the importance of attending to social and cultural context when designing tobacco control programs for this population. Specifically, this research supports the development of family-centred tobacco control interventions alongside wider policy initiatives to counter the normalisation of smoking and assist individuals to quit.     

Racial disparities in tobacco use and social influences in a rural southern middle school

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.     

Bingo halls and smoking: Perspectives of First Nations women

The purpose of this study was to examine bingo halls as a frequent site for exposure to secondhand cigarette smoke for First Nations women in rural communities. Thematic analysis of interviews with key informants, group discussions with young women, and observations in the study communities revealed that smoky bingo halls provided an important refuge from everyday experiences of stress and trauma, as well as increased women's risk for addiction, marginalization, and criticism. The findings illustrate how the bingo economy in isolated, rural First Nation communities influences tobacco use and second-hand smoke exposure, and how efforts to establish smoke-free bingos can be supported.     

Multi-ethnic adolescents' attitudes toward smoking: a focus group analysis

PURPOSE: To explore young, multi-ethnic adolescents' attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led, tobacco prevention drama. DESIGN: Focus groups and demographic surveys. SETTING: Island of Oahu, Hawaii. PARTICIPANTS: Fifty-four multi-ethnic youth, ranging in age from 10 to 14 years, participated. The study was promoted in schools with a large representation of Hawaiian, Filipino, and Pacific Islander students. METHODS: Each of five focus groups was audio-recorded, and an observer recorded extensive notes throughout the sessions. Content analysis consisted of coding focus group notes for recurrent themes and using the audio recording as confirmation. RESULTS: Just more than one quarter (n = 15) of the youth had tried smoking, and two-thirds (n = 35) currently lived with someone who smoked. Participants expressed the feeling of being surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members' tobacco use, and they desired skills that could enable them to help family members stop using tobacco. CONCLUSION: Family influences may play an important role in youth attitudes toward tobacco use, especially given the cultural significance of extended family and of filial piety that are reflected in many traditional, Asian and Pacific Islander families. Interventions targeting youth in Asian and Pacific Islander communities should incorporate key cultural references to the extended family and to a respect for elders to establish relevance in the life experiences of young people in these population groups.     

The “kaleidoscope” of factors influencing urban adolescent pregnancy in Baltimore,Maryland

Existing intervention and prevention efforts for adolescent pregnancy focus primarily on individual-level approaches; however, there is an emerging expectation to include a more contextually based social-ecological approach. This approach is salient in urban communities like Baltimore, Maryland, with one of the nation’s highest adolescent pregnancy and birth rates. Poverty, community violence, and compromised school systems further complicate the precursors and consequences of adolescent pregnancy. In this mixed methods study, we conducted interviews with key informants (n = 16) from community-based organizations, health departments, foundations, the public school system, clinics, and the faith community who worked with youth in Baltimore to gain a more comprehensive perspective on factors affecting adolescent pregnancy. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparative method. Geographic maps of select socio-demographic variables were created to examine the community context. Results highlighted contributing multi-level factors that emerged across the social-ecological model. Key informants described community- (e.g., environment, community norms, public policy; “Teen pregnancy is norm in many communities”), interpersonal- (e.g., peer social norms; “If you don’t perceive that you have a whole lot of options, you might just kind-of do what everybody else does”), and intrapersonal-level (e.g., specific developmental phase, self-esteem; “You need somebody to love and somebody to love you back”) influences on adolescent pregnancy and birth. GIS maps further illustrated disparities in adolescent birth rates, poverty level, and available community resources. Key informants recommended institutional and structural changes in the community, such as improving sexuality education and school-based health centers and increasing inter-organizational collaboration. These findings underscore the importance of considering creative community partnerships that address key social determinants of reproductive health in developing interventions to address adolescent pregnancy.     

Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth

BACKGROUND: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community. METHODS: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008. RESULTS: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. CONCLUSIONS: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.     

Smokeless tobacco use by youth in the U.S

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.     

