There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans.
Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children.
Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car.
This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.
smoking; tobacco; pediatrics; family practice; parent; smoking cessation; secondhand smoke; environmental tobacco smoke; tobacco control
Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m3, and low noise. A linear relationship (R2 = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m3. Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.
A large number of Mexican migrants are deported to Mexico and released in the North Mexican border region every year. Despite their volume and high vulnerability, little is known about the level of HIV infection and related risk behaviors among this hard-to-reach population. We conducted a cross-sectional, probability survey with deported Mexican migrants in Tijuana, Mexico (N=693) and estimated levels of HIV infection and behavioral risk factors among this migrant flow. The sample and population estimated rates of HIV for deported males were 1.23% and 0.80%, respectively. No positive cases were found among the female sample. We found high lifetime rates of reported sexually transmitted infections (22.3%) and last 12-months rates of unprotected sex (63.0%), sex with multiple sexual partners (18.1%), casual partners (25.7%), and sex workers (8.6%), compared to U.S. and Mexico adults. HIV prevention, testing, and treatment programs for this large, vulnerable, and transnational population need to be implemented in both the U.S. and Mexico.
HIV; risk behaviors; Mexican migrants; deportation
Second hand smoke exposure (SHSe) relates to many chronic and acute illnesses. Low income African American (AA) maternal smokers and their children have disproportionately higher tobacco-use and child SHSe-related morbidity and mortality than other populations. While public health officials promote residential smoking restrictions to reduce SHSe and promote smoking cessation, little is known about the impact of restrictions in changing smoking behavior and SHSe in this population. Thus, the purpose of this study was to examine associations between residential smoking restrictions, maternal smoking, and young children’s SHSe in the context of other factors known to influence low income AA mothers’ smoking behavior. For this study, we used cross-sectional, baseline data from 307 AA maternal smokers’ pre-treatment interviews completed as part of a subsequent behavioral counseling trial to reduce their young (< 4 years old) children’s SHSe. Residential smoking restriction was dichotomized as 0 = no restrictions and 1 = some restrictions. Child urine cotinine provided a biomarker of SHSe. Mothers reported cigarettes/day smoked, cigarettes/day exposed to child, and intention to quit. Multivariate regressions modeled effects of restriction as the primary predictor of smoking and exposure outcomes. Maternal smoking patterns such as cigarettes per day (β = 0.52, p < 0.001) and years smoked (β = −0.11; p = 0.03) along with presence of additional smokers in the home (β = 0.10; p = 0.04), but not residential restriction (β = −0.09, p = 0.10), predicted reported SHSe. Restriction did not relate to baby cotinine or maternal intention to quit. Thus, residential smoking restrictions may contribute to efforts to reduce children’s SHSe and promote maternal smoking change; but alone, may not constitute a sufficient intervention to protect children. Multi-level intervention approaches that include SHSe-reduction residential smoking policies plus support and cessation assistance for smokers may be a necessary approach to smoke-free home adoption and adherence.
Home Smoking Policy; Second Hand Smoke; Underserved Populations
To expand understanding of a smoking cessation barrier for women, weight concerns, in a medically underserved population.
Baseline weight concerns were examined among 235 low-income, black maternal smokers enrolled in a smoking trial. Logistic regression evaluated factors related to weight concerns.
Higher BMI (OR 3.35, P<.001), intention to quit (OR 2.12, P=.02), more previous quit attempts (OR 1.14, P=.03), and less support for quitting (OR 0.81, P=.05) predicted weight concerns.
This is the first study to delineate factors predicting weight concerns in this population, thus expanding our understanding of a key cessation barrier and informing future cessation strategies in a population known to bear increased risk of tobacco-related disease.
weight concerns; smoking cessation; maternal; underserved; black
Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001–2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Koreans and Korean Americans, with these patterns also differing between men and women. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.
South Koreans' Health; Korean Americans' Health; Age; Tobacco Control; Immigration; Smoking
This study examined whether thirdhand smoke (THS) persists in smokers’ homes after they move out and nonsmokers move in, and whether new nonsmoking residents are exposed to THS in these homes.
Homes of 100 smokers and 50 nonsmokers were visited before the residents moved out. Dust, surfaces, and air and participants’ fingers were measured for nicotine and children’s urine samples were analyzed for cotinine. The new residents who moved into these homes were recruited if they were nonsmokers. Dust, surfaces, and air, and new residents’ fingers were examined for nicotine in 25 former smoker and 16 former nonsmoker homes. A urine sample was collected from the youngest resident.
