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RESPONSES TO TOBACCO PUBLIC EDUCATION MESSAGES AMONG YOUNG ADULTS: HOW PREVIOUS QUIT ATTEMPTS AND QUIT INTENTIONS AFFECT MESSAGE PERCEPTIONS 

Emma Jankowski, BSPH 

Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 

Joanne G. Patterson, PhD, MPH, MSW 

Division of Health Behavior and Health Promotion, Ohio State University, Columbus, OH 

Introduction:

• A large proportion of young adults are using nicotine vapes and although the rate of cigarette smoking in the young adult population has decreased over time, there is still prevalent combustible use, specifically in minoritized populations (1-2).
• Cigarette initiation is commonly in young adulthood, so interventions must address avoidance of cigarettes as well as quitting in this group (3-5).
• Public education campaigns can effectively prevent smoking and vaping initiation among youth and encourage cessation in adults, but their effect among young adults (YA) is understudied (6-16).
• We tested the effectiveness of messages describing the absolute and comparative risks of smoking cigarettes and vaping nicotine and assessed how quit interest/attempts shaped post-exposure perceptions among YA living in the United States. 

Methods:

• Participants were recruited and prescreened via Prolific and eligible participants were directed to Qualtrics for a survey
  • Eligibility criteria were: participants had to be ages 18-35 and reside in the U.S.
• Participants were asked a series of pre-screening questions about their demographics, as well as their smoking/vaping and cessation history.
• Participants were categorized by current smoking and vaping status for analysis.
• Exposures were analyzed by having a quit attempt in the last 12 months versus not, as well as intention to quit within 6 months, compared to those intending to quit, but not within 6 months and those not intending to quit at all.
• YA aged 18–35 years viewed 8 messages in one of three experimental conditions (control, absolute risk, comparative risk).
• After viewing these messages, participants rated their message and effects perceptions in matrix-style questions, as well as rated their feelings about smoking and vaping, harm perceptions, and behavioral intentions with regards to smoking and vaping in the near future.
• We fit unadjusted, post-exposure regression models to assess main effects of self-reported past 12-month quit attempts and quit interest on outcomes (impact perceptions; intentions to refrain from smoking/vaping in the next 3 months) among current smokers (N=750) and vapers (N=1015). 

Results:

Figure 1: Visual Presentation of Main Results

Table 1: Sociodemographic characteristics of analytic samples 

Table 4b. Main effects of quit interest and quit attempts on outcomes among SMOKERS 

Table 4c. Main effects of quit interest and quit attempts on outcomes among VAPERS 

**All results are Bonferroni corrected so alpha = 0.03 

Conclusions:

• Tobacco public education messages describing the absolute and comparative risks of smoking cigarettes and vaping nicotine were most effective for YA who reported making a recent quit attempt, or who were interesting quitting smoking/vaping within 6 months.
• Results suggest that YA are interested in quitting smoking/vaping and that unique message framing must be developed to engage YA across the quit continuum. 

Funding/Acknowledgements:

• Thank you to all members of the Practice and Science for LGBTQ+ Health Equity Lab for their contributions.
• This research was funded by the National Institutes of Health, National Cancer Institute and FDA Center for Tobacco Products (K99CA260718 and R00CA260718; PI: JGP), and supported by the Ohio State University Comprehensive Cancer Center and the Ohio State University College of Public Health. 