Community activation and health promotion: identification of key organizations

PURPOSE. The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. DESIGN. Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. SETTING. This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. SUBJECTS. Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. MEASURES. Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. RESULTS. Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants).(ABSTRACT TRUNCATED AT 250 WORDS)     

Inhaltliche, konzeptionelle und organisatorische Bedingungen einer erfolgreichen schulischen Prävention des Rauchens

The US Centers for Disease Control and Prevention have published guidelines for school health programs to prevent tobacco use and addiction [Centers for Disease Control and Prevention (1994) Guidelines for school health programs to prevent tobacco use and addiction. MMWR 43 (No. RR-2): 1–18]. Seven recommendations summarize strategies that are effective in preventing tobacco use among youth. To ensure the greatest impact, schools should (1) develop and enforce a school policy on tobacco use, (2) provide instruction about (a) short- and long-term negative physiological and social consequences of tobacco use, (b) social influences on tobacco use, (c) peer norms regarding tobacco use, (d) refusal skills, and (e) life skills, (3) provide education on tobacco use prevention from kindergarten through 12th grade, (4) provide program-specific training for teachers,(5) involve parents or families in support of school-based programs to prevent tobacco use, (6) support cessation efforts among students and all school staff who use tobacco, and (7) assess the tobacco use prevention program at regular intervals. This paper examines opportunities and barriers for the implementation of these recommendations in German schools. It is concluded that the US Centers for Disease Control and Prevention guidelines should also be applied in Germany.     

Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California

BackgroundAmerican-Indian adolescents have the highest tobacco use prevalence of all ethnic groups in the United States. Although much has been written about the role of tobacco in traditional Native-American cultures, little is known about modern-day perceptions of tobacco among American-Indian adolescents.MethodsThis study conducted focus groups of 40 American-Indian adolescents in urban and rural areas of Southern California. Participants discussed the role of traditional ceremonial tobacco use in their lives, the use of commercial tobacco as a substitute for sacred tobacco, the perceived safety of traditional versus commercial tobacco, and the perceptions of American-Indian imagery in tobacco advertising.ResultsMany American-Indian adolescents may be introduced to traditional tobacco use at early ages. Smoking is viewed as a sign of respect for the elders, but there are acceptable ways for adolescents to participate in ceremonies without inhaling smoke. Commercial cigarettes often are substituted for homegrown tobacco at ceremonies and events. Traditional tobacco was perceived as less dangerous than commercial tobacco because it does not contain chemical additives. However, respondents still perceived that smoking traditional tobacco and breathing tobacco smoke conferred health hazards. Participants found the use of American-Indian imagery in tobacco advertising offensive and stereotypical. Indian casinos were mentioned frequently as places where smoking occurred.ConclusionsContinued health education efforts are needed to decrease habitual use of commercial tobacco products and secondhand smoke exposure among American-Indian youth. Further research is needed to identify ways for American-Indian youth to participate in their cultural traditions while minimizing their risk for tobacco-related diseases.     

Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities

OBJECTIVES: To assess the effect of community tobacco interventions in Aboriginal communities. METHODS: The study consisted of a pre- and post-study of the effect of a multi-component tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. RESULTS: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t = -4.5, 95% CI -33.6 - (-12.5), p < or = 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. CONCLUSIONS: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.     

Legislating abjection? Secondhand smoke,tobacco control policy and the public's health

Since the mid-1990s, the position that ‘no amount of secondhand smoke is safe’ has achieved hegemonic status in the field of public health. This has bolstered efforts in the tobacco control community to advocate for smoke-free legislation and a variety of countries around the world have implemented indoor smoking bans, with many others presently following suit. This article examines why secondhand smoke has been such a central focus in tobacco control and public health policy, despite the limitations of the available evidence base on its health impacts. I argue that public health responses to secondhand smoke can only be understood in relation to the liminal and transitive qualities of cigarette smoke and its capacity to dissolve the boundaries between bodies. My key goal is to illustrate the influence of cultural assessments about the nature of ‘risk’ on epidemiological standards of evidence. I contend that the subjectively experienced abjectness of cigarette smoke far more than the ‘objectively’ demonstrable harms to health it causes ultimately explains both popular and public health responses to the substance.     

Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations

We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages.A qualitative study was conducted between March 15 – April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community’s perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic.Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines.Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.     