Smoker homes’ dust, surface, and air nicotine decreased after the change of occupancy (p<.001); yet dust and surfaces showed higher contamination levels in former smoker homes than former nonsmoker homes (p<.05). Nonsmoking participants’ finger nicotine was higher in former smoker homes compared to former nonsmoker homes (p<.05). Finger nicotine levels among nonsmokers living in former smoker homes were significantly correlated with dust and surface nicotine and urine cotinine.
These findings indicate that THS accumulates in smokers’ homes and persists when smokers move out even after homes remain vacant for two months and are cleaned and prepared for new residents. When nonsmokers move into homes formerly occupied by smokers, they encounter indoor environments with THS polluted surfaces and dust. Results suggest that nonsmokers living in former smoker homes are exposed to THS in dust and on surfaces.
Tobacco Smoke Pollution; Secondhand Smoke; Passive Smoking; Thirdhand Smoke; Environmental Tobacco Smoke Exposure
This study estimated the association of cultural and social mechanisms with Korean American women’s drinking behaviors. Data were drawn from telephone interviews with 591 Korean women selected from a random sample of households in California with Korean surnames during 2007. About 62% of eligible respondents completed the interview. Respondents reported any lifetime drinking (yes/no), drinking volume (typical number of drinks consumed on drinking days), level of acculturation, and described their social network by assessing who encouraged or discouraged drinking (drinking support) or drank (drinking models). Multivariable regressions were used for analyses. About 70% (95% confidence interval [95%CI], 67 to 74) of Korean American women reported any lifetime drinking and current drinkers drank 1.18 (95%CI, 1.07 to 1.28) drinks on drinking days. Acculturation was not significantly associated with any lifetime drinking or drinking volume, while models and support for drinking were statistically significantly associated with a higher probability of any lifetime drinking and drinking more on drinking days. Each additional encourager, or one fewer discourager, for drinking in women’s social networks was associated with a 2% (95%CI, 1 to 3) higher probability of any lifetime drinking and drinking 0.25 (95%CI, −0.53 to 1.18) more drinks on drinking days. Each additional drinker in women’s networks was associated with a 4% (95%CI, 1 to 8) higher probability of any lifetime drinking and drinking 0.26 (95%CI, −0.05 to 0.60) more drinks on drinking days. Korean American women’s drinking appears to be strongly related to their social networks, though how women take on traits of their new environment was not.
Korean American Women; Social Networks; Acculturation; Ecological Models of Health Behavior
Objective. The purpose of this study was to determine the gaps between disclosed high-risk behaviors in low-income, mainly Hispanic youth and the identification of these risks by health care providers. Methods. This cross-sectional study included youth 13–19 years old who participated in a study on latent tuberculosis treatment. Youth were interviewed at baseline by bilingual research assistants; the provider visit was assessed by the chart review. Results. Of 221 youth, the majority (96%) were identified as Hispanic, 45% were foreign-born, and 46% were male. A total of 399 risk behaviors were revealed to research staff by the participants; only 24 risk behaviors were revealed to providers. Conclusions. The majority of risk behaviors based on the chart review were neither queried nor disclosed to the physicians. Physicians providing care to adolescents should consider strategies to improve disclosure as a necessary precursor to interventions.
To test effects of parent/child training designed to increase calcium intake, bone-loading physical activity (PA), and bone density.
Two-group randomized controlled trial.
Family-based intervention delivered at research center.
117 healthy children aged 10-13 years (58.1% female, 42.7% Hispanic, 40.2% White). Ninety-seven percent of participants had at least one parent graduate from high school and 37.2% had at least one parent graduate from a 4-year university.
Children and parents were randomly assigned to diet and exercise (experimental) or injury prevention (control) interventions. Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries. Parents were taught behavior management techniques to modify children’s behaviors.
Measures at baseline, three, nine and twelve months included 24-hour diet and PA recalls, and bone mineral density (BMD) by DXA.
ANOVA and Generalized Estimating Equations assessed group by time differences. Comparisons were conducted separately for boys and girls.
For boys, cross-sectional differences between experimental versus control group were achieved for 3 and 9-month calcium intake (1352 vs. 1052mg/day, 1298 vs. 970mg/day, p<0.05). For girls, marginal cross-sectional differences were achieved for high-impact PA at 12 months (p<0.10). For calcium intake, a significant group by time interaction was observed from pre to post test for the full sample (p=.008) and for girls (p=.006) but not for boys. No significant group by time differences in calcium were observed across the follow-up period. No group by time differences were observed for high impact physical activity. Among boys, longitudinal group by time differences reached significance for total hip BMD (p=.045) and femoral neck BMD (p=.033), even after adjusting for skeletal growth. Similar differential increases were observed among boys for BMC at the hip (p=.068) and total body (p=.054) regions. No significant group by time interaction effects were observed for girls at any bone site for BMD. For BMC, control girls showed a significant increase (p=.03) in spine BMC compared to intervention girls
This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA. Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during pre-adolescent years.