References

1. Pierce JP, Luo M, McMenamin SB, et al. Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge. Tobacco Control Published Online First: 08 November 2023. doi: 10.1136/tc-2022-057907
2. Sanford BT, Brownstein NC, Baker NL, et al. Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults. JAMA Intern Med. 2024;184(1):106–108. doi:10.1001/jamainternmed.2023.5239
3. Pérez A, Bluestein MA, Kuk AE, Chen B. Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017). PLoS One. 2021 Dec 13;16(12):e0261243. doi: 10.1371/journal.pone.0261243. PMID: 34898629; PMCID: PMC8668126.
4. Barrington-Trimis JL, Braymiller JL, Unger JB, McConnell R, Stokes A, Leventhal AM, Sargent JD, Samet JM, Goodwin RD. Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018. JAMA Netw Open. 2020 Oct 1;3(10):e2019022. doi: 10.1001/jamanetworkopen.2020.19022. PMID: 33021650; PMCID: PMC7539122.
5. Kelsh S, Ottney A, Young M, Kelly M, Larson R, Sohn M. Young Adults’ Electronic Cigarette Use and Perceptions of Risk. Tob Use Insights. 2023 Mar 7;16:1179173X231161313. doi: 10.1177/1179173X231161313. PMID: 36911177; PMCID: PMC9996725.
6. Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The Influence of the National truth® Campaign on Smoking Initiation. Am J Prev Med. 2009;36(5):379-384. doi:10.1016/j.amepre.2009.01.019
7. Farrelly MC, Duke JC, Nonnemaker J, et al. Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths — United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(02):47-50. doi:10.15585/mmwr.mm6602a2
8. Sly D, Hopkins R, Trapido E, Ray S. Influence of a counteradvertising media campaign on initiation of smoking: the Florida “truth” campaign. Am J Public Health. 2001;91(2):233-238. doi:10.2105/AJPH.91.2.233
9. Weiss JW, Cen S, Schuster D, et al. Longitudinal effects of pro‐tobacco and anti‐tobacco messages on adolescent smoking susceptibility. Nicotine Tob Res. 2006;8(3):455-465. doi:10.1080/14622200600670454
10. Siegel M. What the FDA Gets Wrong About E-Cigarettes. Bloomberg. https://www.bloomberg.com/view/articles/2017-03-16/what-the-fda-gets-wrong-about-e-cigarettes?in_source=embedded-checkout-banner. Published March 16, 2017. Accessed July 25, 2023.
11. Calabro KS, Khalil GE, Chen M, Perry CL, Prokhorov AV. Pilot study to inform young adults about the risks of electronic cigarettes through text messaging. Addict Behav Rep. 2019;10:100224. doi:10.1016/j.abrep.2019.100224
12. U.S National Cancer Institute. A Socioecological Approach to Addressing Tobacco-Related Health Disparities | Division of Cancer Control and Population Sciences (DCCPS). A Socioecological Approach to Addressing Tobacco-Related Health Disparities; 2017. Accessed July 25, 2023. https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-22
13. Duke JC, Farrelly MC, Alexander TN, et al. Effect of a National Tobacco Public Education Campaign on Youth’s Risk Perceptions and Beliefs About Smoking. Am J Health Promot. 2018;32(5):1248-1256. doi:10.1177/0890117117720745
14. Kranzler EC, Hornik RC. The Relationship Between Exogenous Exposure to “The Real Cost” Anti-Smoking Campaign and Campaign-Targeted Beliefs. J Health Commun. 2019;24(10):780-790. doi:10.1080/10810730.2019.1668887
15. The Real Cost E-Cigarette Prevention Campaign. Published online July 21, 2023. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/real-cost-campaign/real-cost-e-cigarette-prevention-campaign#:~:text=Our%20Goal%3A%20Educate%20youth%20about,addiction%20from%20using%20e%2Dcigarettes
16. This Free Life Campaign. Published online March 11, 2022. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/public-health-education-campaigns/free-life-campaign

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Lesbian, Bisexual, and Queer (LBQ+) women and non-binary people assigned female at birth (NB people AFAB) are more likely than their heterosexual peers to smoke. and use e-cigarettes. One explanation is that for over 20 years, the tobacco industry has targeted LGBTQ+ populations through culturally-targeted advertising and marketing. It is possible that culturally-targeted marketing could be leveraged for anti-tobacco public health messaging.

Our study, published in the Journal of Health Communications, found that culturally-targeted anti-tobacco messaging more effectively reached LBQ+ women and NB people AFAB who held more positive feelings about their sexual identity. To read more, https://go.osu.edu/22DLHC

#lgbtqhealth #lgbtqhealthresearch #queerhealth #smokingcessation #womenshealth #tobaccoresearch #thisispublichealth

Cross-posted from: Town Hall Talk: Flavored Tobacco Use in LGBTQ Communities (osu.edu)

Hi all!

I was recently invited to join in a Town Hall Talk on Flavored Tobacco Use among LGBTQ communities hosted by the LGBT Cancer Network and Equitas Health Institute. My colleagues Gabe Glissmeyer (LGBT Tobacco Network), Julia Applegate (Equitas Health Institute), and Michael Pistrui (Ohio University) talk from professional and personal experiences on the issue. Check us out below:

To learn more about tobacco use among LGBT communities check out the LGBT Cancer Network’s fact sheet: National LGBT Cancer Network LGBT Tobacco Fact Sheet (cancer-network.org)

If you want to learn more about the FDA’s proposed regulation on flavored tobacco, visit: FDA Proposes Rules Prohibiting Menthol Cigarettes and Flavored Cigars to Prevent Youth Initiation, Significantly Reduce Tobacco-Related Disease and Death | FDA

Cross posted from On Academic Life and Living

See Dr. Patterson featured on WTVN 10

Ohio’s House Bill 616  states that no public school, community school or private school that accepts vouchers shall “teach, use, or provide any curriculum or instructional materials on sexual orientation or gender identity” in kindergarten through third grade. And older kids can’t be taught “any curriculum or instructional materials on sexual orientation or gender identity in any manner that is not age-appropriate or developmentally appropriate for students in accordance with state standards.”

