Editor’s Note: These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen. They were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. For more information, contact Dr. Erlen through the link above.
Informing E-cigarette Policy: Population Effects and Tobacco Industry Incentives
Author: Cahn, Zachary
Abstract: This dissertation consists of a set of papers intended to inform practitioners and scholars of nicotine policy in general and e-cigarettes specifically. The first chapter frames the subsequent chapters and introduces some key concepts that are necessary to understand this framing. The second chapter synthesizes the research on past obstacles to cigarette innovation in order to 1) determine why cigarette innovation did not yield substantially reduced hazard for decades, and 2) gain insight into how tobacco companies are likely to behave today and in the future. Special attention will be paid to the emergence of e-cigarettes and why the industry did not enter this market sooner. The third chapter focuses on the potential for e-cigarettes to “renormalize” cigarette smoking. Looking at one specific pathway—social renormalization—this chapter seeks to estimate whether peer vaping affects the perception of peer smoking among youths. The fourth chapter examines predictors of initiation of e-cigarette use among consistent smokers and analyzes the impact of e-cigarette use on cessation among smokers in a national U.S. consumer panel. The fifth chapter puts the findings from the previous chapters into context and develops core lessons for scholars that seek to study e-cigarettes and policymakers that seek to regulate them.
Publication year: 2016
Advisor: Saltman, Richard B.
Committee members: Berg, Carla Michael; Haardoerfer, Regine Michael; Hockenberry, Jason Michael
University/institution: Emory University
Department: Health Services and Research Health Policy
The Effect of Macro-Level Factors (Policies, Prices, and Neighborhood Social Environment) on Smoking Behavior in Two Multi-Ethnic Cohorts of U.S. Adults
Author: Mayne, Stephanie Lynne
Abstract: OBJECTIVE: This dissertation explores the effect of three macro-level factors on smoking behavior among U.S. adults: 1) bar and restaurant smoking ban policies, 2) cigarette prices, and 3) social aspects of the neighborhood environment. METHODS: Longitudinal epidemiologic cohort data from two sources: 1) the Coronary Artery Risk Development in Young Adults (CARDIA, 1985-2011, N=5071 young/middle-aged adults); 2) Multi-Ethnic Study of Atherosclerosis (MESA, 2000-2012, middle-aged to older adults, samples used were N=4884 and N=5856). Cohort data were geocoded and linked to three datasets: 1) state, county, city 100% smoke-free policies in bars and restaurants (American Non-Smokers Rights Foundation’s Local Ordinance Database 1985-2011); 2) cigarette prices at chain supermarkets and drug stores within 3 miles of the participant’s residence (IRI 2001-2011); and 3) neighborhood social environment scores for three domains: aesthetic quality, safety, and social cohesion (MESA Neighborhood Survey, 2002-2005 and 2010-2012). Various statistical modeling approaches were used: econometric models with subject fixed effects for within-person change in smoking outcomes, modified Poisson regression, and generalized linear mixed models for longitudinal and cross-sectional analyses. RESULTS: Smokefree policies : Restaurant/ bar smoking bans were associated with a significant decline in current smoking risk and smoking intensity (risk ratio (RR): 0.92, 95% confidence interval (CI): 0.87, 0.97, and RR: 0.91 (0.83, 0.99), respectively), and an increased likelihood of a quit attempt (RR: 1.10 (1.02, 1.19)). Policy impacts on declines in current smoking were strongest among those with higher education (≥bachelor’s degree) but the impact on quit attempts was strongest among women and lower income individuals. Cigarette prices : A $1 higher cigarette pack price was associated with lower smoking prevalence (prevalence ratio (PR): 0.88 (0.77, 1.01)) and smoking intensity in MESA year 10 (PR: 0.77 (0.62, 0.95)). A $1 increase in pack price was associated with reductions in current smoking risk (RR: 0.97 (0.93, 1.01)), intensity (RR: 0.93 (0.87, 0.99), and risk of relapse (RR: 0.72 (0.56, 0.95). Social environment : Participants living in areas with higher baseline neighborhood social environment composite score (reflecting a better environment) had 13% lower prevalence of baseline smoking (PR: 0.87 (0.78, 0.98). Similar results were observed for neighborhood safety and aesthetic quality but not for social cohesion. No associations were observed between neighborhood social environment and changes in smoking status or smoking intensity over time. CONCLUSIONS: Macro-level factors play an important role in smoking behavior. The differential effect of smoking bans by socioeconomic status underscores the importance of evaluating equity throughout policy implementation. Future work is needed to evaluate whether the neighborhood social environment influences earlier life smoking patterns.
Publication year: 2016
Advisor: Auchincloss, Amy H.
Committee members: Diez Roux, Ana V.; Michael, Yvonne L.; Stehr, Mark; Tabb, Loni P.
University/institution: Drexel University
Department: Epidemiology – School of Public Health
Examining Weight Gain in Treatment-Seeking African American Smokers: A Biopsychosocial Approach
Author: McNutt, Marcia D.
Abstract: Research has shown that African Americans gain excessive, or more than average, weight after smoking cessation. However, African Americans have been underrepresented in post-cessation weight gain research. Associations between weight gain and sex, age, cortisol levels, depressive symptoms, weight concern, and socioeconomic status have been documented, but few studies have examined 1) the pattern of weight gain and 2) factors associated with weight gain among African American smokers. The current study aimed to examine biopsychosocial predictors of weight gain in a sample of treatment-seekers. Data were drawn from a randomized controlled trial (RCT) testing the efficacy of a culturally specific smoking cessation intervention among African Americans. The intervention consisted of eight sessions (four weeks) of group cognitive behavioral therapy (CBT) and eight weeks of transdermal nicotine patches (TNP). Participants ( N =342) completed assessments at baseline, the end of counseling (EOC), 3-, 6-, and 12-month follow ups. Baseline measures included salivary cortisol, depressive symptoms, and weight concern. Weight and self-reported smoking status were measured at all assessments. Random effects (mixed effects) multilevel modeling including all time-points was used to examine the pattern and predictors of weight gain over twelve months post CBT. A fully unconditional model was specified to test the pattern of weight gain over time and the appropriateness of using random effects modeling for this data. Next, smoking status was included as a time-varying variable on level 1. The group level effects of biopsychosocial variables were then examined on level 2. Finally, cross-level interactions of the biopsychosocial factors and smoking status on weight were explored. Results of a univariate model revealed that weight significantly increased among those who remained abstinent over twelve months post CBT. Controlling for intervention condition and baseline obesity, smoking status positively predicted weight gain in the full sample, such that abstinence was associated with increased weight. A multivariate analysis revealed that male sex and weight concern were positively associated with baseline weight. Exploratory analyses indicated that depressive symptoms moderated the association between smoking status and weight. In this sample of African American smokers, weight gain was comparable to previous post-cessation weight gain research. We also found that psychosocial factors emerged as most important in predicting weight gain. Future research is needed to assess further the psychosocial variables, specifically depressive symptoms, which predict weight gain in African American smokers. Examining predictors of weight gain will inform future smoking cessation interventions and help elucidate factors that contribute to tobacco- and obesity-related health disparities.
Publication year: 2016
Advisor: Hooper, Monica Webb
Committee members: Antoni, Michael H.; Musselman, Dominique L.; Saab, Patrice G.; Schneiderman, Neil; Wohlgemuth, William
University/institution: University of Miami