The Impact of Tobacco Control Policies on Health Equity in the United States (R37CA214787)

Project Description

Since the mid-1900s, tobacco control policies have effectively decreased smoking prevalence in the United States. However, important disparities by socioeconomic status (SES) and race/ethnicity in smoking prevalence and tobacco-related health outcomes persist. People with relatively lower education and income are more likely to smoke than their more affluent counterparts. In addition, although non-Hispanic Blacks and non-Hispanic Whites have a similar prevalence of smoking, Blacks have lower quit rates and higher lung cancer incidence and mortality than Whites. Hispanics, on the other hand, smoke less than Blacks or Whites. This suggests that current tobacco control policies do not adequately reduce, let alone eliminate, smoking disparities in vulnerable subgroups. However, few policy evaluations address smoking disparities, and the effects of policies across different SES and racial/ethnic subgroups are mostly unknown. Moreover, tobacco control policies are generally designed with broad populations in mind, without a focus on reducing the prevalence of smoking among specific populations. As a consequence, some policies may actually be exacerbating smoking disparities, even if their net population effect is positive.

Aims

  1. To determine how three established tobacco control policies (i.e., taxation, smoke-free air laws, mass media campaigns) and an emerging policy (i.e., Tobacco 21) influence smoking initiation among youth by parental education and race/ethnicity, including differences in these relationships by gender.
  2. To determine how four established tobacco control policies (i.e., taxation, smoke-free air laws, mass media campaigns, cessation treatment) and two emerging policies (i.e., pictorial health warning labels, point-of-sale display bans) influence smoking cessation among adults by educational attainment, income, and race/ethnicity, including differences in these relationships by gender.
  3. To predict which combination of policies will be necessary to reduce tobacco-related health disparities over time using a tobacco policy simulation model. 

MERIT Extension Aims

  1. To determine the extent to which taxation, smoke-free, and T21 policies interact to impact youth smoking initiation, and differences in these associations by sex, race/ethnicity, and socioeconomic status.
  2. To examine how taxation, smoke-free, and Tobacco 21 policies affect the use of e-cigarettes among youth overall and by sex, race/ethnicity, and socioeconomic status.


GRANT INFORMATION

Tobacco 21 Population Coverage Database

Tobacco 21 Population Coverage Database
The Tobacco 21 Population Coverage Database provides researchers with information about Tobacco 21 laws enacted in the United States from 2014-2020.

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2023

Usidame B, Xie Y, Colston D, Titus AR, Henriksen L, Kelly BC, Fleischer NL. The association between local tobacco retail licensing and adult cigarette smoking by race/ethnicity, income, and education in California (2012–2019). Preventive Medicine Reports. 2023. doi: 10.1016/j.pmedr.2022.102064.

Colston DC, Cruz J, Simard B, Fleischer NL.A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the United States. AJPM Focus. 2023. doi: 10.1016/j.focus.2022.100042.

Kalousova L, Xie Y, Levy D, Meza R, Thrasher JF, Elliott MR, Titus AR, Fleischer NL. Cigarette Prices and Disparities in Cessation in the United States. Nicotine & Tobacco Research. 2023. doi: 10.1093/ntr/ntad254. 


2022

Usidame B, Xie Y, Thrasher JF, Lozano P, Elliott MR, Fong GT, Fleischer NL. Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey. Tobacco Control. 2022. doi: 10.1136/tobaccocontrol-2021-056805.


Colston DC, Xie Y, Patrick ME, Thrasher JF, Titus AR, Elliott MR, Levy DT, Fleischer NL. Tobacco 21 laws may reduce smoking and tobacco-related health disparities among youth in the U.S. Preventive Medicine Reports. 2022. doi: 10.1016/j.pmedr.2022.101762.


Parks MJ, Fleischer NL, Patrick ME. Increased nicotine vaping due to the COVID-19 pandemic among US young adults: Associations with nicotine dependence, vaping frequency, and reasons for use. Preventive Medicine. 2022. doi: 10.1016/j.ypmed.2022.107059.