Calcium; diet; parent education; physical activity; preteens; Osteoporosis prevention; Manuscript format: research; Research purpose: intervention testing/ program evaluation; Study design: randomized trial; Outcome measure: behavioral, biometric; Setting: family; Health focus: fitness/physical activity, nutrition; Strategy: education, skill building/behavior change; Target population age: youth; Target population circumstances: geographic location
This paper reviews methodological and theoretical fidelity of secondhand smoking (SHS) intervention studies (n=29) that target protection of children in their home. In 2005, interventions were evaluated in terms of treatment fidelity according to guidelines provided by Borrelli et al. of the National Institutes of Health Behavior Change Consortium. The degree of fidelity was evaluated based on the percentage of criteria met; the inter-rater reliability based on percent agreement across independent raters was 0.78. Analysis indicated that studies with higher treatment fidelity were more likely to obtain statistically significant results (p=.003) with the average fidelity rating of 0.74 for statistically significant studies vs. 0.50 for statistically non-significant studies. Higher treatment fidelity was also significantly associated with being a more recent investigation (year 2000 or later), an efficacy as compared to effectiveness trial, more intensive as compared to less intensive intervention, a trial in the U.S. as compared to foreign nations, and having a theoretical basis. After taking all other variables into account, only treatment fidelity was significantly related to study outcome (p=.052). Ratings of treatment fidelity were ranked and compared to previous rankings based on 342 behavioral change interventions; the rank-ordered correlation between previous and current ratings was 0.84, although median fidelity ratings were 0.10 points lower in the previous than in the present study (0.52 vs. 0.62; intraclass correlation=0.79). Improvements to the treatment fidelity evaluation guidelines were suggested, including the consideration of theoretical fidelity. Enhancing methodological and theoretical fidelity will speed identification of valid theoretical precepts that will, in turn, guide effective public health prevention programs.
To test and compare 2 predictive models of weapon carrying in youth (n=308) recruited from 4 drop-in centers in San Diego and Imperial counties.
Both models were based on the Behavioral Ecological Model (BEM).
The first and second models significantly explained 39% and 53% of the variance in weapon carrying, respectively, and both full models shared the significant predictors of being black(−), being Hispanic (−), peer modeling of weapon carrying/jail time(+), and school suspensions(+).
Results suggest that the BEM offers a generalizable conceptual model that may inform prevention strategies for youth at greatest risk of weapon carrying.
weapon carrying; risk factors; protective factors; adolescents; drop-in centers
The Arkansas Method (AM) for Isoniazid (INH) metabolite detection is a relatively inexpensive, simple, objective measure of adherence. The purpose of the study was to explore whether variations in urine sample handling and storage will produce accurate assay outcomes. Participants were a convenience sample of 28 adults and adolescents prescribed INH for Latent Tuberculosis Infection (LTBI). Participants provided one sample to test effects of: mixing processes; durations at room temperature, in a refrigerator, or frozen; and effects of freeze/thaw cycles on AM outcomes. No manipulations had a discernible impact on outcomes with concordant positive rates from 85–100%. Concordance rates of manipulated samples didn’t appear to differ from rates of norm samples. Results suggest that urine samples can withstand a variety of manipulations in both handling and storage without affecting the accuracy of AM assay results. These findings have important implications for providers of treatment and researchers, and provide the impetus for both to examine the potential of using the AM of INH metabolite testing as a measure of medication adherence.
Arkansas Method; Tuberculosis; LTBI; Adherence; Isoniazid
Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated > 12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans.
Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected.
Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p < .01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p < .05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p < .02).
The most disadvantaged families were least likely to have protective health behaviors in place to reduce SHSe and, consequently, are most at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed.
Susceptibility to cigarette smoking in tobacco-naive youth is a strong predictor of smoking initiation. Identifying mechanisms that contribute to smoking susceptibility provide information about early targets for smoking prevention. This study investigated whether sensitivity to secondhand smoke exposure (SHSe) contributes to smoking susceptibility.
