Effects of State-Level Tobacco Environment on Cigarette Smoking are Stronger Among Those With Individual-Level Risk Factors

Abstract

Introduction: To better understand the impact of the state-level tobacco environment (eg, tobacco control policies, attitudes towards smoking) on cigarette smoking, we examined whether the relationship of state tobacco environments to smoking is modified by individual-level vulnerability factors. Methods:In a nationally representative sample of US adults (N = 34 638), past-year smoking and heavy smoking were examined. State-level tobacco environment was defined by tobacco-related control policies and attitudes, ranging from permissive to restrictive; individual vulnerability was defined by childhood maltreatment and/or parental substance problems. Additive interaction tested differences in state-level tobacco environment effects on smoking and heavy smoking by individual-level vulnerability. Results: Significant interactions (P values < .01) indicated that the state tobacco environment had the strongest relationship to smoking outcomes among individuals with greatest individual vulnerability. For example, among respondents with childhood maltreatment and parental substance problems, those in states with permissive tobacco environments had 13.3% greater prevalence of smoking than those in restrictive states. Among respondents with neither individual-level risk factor, those in permissive states had 2.8% greater prevalence than those in restrictive states (interaction P value = .0002). Conclusions: Further restricting states' smoking environments could help reduce the prevalence of smoking and heavy smoking, particularly among those at increased individual risk in the general population. Implications: This study shows that the protective effect of restrictive state-level tobacco environments on smoking or heavy smoking was stronger among those especially vulnerable due to individual-level risk factors (parental substance problems, childhood maltreatment). Thus, public health campaigns to influence attitudes towards smoking or legislation to strengthen tobacco control could have a broad effect, particularly impacting those with vulnerability to smoking, which may help decrease smoking prevalence and reduce the massive public health burden of tobaccorelated morbidity and mortality.

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants

“…Existing studies have shown that being in a high smoking prevalence environment is associated with an increased likelihood of smoking. [46][47][48][49] In our study, the data showed that a lower rate in the MRP was not a protective factor for men's smoking, compared with women; although this clearly suggests that moving to a low smoking prevalence environment would not reduce smoking in men, the reasons still need to be explored. Qualitative research from China found that men's smoking was considered 'normal' 50 or acceptable, which might mean that men who smoke are not as sensitive to environmental changes.…”

“…As for our hypothesis 1, the gap in smoking prevalence and women’s empowerment between the MRP and MSP for women were positively correlated with smoking risk; this indicates that environmental changes were significantly correlated with women’s smoking. Existing studies have shown that being in a high smoking prevalence environment is associated with an increased likelihood of smoking 46–49. In our study, the data showed that a lower rate in the MRP was not a protective factor for men’s smoking, compared with women; although this clearly suggests that moving to a low smoking prevalence environment would not reduce smoking in men, the reasons still need to be explored.…”

Outcome of tobacco cessation in workplace and clinic settings: A comparative study

“…The early age of initiation of tobacco consumption and higher tobacco dependence may also be responsible for high failure rate and dropout in the TCC group than the workplace group in addition to various individual predictors such as sociodemographic variables (socioeconomic status and residence), number of quit attempts, motivational variables, and nicotine-related variables. [3233] Tobacco cessation barriers include poor knowledge, lack of advice and support, lack of motivation, as well as intrapersonal, social, cultural, and financial factors. [34] Most of these barriers may be reduced or eliminated by multiple interventions carried out in our study such as pre-awareness session, focus group discussion, one-on-one counseling, and pharmacotherapy resulting in low dropout rate and adherence to the tobacco cessation program.…”

What Regional Living Conditions Affect Individual Smoking of Adults in Russia

“…There are considerably fewer works devoted to the research of territorial smoking predictors at the international level (28)(29)(30). Moreover, studies of "smoking geography" covering territorial entities between countries and small areas, that is, large regions, provinces, and states within a country, are even more sporadic (31)(32)(33). Apparently, such studies are likely to be of interest mostly for countries with a large territory.…”

“…Therefore, associations of a specific territorial characteristic with health indicators may not indicate a cause-and-effect relationship, but a relationship mediated by other territorial characteristics. Thus, many researchers of “smoking geography” apply composite socio-economic indices calculated based on several social and economic territorial characteristics at once ( 14 , 15 , 24 , 25 , 28 , 32 ). These studies allow to evaluate socio-economic territorial predictors of health status.…”