Usidame B, Meng G, Thrasher JF, Thompson ME, Fong GT, Fleischer NL. The differential impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by sex and education: A Difference-In-Difference-In-Difference Model, Nicotine & Tobacco Research. 2022. doi: 10.1093/ntr/ntac122. 


Titus AR, Gamarel KE, Thrasher JF, Elliott MR, Fleischer NL. Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA. International Journal of Behavioral Medicine. 2022. doi: 10.1007/s12529-022-10099-1.


Titus AR, Thrasher JF, Gamarel KE, Emery SL, Elliott MR, Fleischer NL. Televised Anti-Tobacco Media and Smoking Outcomes Among Heterosexual and Sexual Minority Adults in the United States. Health Education & Behavior. 2022. doi: 10.1177/10901981221116783.


Slocum E, Xie Y, Colston DC, Emery SL, Patrick ME, Thrasher JF, Elliott MR, Fleischer NL. Impact of the Tips from Former Smokers Anti-Smoking Media Campaign on Youth Smoking Behaviors and Anti-Tobacco Attitudes. Nicotine & Tobacco Research. 2022. doi: 10.1093/ntr/ntac152.


Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. Examining the Effectiveness of the 2012 Canadian Graphic Warning Label Policy Change by Sex, Income, and Education. Nicotine & Tobacco Research. 2022. doi: 10.1093/ntr/ntac235.


2021

Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999–2014. Nicotine & Tobacco Research. 2021. doi: 10.1093/ntr/ntab038.


Colston DC, Simard B, Xie Y, Fleischer NL, McLeod MC, Elliot MR, Thrasher JF. The Association Between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Gender. International Journal of Environmental Research and Public Health. 2021. doi: 10.3390/ijerph18063297.


Colston DC*, Cho B*, Thrasher JF, Titus AR, Xie Y, Emery SL, Elliott MR, Fleischer NL. Anti-smoking Media Campaigns and Disparities in Smoking Cessation in the United States, 2001-2015. American Journal of Health Promotion. 2021. *Authors contributed equally to work. doi: 10.1177/0890117120985818.


Colston DC, Titus AR, Thrasher JF, Elliott MR, Fleischer NL. Area-Level Predictors of Tobacco 21 Coverage in the US Before the National Law: Exploring Potential Disparities. American Journal of Preventive Medicine. 2021. doi: 10.1016/j.amepre.2020.06.026.


Colston DC, Xie Y, Thrasher JF, Emery S, Patrick ME, Titus AR, Elliott MR, Fleischer NL. Exploring How Exposure to Truth and State-Sponsored Anti-Tobacco Media Campaigns Affect Smoking Disparities among Young Adults Using a National Longitudinal Dataset, 2002–2017. International Journal of Environment Research and Public Health 2021. doi: 10.3390/ijerph18157803.


Titus AR, Xie Y, Thrasher JF, Levy DT, Elliott MR, Patrick ME, Fleischer NL. "A longitudinal analysis of smoke-free laws and smoking initiation disparities among young adults in the United States." Addiction. 2021. doi: 10.1111/add.15658.


Titus AR, Xie Y, Colston DC, Patrick ME, Elliott MR, Levy DT, Thrasher JF, Fleischer NL. Smoke-Free Laws and Disparities in Youth Smoking in the U.S., 2001−2018. American Journal of Preventive Medicine. 2021. doi: 10.1016/j.amepre.2021.05.013.


Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. "Cigarette Pack Price and Its Within-Person Association With Smoking Initiation, Smoking Progression, and Disparities among Young Adults." Nicotine & Tobacco Research. 2021. doi: 10.1093/ntr/ntab210.


Usidame B, Hirschtick JL, Zavala-Arciniega L, Mattingly DT, Patel A, Meza R, Levy DT, Fleischer NL. Exclusive and dual menthol/non-menthol cigarette use with ENDS among adults, 2013–2019. Preventive Medicine Reports. 2021. doi: 10.1016/j.pmedr.2021.101566.


Colston DC, Xie Y, Thrasher JF, Patrick ME, Titus AR, Emery S, McLeod MC, Elliott MR, Fleischer NL. Examining Truth and State-Sponsored Media Campaigns as a Means of Decreasing Youth Smoking and Related Disparities in the US. Nicotine & Tobacco Research. 2021. doi: 10.1093/ntr/ntab226.