PARTICIPANTS AND METHODS:
Subjects were high-risk, ethnically diverse 8- to 13-year-old subjects who never smoked and who lived with at least 1 smoker and who participated in a longitudinal SHSe reduction intervention trial. Reactions (eg, feeling dizzy) to SHSe were assessed at baseline, and smoking susceptibility was assessed at baseline and 3 follow-up measurements over 12 months. We examined the SHSe reaction factor structure, association with demographic characteristics, and prediction of longitudinal smoking susceptibility status.
Factor analysis identified “physically unpleasant” and “pleasant” reaction factors. Reported SHSe reactions did not differ across gender or family smoking history. More black preteens reported feeling relaxed and calm, and fewer reported feeling a head rush or buzz compared with non-Hispanic white and Hispanic white counterparts. Longitudinally, 8.5% of subjects tracked along the trajectory for high (versus low) smoking susceptibility. Reporting SHSe as “unpleasant or gross” predicted a 78% reduction in the probability of being assigned to the high–smoking susceptibility trajectory (odds ratio: 0.22 [95% confidence interval: 0.05–0.95]), after covariate adjustment.
Assessment of SHSe sensitivity is a novel approach to the study of cigarette initiation etiology and informs prevention interventions.
secondhand smoke; sensitivity; smoking susceptibility; trajectories; preteens
The latest amendment to the ban on smoking in public places in Israel was implemented in 2007, adding pubs and bars (P&B) to the list of public places in which smoking is prohibited. However, smoking in most P&B continued. The aim of the study was to identify the theoretically plausible reasons for the partial success of a public ban on smoking in P&B settings. Explanations provided by P&B owners were interpreted as probable causal factors based on the Behavioral Ecological Model (BEM).
Qualitative interviews were performed with 36 P&B owners in Tel-Aviv and 18 Israeli towns and cities of various population size.
P&B owners reported a variety of situational factors (i.e., contingencies) and reinforcers as likely explanations of the partial failure of the legislated ban on smoking in public places, particularly P&B. The major reinforcers for non-adherence with the law were no or low frequency of inspections and low penalties from authorities. P&B owners also feared loss of customers and revenue if bans were enforced in their own establishment but not in competing establishments. Finally, owners reported social norms prevailing among some Israeli patrons supporting smoking in P&B settings, in part to express opposition to the new law.
Qualitative assessment can uncover probable social situations that operate to prevent greater adherence to smoking bans. The results warrant confirmation by quantitative analyses. Policies with mandated inspections and penalty requirements that are implemented in all bars without prejudice could lead to greater adherence to smoking bans. Positive reinforcing consequences that encourage adherence (such as publicity and support from non-smokers) would be more likely to generate both greater adherence to the policy and good will toward the government. Principles of behavior outlined in the BEM offer guidance for designing quantitative confirmation analyses of future bans.
Smoking ban; Bars; Pubs; Behavioral ecological model; Israel
Given the considerable variability in drinking practices among Asian American groups, the generalizations that suggest an increase in their alcohol use associated with acculturation need to be questioned. Also, the experience of children of immigrants growing up in the United States may be much more complex than a focus on acculturation can capture. Informed by the theory of segmented assimilation, this study addresses two research questions: 1) Is acculturation associated with alcohol use of Korean American adolescents? and 2) What other social, economic, and cultural forces influence their alcohol use? Survey data collected from 202 adolescents of Korean descent in Southern California were used. Multivariate regression analyses revealed that acculturation was not a significant predictor of most measures of alcohol use, while peer influence, scholastic achievement/aspirations, and current smoking were predictive. Gender and social class were unrelated to drinking. Findings suggest focusing research on an integrative approach to understanding drinking in complex social, economic, and social contexts may be useful.
Home and car smoking bans implemented by caregivers are important approaches to reducing children’s secondhand smoke (SHS) exposure and attendant health risks. Such private smoking bans are usually informal and are subject to individuals’ interpretation, observation, and recall. Relying on a single reporter may lead to misclassification of bans in families.
To determine (1) proportion of families with discordant reports of bans; (2) association between parent–child report agreement and SHS exposure; and (3) whether including a second reporter of bans improves prediction of child SHS exposure.
In each of 386 participating families a preteen and a parent reported separately on their home and car smoking bans, and agreement was determined. ANOVA, chi-square, and multiple regression were used to determine relationships between SHS exposure (measured by urine cotinine and reported exposure) and home/car smoking bans reported by preteens and parents.
In 19% of families, reports disagreed for home smoking bans; 30% for car smoking bans. Families who agreed on the presence of a ban had the lowest exposure, families who agreed on the absence of a ban had the highest exposure, and intermediate exposure for those who disagreed. Parent and child reports of bans each explained significant, unique variance in child SHS exposure.