Correlates and Predictors of Tobacco Use Among Immigrant and Refugee Youth in a Western Canadian City

Background Tobacco control is a priority of the British Columbia Ministry of Health as illnesses associated with tobacco use are the leading cause of preventable death in the province. As a result of increased immigration, British Columbia’s demographic profile is becoming more diverse and necessitates approaches to health promotion and disease prevention that are culturally relevant. In order to develop culturally relevant anti-smoking messages and resources for immigrant and refugee youth, surveys were administered to 194 youth to better understand their attitudes towards smoking and to explore predictors of tobacco use. Results Twelve percent of respondents reported smoking all or part of a cigarette within the past 30 days. Male respondents were three times more likely to smoke than female respondents. Logistic regression analysis showed that immigrant and refugee youth were more likely to be non-smokers if they did not have a father who smokes, drank alcohol less frequently and had fewer close friends who smoke. Implications These findings support previous research studies that relate youth smoking to social influences and demonstrate a need to address gender differences, the confluence of smoking and drinking and the significance of family and peer pressure on smoking when designing culturally relevant anti-smoking resources.     

Myths and attitudes that sustain smoking in China

China is a particularly critical country for global tobacco control. It has the world's largest number of smokers and is a prize target for the multinational tobacco companies. This article presents results from 80 focus groups and 30 in-depth interviews on the salient myths and misconceptions concerning active and passive smoking for the purpose of developing appropriate tobacco control policies and intervention strategies to reduce tobacco consumption and secondhand smoke exposure. All participants resided in three counties in Jiangxi, Henan, and Sichuan provinces and were from hospitals, schools, and rural and urban communities. The myths and misconceptions included the identification of smoking as a symbol of personal freedom, the importance of tobacco in social and cultural interactions, the ability to control the health effects of smoking through "reasonable" and "measured" use, and the importance of tobacco to the economy. These myths were found in nonsmokers and smokers alike, in both rural and urban areas, and across the key professional groups. For China to curb its current smoking epidemic, tobacco control efforts will have to persuasively address and counter prevailing misconceptions and social norms surrounding smoking. This article discusses the implications of misconceptions and prosmoking attitudes for tobacco control efforts in China.     

家庭环境中控烟干预措施实施效果评价

目的 探讨家庭创建无烟环境的有效措施。 方法 于2014年在天津市选取两个社区进行干预。采用多阶段整群抽样的方法,抽取住户,以户为单位,联合社区居委会、学校及社区卫生服务保健机构对其进行干预,主要形式包括大众媒体宣传、发放宣传材料、主题巡展、控烟讲座、烟草危害知识竞赛、微博转发、无烟家庭申报等宣传活动,干预前后调查该户全部15岁以上家庭成员的烟草使用情况及上一周内所有家庭成员及来访客人在家庭中吸烟情况。 结果 共调查976人,总吸烟率为21.3%。其中男性468人,女性508人,男性吸烟率为41.0%,女性为3.1%,干预后调查人群吸烟率较干预前下降了0.4%,但变化差异无统计学意义(P=0.87)。干预后“不想戒烟”的比例由干预前的74.3%下降至58.3%,差异有统计学意义(P=0.000)。干预后家庭成员或客人在家中吸烟、用香烟招待客人、把香烟作为礼物送给别人的比例较干预前有所下降,下降比例分别为19.6%、32.5%和63.0%,差异有统计学意义(P=0.000)。对吸烟及二手烟对健康危害的认知均得到较大程度的提升。无烟环境布置情况均有较大改善,摆放香烟及烟灰缸的现象由62.1%和58.1%分别下降至37.9%和41.9%,有烟蒂(34.7% vs. 65.3%)及烟味(35.4% vs. 64.6%)的比例也有较大幅度下降。 结论 在社区居委会、学校及社区卫生服务保健机构的共同配合下,通过在家庭中实施简单易行的控烟干预方式即可以取得良好的控烟效果。     

Smoke-Free Coalition Cohesiveness in Rural Tobacco-Growing Communities

Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members’ perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6 %) and Caucasian (99.5 %). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.