Proposed HB616 is an LGBTQ+ health equity and public health concern.

The proposed legislation’s language, particularly the phrases “classroom instruction” and “age-appropriate,” could be interpreted so broadly that it creates unsafe spaces for teachers who may be more likely avoid the subjects entirely or fear repercussion from any private citizen that disagrees with them. By silencing teachers, legislation like HB616 codifies oppression. This is unacceptable. Developmentally appropriate K-5 education includes teaching about people and families of diverse identities and structures – that includes LGBTQ+ families and people.

HB616 isn’t happening in a vacuum.

This year, state lawmakers have proposed more than 280 bills that would limit LGBTQ people’s rights. About half target transgender people specifically. In 2018, less than 50 of these bills were introduced.

The slate of legislation includes measures like HB616 that restrict LGBTQ issues in school curriculum along with legislation that would 

• • permit religious exemptions to discriminate against LGBTQ people
  • limit transgender people’s ability to play sports and use bathrooms that correspond with their gender identity
  • ban access to gender-affirming health care.

Yet support for public LGBTQ rights and policies prohibiting LGBTQ discrimination is at an all time high. Nearly 8 in 10 Americans support laws that protect LGBTQ people from discrimination. Legislation like HB616 does not represent majority public opinion. BUT, it is dangerous, because it creates a hostile climate– especially for LGBTQ young people.

HB616 threatens to widen health inequities experienced by LGBTQ youth.

Approximately 11% of young people in grades 9-12 years old identify as LGBTQ. The CDC’s recent Adolescent Behaviors and Experiences Survey (ABES) found that LGBTQ students are experiencing disproportionately high levels of poor mental health and suicide-related behaviors.

• 2 out of 3 LGBQ high school students experienced poor mental health during the pandemic (vs 1 in 3 heterosexual student), including feeling persistently sad or hopeless.
• LGBQ students were more likely to vape and smoke cigarettes than their cishet peers (22% vs 14% reported any current tobacco use).
• LGBQ students also reported higher current alcohol use (26 vs 19%) and binge drinking (9 vs 8%), marijuana use ( 18 v 12% ), and prescription opioid misuse (7 vs 4%).

• In 2021, almost 1 in 2 LGBQ high school students seriously considered attempting suicide.
• 1 in 4 LGB and 1 in 6 students who identified their sexual orientation as other or questioning reported ATTEMPTING suicide  (vs 5% heterosexual peers)

ABES doesn’t reported on transgender and gender diverse students, but from YRBS data, we know that T/gender diverse students are more likely to experience violence victimization, ATOD, and suicidal ideation and attempts than cishet students.

Higher rates of poor mental health, risk behaviors, and suicidality are not a failing for  LGBTQ students. We are failing them. 

Creating safe schools protects LGBTQ students. 

Connectedness refers to a sense of being cared for, supported, and belonging, and can be centered on feeling connected to school and peers. In 2021, Fewer LGB students felt close to people at school (ABES).

This is problematic because, compared to students who were not connected to peers, students who felt close to people at school had lower rates of poor mental health during the pandemic (28.4% versus 45.2); less persistent sadness or hopelessness (35.4% versus 52.9%), and were less likely to seriously consider or attempt suicide (14.0% vs 25.6%) (5.8% vs 11.9%).

School connectedness is also protective across the lifecourse. Youth who feel connected at school are 66% less likely to experience poor mental health and health risk behaviors, including ATOD use and violence in adulthood.

If we know that school connectedness protects students’ health, then we have to create environments where all students can feel connected. For LGBTQ students, this means creating LGBTQ supportive school environments through:

• • Gay-Straight/Genders and Sexuality Alliances
  • Developing safer spaces to learn, work, and play
  • Inclusive curricula

Teaching inclusive curriculum is especially important. LGBTQ+ youth are not often taught about LGBTQ+ history, culture, and people. In 2019, a study by GLSEN found that only half of LGBTQ students could find LGBTQ+ relevant content at the school library or access LGBTQ+ content from school computers.

School environments which are inclusive of LGBTQ+ history + culture are safer learning environments for LGBTQ+ youth. According to the same study,

• LGBTQ+ students whose schools had inclusive curricula reported hearing fewer slurs and experienced lower levels of victimization
• They report feeling safer and more accepted in their community (GLSEN, 2019).

Teaching inclusive curriculum also resulted in better educational outcomes.