2020

Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012–2014. Annals of Behavioral Medicine. 2020. doi: 10.1093/abm/kaaa086. 


Kalousova L, Levy D, Titus AR, Meza R, Thrasher J, Elliott MR, Fleischer NL. Cigarette Taxes, Prices, and Disparities in Current Smoking in the United States. SSM-Population Health. 2020. doi: 10.1016/j.ssmph.2020.100686.


Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Tobacco Taxation and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among Young Adults. Journal of Adolescent Health. 2020. doi: 10.1016/j.jadohealth.2020.08.031.


Titus AR, Gamarel KE, Thrasher JF, Emery SL, Elliott MR, Fleischer NL. Are sexual minority adults differentially exposed to smoke-free laws and televised anti-tobacco media campaigns compared to the general US population? A descriptive analysis. Tob Control. 2020. doi: 10.1136/tobaccocontrol-2020-055893.


Fleischer NL, Donahoe JT, McLeod MC, Thrasher JF, Levy DT, Elliott MR, Meza R, Patrick ME. Taxation reduces smoking but may not reduce smoking disparities in youth. Tob Control. 2020 Apr 8. doi: 10.1136/tobaccocontrol-2019-055478.


Abrams LR, Kalousova L, Fleischer NL. Gender differences in relationships between sociodemographic factors and e-cigarette use with smoking cessation: 2014-15 current population survey tobacco use supplement. J Public Health (Oxf). 2020 Feb 28;42(1):e42-e50. doi: 10.1093/pubmed/fdz017.


Lozano P, Thrasher JF, Forthofer M, Hardin J, Shigematsu LMR, Arillo Santillán E, Fleischer NL. Smoking-Related Stigma: A Public Health Tool or a Damaging Force?. Nicotine Tob Res. 2020 Jan 27;22(1):96-103. doi: 10.1093/ntr/nty151.


Gamarel KE, Watson RJ, Mouzoon R, Wheldon CW, Fish JN, Fleischer NL. Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA. Int J Behav Med. 2020 Apr;27(2):179-187. doi: 10.1007/s12529-019-09846-8.


2019

Donahoe JT, Norton EC, Elliott MR, Titus AR, Kalousová L, Fleischer NL. The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers. Am J Prev Med. 2019 Dec;57(6):e203-e210. doi: 10.1016/j.amepre.2019.07.004.


Titus AR, Kalousova L, Meza R, Levy DT, Thrasher JF, Elliott MR, Lantz PM, Fleischer NL. Smoke-Free Policies and Smoking Cessation in the United States, 2003-2015. Int J Environ Res Public Health. 2019 Sep 2;16(17). doi: 10.3390/ijerph16173200.


Fleischer NL, Lozano P, Wu YH, Hardin JW, Meng G, Liese AD, Fong GT, Thrasher JF. Disentangling the roles of point-of-sale ban, tobacco retailer density and proximity on cessation and relapse among a cohort of smokers: findings from ITC Canada Survey. Tob Control. 2019 Jan;28(1):81-87. doi: 10.1136/tobaccocontrol-2017-054081.


Donahoe JT, Titus AR, Fleischer NL. Key Factors Inhibiting Legislative Progress Toward Smoke-Free Coverage in Appalachia. Am J Public Health. 2018 Mar;108(3):372-378. doi: 10.2105/AJPH.2017.304244.

2024

Vander Woude CA,  Xie Y, Cook S, Buszkiewicz JH, Patrick ME, Thrasher JF, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Tobacco 21 Laws on Smoking Behaviors Among US Youth. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2024; Edinburgh, Scotland.


2023

Buszkiewicz JH, Xie Y, Cohen AL, Colston DC, Patrick ME, Fleischer NL. Interaction of Tobacco 21 and Taxation Policies on Youth Cigarette Smoking Outcomes. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2023; San Antonio, TX. 

Vander Woude CA, Xie Y, Patrick ME, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Cigarette Taxation Among Youth. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2023; San Antonio, TX. 

