The widely-used Kessler K6 nonspecific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6≥5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.

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OBJECTIVES: The purpose of this study was to examine the relative effects of taxation vs an anti-smoking media campaign on cigarette consumption in California. METHODS: Quarterly cigarette sales data reported by the California State Board of Equalization between 1980 and 1992 were used to estimate a time-series model, adjusted for seasonal variations and time trends. RESULTS: The estimated results show that sales of cigarettes were reduced by 819 million packs from the third quarter of 1990 through the fourth quarter of 1992 owing to an additional 25-cent state tax increase, while the anti-smoking media campaign reduced the cigarette sales by 232 million packs during the same period. CONCLUSIONS: Both taxation and anti-smoking media campaigns are effective means of reducing cigarette consumption. The strength of those effects, however, is influenced by the magnitude of the taxes and the amount of media campaign expenditures.

IntroductionThe tobacco product landscape has changed substantially. Little is known about the recent pattern of polytobacco use (at least two tobacco products) among US adults and its relationship to nicotine dependence.MethodsUsing the 2012–2013 and 2013–2014 National Adult Tobacco Survey (NATS) data (N = 135 425 adults), we analyzed the prevalence and correlates of polytobacco use among each of the six categories of current tobacco user (cigarettes, cigars, pipes, hookah, e-cigarettes, and smokeless tobacco). Based on five nicotine dependence symptom measures from the NATS, difference in the prevalence of dependence symptoms between polytobacco and sole-product users for each category of tobacco user was assessed using multivariable regression analyses.ResultsDuring 2012–2014, 25.1% of adults were current users of any tobacco product. Among them, 32.5% were poly users with the largest poly use category being dual use of cigarettes and e-cigarettes (30.2%). Poly use prevalence was the lowest among current cigarette smokers (38.7%), followed by current users of smokeless tobacco (52.4%), hookah (59.2%), cigars (69.3%), e-cigarettes (80.9%), and pipes (86.2%). Among each category of current tobacco user, the prevalence of dependence symptom was consistently greater in polytobacco users than sole users for every symptom measure. After controlling for frequency of use and demographic covariates, the difference in nicotine dependence between poly users and sole users was statistically significant and consistent across all symptom measures for each category of tobacco user.ConclusionsBetween 52% and 86% of noncigarette tobacco users and nearly 40% of cigarette smokers engaged in polytobacco use. Poly users showed greater nicotine dependence than sole-product tobacco users.ImplicationsThis study examines recent patterns of polytobacco use separately for US adult current cigarette smokers, cigar smokers, pipe smokers, hookah users, e-cigarette users, and smokeless tobacco users. By including more tobacco products, particularly e-cigarettes and hookah, this study provides more comprehensive insight into polytobacco use. This study is also unique in comparing nicotine dependence between polytobacco and sole-product users among each category of tobacco users. Our results indicate that polytobacco use is very common and is associated with greater likelihood of reporting nicotine dependence symptoms. Tobacco cessation policies and programs should be tailored to address polytobacco use.