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Objectives: The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California., Methods: Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment., Results: In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status., Conclusions: Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women.

Objectives: We examined the exposure to tobacco direct mail marketing and its effect on subsequent smoking behaviors in a US Midwest regional cohort of young adults., Methods: Data were collected from 2622 young adults (mean age = 24 years) in 2010 to 2011 (baseline) and 2011 to 2012 (follow-up). We collected information on demographics, tobacco use, and exposure to tobacco direct mail materials in the previous 6 months at baseline. Smoking behaviors were reassessed at follow-up. We investigated the characteristics associated with receiving these materials at baseline, and the associations between receiving cigarette coupons in the mail at baseline and smoking behaviors at follow-up., Results: Thirteen percent of participants reported receiving tobacco direct mail materials in the previous 6 months. Receipt of these materials was associated with age, education, and tobacco use (P < .05). Among those who received these materials, 77% and 56% reported receiving coupons for cigarettes and other tobacco products, respectively. Among baseline nonsmokers and ex-smokers, receiving coupons was associated with becoming current smokers at follow-up (P < .05). Among baseline current smokers, receiving coupons was associated with lower likelihood of smoking cessation at follow-up (P < .05)., Conclusions: Tobacco direct mail marketing promoted and sustained smoking behaviors among US Midwest young adults. Regulating this marketing strategy might reduce the prevalence of smoking in this population.

Objectives: We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood., Methods: We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16-18 years) to young adulthood (ages 18-20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006., Results: Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time., Conclusions: In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.

Background: Previous cross-sectional studies found that positive beliefs about electronic nicotine delivery systems (commonly known as electronic cigarettes or e-cigarettes) were associated with use of these products. However, the prospective association between these beliefs and subsequent use of e-cigarettes is unclear., Purpose: To identify the beliefs predicting subsequent use of e-cigarettes., Methods: A total of 1379 young adults (mean age=24.1 years) from the Minnesota Adolescent Community Cohort who reported never using e-cigarettes at baseline (collected Oct 2010-Mar 2011) and completed follow-up data collection (during Oct 2011-Mar 2012) were included in this analysis. Participants' beliefs about e-cigarettes (potential as quit aids, harmfulness and addictiveness relative to cigarettes) were asked at baseline (yes/no). At follow-up, participants were asked if they had ever used e-cigarettes. Logistic regression models were used to assess the associations between beliefs about e-cigarettes and subsequent experimentation. Analysis was conducted in 2012., Results: At follow-up, 7.4% of the sample reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Participants who believed e-cigarettes can help people quit smoking and perceived e-cigarettes to be less harmful than cigarettes at baseline were more likely to report experimenting with e-cigarettes at follow-up (p<0.05). These associations did not differ by smoking status., Conclusions: Given that young adults are still developing their tobacco use behaviors, informing them about the lack of evidence to support e-cigarettes as quit aids and the unknown health risk of e-cigarettes may deter young adults from trying these products., (© 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.)

Background: Although it is known that cigarette companies use cigarette coupons to market their products, little is known about the characteristics of those who receive these coupons. The influence of receipt and redemption of these coupons is also unknown., Methods: Participants of the Minnesota Adult Tobacco Survey Cohort Study who were smokers in 2008, completed surveys in 2008 and 2009, and had smoked for at least 6 months between those surveys, were included. In 2009, participants reported whether they had received cigarette coupons in the past 12 months, and whether they had used the coupons. They also reported their perceptions of cigarette companies and their smoking status. Multivariate logistic regressions were used to assess associations between receiving and redeeming coupons, perceptions of cigarette companies, and smoking status., Results: Overall, 49.4% of the sample reported receiving cigarette coupons, and 39.9% redeemed them (80.1% of those who received these coupons). Female, younger and heavier smokers were more likely to report receiving these coupons (p<0.05). Smokers who received these coupons were more likely to agree that cigarette companies care about their health and do the best they can to make cigarettes safe, and less likely to agree that cigarette companies lie (p<0.05). Smokers who used these coupons were less likely to quit smoking (p<0.05)., Conclusions: Our findings suggest a negative association between cigarette coupons and smoking cessation. Longitudinal studies are needed to establish whether cigarette coupons influence smoking behaviour to inform the necessity for policies to prohibit the use of these coupons to assist smokers to quit smoking.

Purpose: Many young adult smokers routinely smoke less than daily. Prospective, longitudinal data are needed to describe and predict the influences on smoking patterns among nondaily young adult smokers., Methods: Latent class growth analysis was used to examine developmental trajectories and predictors of nondaily cigarette smoking among young adults aged 18 to 21 in the Upper Midwestern United States., Results: There were three distinct groups of nondaily smokers during young adulthood (n=519). College status, previous quit attempts, attitudes toward the meanings of cigarettes, and situational factors influencing smoking were significant predictors of group membership., Conclusions: Nondaily smoking in young adulthood may result in several discrete patterns of smoking between age 18 and 21. Predictors that differentiate smoking trajectories may be useful to promote cessation or reduction in young adult smoking., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES., Methods: The study included 3635 randomly recruited adolescents from 5 age cohorts (12-16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort-sequential latent growth model to examine smoking from age 12 to 18 years with predictors., Results: Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES., Conclusions: We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.

