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The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is "no safe tobacco," therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people's experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual's priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people's lives and responsive to their needs.

We investigated associations between experiences with police discrimination, police mistrust, and substance use in a convenience sample of 237 sexual and gender minority (SGM) adults in California. In a cross-sectional survey, collected between January 2016 and July 2017, participants reported substance use, lifetime experiences with SGM-related police discrimination, police mistrust, demographics and SGM visibility. In adjusted logistic regression models, we found a positive association between lifetime police discrimination and past-two-week heavy episodic drinking. Police mistrust also was positively associated with past-month marijuana use. Several significant interactions between lifetime police discrimination or police mistrust with other socially stigmatized identities including being African American, insecure housing, and being a gender minority on a few substance use outcomes suggest that effects of police discrimination and mistrust on substance use are stronger among participants with multiple stigmatized identities. Results suggest the importance of policies and interventions that focus on eliminating police discrimination and increasing police legitimacy to reduce risk of substance use among SGM individuals.

Research suggests that Black youth are less likely to use e-cigarettes than their white counterparts, yet little is known as to why. We examined perceptions of e-cigarettes among Black young adults (ages 18-25) to explore the meanings these youth ascribe to e-cigarettes and the role that identity plays in how these devices are viewed. Analysis of in-depth interviews with 36 Black smokers and non-smokers in the San Francisco Bay Area suggests that Black youth perceive e-cigarettes as serving distinct, yet overlapping roles: a utilitarian function, in that they are recognized as legitimate smoking cessation tools, and a social function, insofar as they serve to mark social identity, specifically a social identity from which our participants disassociated. Participants described e-cigarette users in highly racialized and classed terms and generally expressed disinterest in using e-cigarettes, due in part perhaps to the fact that use of these devices would signal alignment with a middle class, hipster identity. This analysis is discussed within a highly charged political and public health debate about the benefits and harms associated with e-cigarette use.

In the last ten years, an eclectic mix of electronic nicotine delivery products ('e-cigarettes') and practices have proliferated in the US with little restriction, producing a vast array of vaping mechanisms, flavors, and styles. At the same time, anti-tobacco movements have targeted e-cigarettes as a threat to public health and advocated for restricting e-cigarettes in much the same way as conventional cigarettes. While anti-vaping proponents associated with public health movements have typically regarded e-cigarettes as primarily harmful products that should be suppressed, vaping advocates regard e-cigarettes as harm reduction products that should be readily accessible to smokers. Distrust between these two warring "sides" animates the controversy over e-cigarettes. In our role as researchers conducting a qualitative study on e-cigarette use, we encountered suspicion and anger from members of an e-cigarette forum who felt that pro-vaping perspectives were often misrepresented by researchers. As a result, we dropped our initial plan to host a group discussion of questions directly related to our study on the forum. Nevertheless, the incident illuminated how vaping advocates have resisted dominant narratives regarding tobacco and nicotine use, destabilized nicotine product categories and challenged interpretations of nicotine use that dichotomize pleasure and health.

Rape is an underreported violent crime that frequently remains uncleared (open) in the legal system. Rape disproportionately affects women, with 91% of rape victim-survivors estimated to be female. However, law enforcement agencies, the entry point into the criminal justice system, are predominantly comprised of male officers. According to the theory of representative bureaucracy, groups with greater representation in a bureaucratic system are more likely to have their interests protected. This study aims to determine if California law enforcement agencies with a higher percentage of female officers are more likely to have higher rates of rape reporting, clearances, and arrests. No previous study has examined this relationship using statewide data. Crimes and Clearances, Monthly Arrest and Citation Register, and Uniform Crime Reporting data for California (2013–2016) were aggregated into 499 Law Enforcement Reporting Areas (LERA). Bayesian space-time Poisson regressions controlling for LERA demographics and crime produced scaled relative rates for three outcomes: (a) rape report rate: number of reports relative to population ages 18+; (b) rape clearance rate: number of clearances relative to reports; and (c) rape arrest rate: number of arrests for rape relative to reports. A 5% increase in the percentage of female officers within an agency was associated with a 6.2% increase in the rape report rate (ARR: 1.062, 95% credible interval (CI) [1.048, 1.077]), a 2.9% decrease in the clearance rate (ARR: 0.971 95% CI [0.950, 0.993]), and no change in the rape arrest rates (ARR: 1.010; 95% CI [0.981, 1.039]) across all LERA. Thus, increased female officer representation was associated with an increase in rape reporting rates but associated with a decrease in rape clearance rates. The theory of representative bureaucracy was only partially supported, and these relationships may not be causal. The quantity of rape reports received by an agency, employment and promotion practices of agencies, and victim-survivor's attitudes toward officer's gender should also be considered. [ABSTRACT FROM AUTHOR]