• Students at schools with inclusive education missed fewer days of school and had a higher GPA ( vs students whose schools did not cover LGBTQ+ (GLSEN, 2019)
• Data from the Trevor Project suggests that LGBTQ youth who learn about LGBTQ issues in school are less likely to attempt suicide.

Inclusive curriculum is about more than teaching culture and history… it’s about creating spaces where all youth – including LGBTQ youth and children with LGBTQ parents feel seen, affirmed, and safe, HB616 threatens to eliminate that safety for LGBTQ students in Ohio.

What can you do?

Call or write your legislators. Tell them you disagree with HB616.

• Stonewall Columbus has postcards in their lobby folks can pick up for free!

Let your local PTO and School Board know that you disagree with HB616.

Talk to your children about why teaching about LGBTQ people and culture is important.

Show community support by joining in a PRIDE event this year.

Donate to a local LGBTQ organization, especially those that serve youth and young adults in our greater Columbus community.

• Kaleidoscope Youth Center

• Stonewall Columbus

Get to know local LGBTQ healthcare organizations.

• Mozaic
• Equitas Health
• National Wide Children’s Thrive

In a US national study of women surviving cancer, researchers at The Ohio State University James Comprehensive Cancer Center and University of Kentucky Markey Cancer Center found that lesbians and bisexual women cancer survivors reported poorer quality of life and increased health risk behaviors than heterosexual women.

These factors may contribute to excess chronic disease morbidity and mortality among lesbian and bisexual women, and widen existing disparities.

Findings underscore the importance of investing in cancer prevention and survivorship research that intentionally engages LGBT populations.

Hutchcraft ML, Teferra AA, Montemorano L, Patterson JG. LGBT Health. 2021; 8(1).

Read more: https://www.liebertpub.com/doi/full/10.1089/LGBT.2020.0185 

Our recently published study, Sexual orientation disparities in food insecurity and food assistance use in U.S. adult women: National Health and Nutrition Examination Survey, 2005–2014, was featured today in the BMC Series blog.

Documenting food security disparities among sexual minority women women in the United States, we found that:

• 1 in 4 sexual minority women experienced food insecurity in the past 12-months
• Sexual minority women were 34-52% more likely to be food insecure
• Alarmingly, sexual minority women were 50-84% more likely to experience at least one period during the past 12-months where eating patterns were disrupted and food intake was reduced due to lack of money or other resources (severe food insecurity)
• Lesbians and heterosexual women reporting past same-sex behavior were more likely to rely on emergency food assistance (e.g., food pantries) to supplement food intake.
• Sexual minority and heterosexual women were equally as likely to use federal food assistance programs (e.g., Supplemental Nutrition Assistance Program; SNAP)

Food insecurity is associated with nutritional deficiencies and increased risk for cancer, diabetes, and cardiovascular diseases. Addressing food insecurity in the population may require:

• increasing overall economic stability (e.g., reducing job discrimination, increasing compensation)
• increasing SNAP use among sexual minority women
• improving access to nutritious food via local and LGBTQ-accessible emergency food assistance (e.g., food pantries and soup kitchens)

Read the blog post at the BMC Series Blog and our original article at BMC Public Health.

Citation: Patterson JG, Russomanno J, Jabson Tree JM. Sexual orientation disparities in food insecurity and food assistance use in U.S. adult women: National Health and Nutrition Examination Survey, 2005–2014. BMC Public Health 2020: 20, 1155. https://doi.org/10.1186/s12889-020-09261-9

Welcome to Practice & Science for LGBTQ Health Equity! Our mission is to highlight interdisciplinary and translational research and practice dedicated to dedicated to eliminating health and cancer-related inequities in lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. We aim to achieve our mission by connecting research with practice in order to (1) engage LGBT community members as experts, (2) identify multilevel determinants of health inequities in LGBTQ populations, (3) develop community-based, innovative, culturally congruent, evidence-based approaches to addressing disparities, and (4) reach scientific, practice, policy, and general audiences.

Who. What. Why.

PS: LGBTQ Health Equity represents the efforts of scientists and practitioners conducting LGBTQ health and cancer-related research and community-based practice at The Ohio State University. The program was created by Joanne G. Patterson, PhD, MPH, MSW – a T32 Cancer Prevention and Control Postdoctoral Research Fellow at The Ohio State University Comprehensive Cancer Center (CCC) – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. 

As member of The Ohio State University,  Dr. Patterson aims to connect LGBTQ health equity researchers and practitioners at The Ohio State University with the intent to  highlight innovative research-in-progress and community-based practice to improve LGBTQ health equity.

Interested in collaborating? Sharing your research? Learning more? Contact us at PS: LGBTQ Health Equity.