Due to relatively high prevalence of discordant reporting, a more accurate classification of home/car bans may result from including multiple reporters.
To investigate the sensitivity to secondhand smoke exposure (SHSe) in preteens age 8 to 13 who have never smoked, and to determine whether SHSe sensitivity predicts smoking susceptibility.
We assessed sensitivity to SHSe using reactions commonly used for assessment of sensitivity to the first smoked cigarette (e.g., feeling dizzy), and investigated the factor structure of these reactions for the purpose of data reduction. We examined the association of each reaction measure and summary score with demographic characteristics and with smoking susceptibility, using logistic regression and ordinal logistic regression.
One factor was identified that captured physical/unpleasant reactions. Older preteens and preteens with more highly educated parents reported fewer reactions to SHSe. More African American preteens reported feeling relaxed or calm compared to all other racial/ethnic groups. Experiencing physical/unpleasant reactions to SHSe predicted lower risk for smoking susceptibility.
This was the first study to extend analytical methodology for sensitivity to active smoking to sensitivity to SHSe in youth who have never smoked. Results suggest a desensitization process with age and lower sensitivity to some reactions in preteens from more highly educated households. Preteens who have more aversive experience s with SHSe tend to be less susceptible to smoking than those who experience fewer aversive reactions. Assessment of sensitivity to SHSe is a novel approach to the study of cigarette use etiology and may contribute to better prediction of smoking initiation.
preteens; secondhand smoke; reactions; sensitivity; smoking susceptibility
The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status.
Materials and Methods
Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies.
Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling.
These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.
South Koreans' health; smoking; military; tobacco control
Immigration involves challenges and distress, which affect health and well-being of immigrants. Koreans are a recent, fast growing, but understudied group of immigrants in the US, and no study has established or evaluated any immigration stress measure among this population. This study explores the psychometric properties of Korean-translated Demands of Immigration (DI) Scale among first-generation female Korean immigrants in California. Analyses included evaluation of factor structure, reliability, validity, and descriptive statistics of subscales.
A surname driven sampling strategy was applied to randomly select a representative sample of adult female Korean immigrants in California. Telephone interviews were conducted by trained bilingual interviewers. Study sample included 555 first-generation female Korean immigrants who were interviewed in Korean language. The 22-item DI scale was used to assess immigration stress in the study sample.
Exploratory Factor Analysis suggested six correlated factors existed in the DI scale: language barriers, sense of loss, not feeling at home, perceived discrimination, novelty, and occupation. Confirmatory Factor Analysis validated the factor structure. Language barriers accounted for the most variance of the DI Scale (29.11%). The DI scale demonstrated good internal consistency reliability and construct validity.
Evidence has been offered that the Korean-translated DI scale is a reliable and valid measurement tool to examine immigration stress among Korean immigrants. The Korean-translated DI scale has replicated factor structure obtained in other ethnicities, but addition of cultural-specific items is suggested for Korean immigrants. High levels of language and occupation related stress warrant attention from researchers, social workers and policy makers. Findings from this study will inform future interventions to alleviate stress due to demands of immigration.
Immigration; immigrant; stress; distress; Korean; Demand of Immigration; Exploratory Factor Analysis; Confirmatory Factor Analysis
Secondhand smoke (SHS) is hazardous to children’s health. Designing interventions to reduce exposure requires understanding children’s behavior in the presence of smokers, yet little is known about this behavior.
To determine whether children’s avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.
Preteens aged 8–13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person’s smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multivariable Logistic Regression was used to determine predictors of SHS avoidance.
Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.
Most SHS exposure reduction interventions have targeted changes in smokers’ behavior. Reductions can also be achieved by changing exposed nonsmokers’ behavior, such as avoiding the exposure. Future studies should measure young people’s SHS avoidance and test interventions to increase their avoidance practices.
Secondhand smoke (SHS); Avoidance; Children; Youth; Ecological model
This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States.
A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001–02. Multivariable regressions were used for analyses.
Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16–23) versus 66% (95% CI: 64–68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60–69) versus 5% (95% CI: 4–6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76–86) versus 36% (95% CI: 17–57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7–13) versus 7% (95% CI: 3–13).
Consistent with ecological frameworks, exposure to California’s antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.
To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged ≥ 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.
Validity; Self-Reported; Healthcare Utilization; Community Health Survey
Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents’ home to the nearest A&T retailer (−), acculturation (+), parents’ consistent use of contingency management (−), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents’ consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US–Mexico border region.
GIS; Alcohol use; Tobacco use; Built environment; Latinos; Adolescents