Introduction Cigarette smoking is among the most harmful ways to consume nicotine and tends to be concentrated among socially marginalized groups of people, including sexual and gender minorities (SGM). Though some approaches to tobacco control in the United States are harm reduction strategies (eg, smoke-free environments), often abstinence is an explicitly stated goal and discussions of tobacco harm reduction (THR) are controversial, particularly for young people. Despite this controversy in the tobacco field, emerging research suggests that THR may be gaining momentum as a "community-led" rather than "public health-led" health practice. To date, little is known about how SGM young adults negotiate their use of tobacco products, particularly in terms of minimizing the harms associated with smoking. Aims and Methods We conducted 100 in-depth interviews with SGM young adults ages 18–25 years living in the San Francisco Bay Area, to better understand participant perceptions and everyday practices related to THR. Results A thematic analysis of interview narratives revealed the ways in which participants relied upon various THR strategies while balancing their well-being within the context of broader socio-structural harms. Participants' narratives also underscored beliefs about the importance of pragmatic, nonjudgmental, and person-centered approaches to preventing inequities in tobacco-related illnesses. Conclusions Findings represent a significant departure from the mainstream discourse in the U. S. surrounding THR, by revealing how understanding the practice of THR among SGM young adults who use nicotine and tobacco can be instrumental in shaping approaches to tobacco control policy and prevention that may ultimately help to reduce inequities in tobacco-related illnesses. Implications Findings from this study present the perspectives and practices of THR among sexual and gender minority young adults and emphasize the importance of integrating this approach in tobacco control to better achieve tobacco-related equity. Results can be used to better design tobacco prevention, treatment, and policy strategies that are compassionate and responsive to the needs of these important priority populations. [ABSTRACT FROM AUTHOR]

To answer this special issue provocation, Is Lesbian Identity Obsolete? we analyzed interviews with people who had identified at some point in their lives as lesbians, or as women/femmes who were attracted to women – some of them part of the Baby Boomer generation and some part of the Millennial generation. Participants from both generations rejected the gender binary. Nevertheless, we found a shift away from understanding gender as an oppressive category to an understanding of gender as a proliferating identity in which one may play with gender in an intentional and creative manner. It appears that participants across generations articulated their sexual identities strategically to express not only a sexual orientation but more importantly political and community alliances. For Baby Boomer lesbians, lesbian identity connoted an alliance with feminism, and for Millennials their sexual identity indicated a political alliance with queer and trans* movements. In order to sustain solidarity between lesbians of different generations, we suggest that narratives about gender should include both intrinsic and extrinsic components. We further suggest that the political project of ending the oppression of all lesbians/women who love women is fraught, but essential in a world that hates women. [ABSTRACT FROM AUTHOR]

Introduction Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. Methods We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. Results The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. Conclusion Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. Implications This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation. [ABSTRACT FROM AUTHOR]

Tobacco denormalization is a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of widespread beliefs about the effectiveness of tobacco denormalization approaches, concerns about their emphasis on stigmatization have emerged. Social science research on smoking stigma raises questions about the potential iatrogenic consequences of tobacco denormalization approaches. Few studies have considered how smoking stigma may be internalized differently by different people, particularly those who experience stigmatization because of other socially ascribed makers of inequity (e.g. race, ethnicity, gender, sexuality). The intersection of multiple stigmas may work to intensify the ‘social isolation and marginalization’ that some people already experience. This paper presents results from a pattern-level analysis of focus group and interview data from a study investigating smoking-related stigma and perceptions of tobacco denormalization approaches among 15 low income Black women who smoke in the San Francisco Bay Area. Our analysis revealed a cycle where Black women’s experiences with structural oppression resulted in stress and the use of cigarettes to cope with that stress. Though the connection between smoking and stress is well documented in previous research, our analysis further revealed the additional contribution of the stigmatization of smoking and how it intensifies inequity for Black women who smoke. Implications of these findings for tobacco control and prevention are discussed. [ABSTRACT FROM PUBLISHER]