Buszkiewicz JH, Xie Y, Cohen AL, Colston DC, Patrick ME, Fleischer NL. Interaction of Tobacco 21 and Taxation Policies on Youth Cigarette Smoking Outcomes. Poster presentation at: Annual Meeting of the Society for Epidemiologic Research; June 2023; Portland, OR. 

Vander Woude CA, Xie Y, Buszkiewicz JH, Patrick ME, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Cigarette Taxation Among Youth. Oral presentation at: Annual Meeting of the Society for Epidemiologic Research; June 2023; Portland, OR. 


2022

Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Cigarette Pack Price and its Within-Person Association With Smoking Initiation, Smoking Progression, and Disparities Among Young Adults. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.


Slocum E, Xie Y, Colston DC, Emery S, Patrick ME, Thrasher JF, Elliott MR, Fleischer NL. Impact of the Tips From Former Smokers Anti-Smoking Media Campaign on Youth Smoking Behaviors and Anti-Tobacco Attitudes. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.


Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. The differential impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by sex and education: A Difference-In-Difference-In-Difference Model. Pre-Recorded Paper “Plus” presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.


Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. The Sociodemographic Impact of the 2012 Canadian Graphic Warning Label Policy on Smoking Prevalence: A Difference-In-Difference-In-Difference Model. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.


Usidame B, Xie Y, Colston D, Titus A, Henriksen L, Fleischer NL. The Association between Local Tobacco Retail Licensing Ordinances and Adult Cigarette Smoking by Race/Ethnicity, Income, and Education (2012-2019): The Case in California. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.


2021

Usidame B, Hirschtick JL, Mattingly DT, Patel A, Patrick ME, Fleischer NL. Exclusive and Dual Combustible and E-Cigarette Use Among US Adolescents. Poster presentation at: NIH Tobacco Regulatory Science Meeting; October 2021; Virtual.


Colston DC, Cho B, Thrasher J, Titus A, Xie Y, Emery SL, Elliott MR, Fleischer NL. Anti-Smoking Media Campaigns and Disparities in Smoking Cessation in the United States, 2001-2015. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Colston DC,  Xie Y, Thrasher J, Patrick ME, Titus A, Emery SL, McLeod MC, Fleischer NL. Examining Truth and State-Sponsored Media Campaigns as a Means of Decreasing Youth Smoking and Tobacco-Related Health Disparities in the US. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Colston DC, Patrick ME, Fleischer NL. Impact of Tobacco 21 Policies on Youth Smoking Disparities, Takeaways for the National Policy. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Titus AR, Xie Y, Thrasher JF, Levy DT, Elliott MR, Patrick ME, Fleischer NL. A Longitudinal Analysis of Smoke-Free Laws and Smoking Disparities among Young Adults in the United States. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities in Secondhand Smoke Exposure among Nonsmoking Adults in the United States, 1999-2014. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Usidame B, Hirschtick JL, Patrick ME, Fleischer NL. Exclusive and Dual Combustible and E-cigarette Use among US Adolescents. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


Usidame B, Xie Y, Thrasher JF, Lozano P, Fong GT, Fleischer NL. The differential impact of the POS ban on quit attempts and smoking cessation by sex, income, and education. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.


2020


Colston DC, Patrick ME, Fleischer NL. Impact of tobacco 21 policies on youth smoking disparities: Takeaways for the national policy. Poster presentation at: Annual Meeting of the American Public Health Association; October 2020.


Colston DC, Titus AR, Thrasher JF, Elliott MR, Fleischer NL. Area Level Predictors of Tobacco 21 Coverage in the United States Prior to the National Law: Exploring Potential Disparities. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2020; New Orleans, LA.


Titus AR, Gamarel KE, Thrasher JF, Emery SL, Elliott MR, Fleischer NL. Exposure to Smoke-free Laws and Televised Anti-Tobacco Media Campaign Ads among Sexual Minorities Compared to the General Population. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2020; New Orleans, LA. 


Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. Examining sexual orientation smoking disparities through the lens of structural stigma. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2020; New Orleans, LA.