Tobacco use and binge drinking are commonly associated with each other and research has shown that reducing smoking may influence alcohol use in alcohol-dependent populations. Although African Americans report a lower prevalence of binge drinking than other racial/ethnic groups, they are more likely to report consequences associated with this behavior. The aim of this article was to study the effect of a smoking intervention (counseling) on binge drinking prevalence and the frequency and average daily alcohol consumption in a sample of African American light smokers (those who smoke 10 cigarettes or less per day). Multivariate models were used to assess whether counseling type (health education or motivational interviewing) affected binge drinking prevalence and frequency or average daily alcohol consumption among participants (N = 755). Generalized linear models were run to assess the mediation effect of smoking cessation on the relationship between the counseling intervention and drinking outcomes. Finally, smoking cessation (regardless of counseling type) was assessed to determine the effect on alcohol use outcomes. Overall, counseling type was significantly related to a reduction in past 30-day binge drinking prevalence at week 8 among participants in the health education counseling (P = .045); however, these results diminished within 6 months. Smoking cessation did not appear to mediate the relationship between counseling type and alcohol use outcomes. Regardless of counseling type, individuals who quit smoking within the first 8 weeks of the study reported lower past 30-day binge drinking prevalence at week 8 than those who did not quit during the first 8 weeks (P = .035), but the effect was not sustained at the end of the study (week 26). These results show that tobacco interventions can affect binge drinking, but the effect does not appear to be sustained over time.

Background: Young adults have the highest rate of smoking among any age group., Purpose: The purpose of this study is to assess the short-term effects of Minnesota's comprehensive statewide smokefree law on young adult smoking perceptions and behavior., Methods: Telephone surveys were conducted before and up to 18 months after Minnesota's statewide smokefree law went into effect on October 1, 2007 (data analyzed 2010-2011). Participants included young adults from a population-based cohort in Minnesota (n=1458) and from five other upper Midwest states that serve as a comparison (n=248). Differences in perceptions and smoking behavior were examined between Minnesota participants who lived with and without a local smokefree law prior to Minnesota's statewide law, and participants who lived in the comparison states., Results: The majority of youth in Minnesota were aware of the smoking restrictions in restaurants and bars following the law. After implementation of the law, Minnesota participants who previously lived without a local law (versus comparison) were more likely to perceive fewer adult and peer smokers and less likely to report leaving social events early because it was too smoky. No changes in smoking behaviors were observed before and after the law. Minnesota participants, however, who lived without a prior law (versus participants with a prior law) were more likely to attribute a quit attempt after the law to smoking restrictions in restaurant and bars., Conclusions: Results suggest that Minnesota's law has changed perceptions of the tobacco environment. Longer-term follow-up may be needed to observe changes in smoking behavior., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the extent to which young adults initiate smoking between the ages of 18 and 21 years; to characterize the frequency and quantity of use among initiators; and to examine predictors of initiation., Methods: Participants included youth who were part of the Minnesota Adolescent Community Cohort Study and had not smoked a whole cigarette before age of 18 (n = 2,034). Initiation in the present study was defined as having smoked a whole cigarette or more between the ages of 18 and 21. Predictors of initiation were measured at age 18 and included sociodemographic characteristics, social influences, and attitudes and beliefs about smoking., Results: Twenty-five percent (n = 510) of participants initiated smoking between the ages of 18 and 21 years. Among those who initiated, the majority (64%) reported smoking during the past 30 days, and approximately one-quarter (24%) reported smoking 100 cigarettes or more. Predictors of young adult initiation included being male, living in a metropolitan area, having friends who smoke, and the belief that smoking can calm someone down when they are angry or nervous., Conclusions: This study indicates that smoking initiation during young adulthood is not uncommon. These results highlight the need for tobacco prevention programs that target young adults., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Circles of Tobacco Wisdom (CTW) was an elder-led, community-based project that aimed to enhance tobacco control in the American Indian community. Its goal was to provide elders with the knowledge, opportunities, and support to enable them to assume leadership of a tobacco control movement that was grounded in the ceremonial traditions of tobacco use., Purpose: The purpose of this study was to test the effects of the pilot intervention on participants., Design: The design of this pilot study intervention was a single group, pre-post comparison, with a pre-post survey, monthly check-ins, and a post-1-year focus group., Participants: Twelve elders were included in the pre- and post-analyses. All twelve elders were women who self-identified as American Indian (mean age = 64)., Intervention: The CTW elders participated in monthly talking circles, quarterly learning sessions, and a post-1-year focus group, and took part in other learning, support, and community action opportunities. Data were collected from December 2008 through November 2009 and analyzed throughout the process., Main Outcome Measures: American Indian Elders' tobacco-related knowledge, perceptions, beliefs, and behaviors were measured while participating in the CTW project., Results: Knowledge, perceptions, beliefs, and behavior changes were seen with cigarette smoking, secondhand smoke, and ceremonial tobacco use and risk perception. After 6 months, the number of people the elders had talked with about tobacco increased, elders were more likely to have a discussion on tobacco at a community event, and their comfort level talking about commercial and traditional tobacco also increased. A number of themes also were identified in the focus group: feeling more comfortable talking about tobacco issues, learning a lot about traditional and commercial tobacco, and realizing the dangers of smoking., Conclusions: Elders increased their knowledge about commercial and traditional tobacco and changed related attitudes as a result of CTW. Further, American Indian Elders perceived that CTW was effective., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Our objective was to determine how point-of-sale tobacco marketing may relate to sales to minors. The authors used data from a 2007 cross-sectional study of the retail tobacco marketing environments in the St. Paul, MN metropolitan area matched with a database of age-of-sale compliance checks (random, covert test purchases by a minor, coordinated by law enforcement) of tobacco retailers and U.S. Census data to test whether certain characteristics of advertising or neighborhoods were associated with compliance check failure. The authors found that tobacco stores were the most likely type of store to fail compliance checks (44% failure), supermarkets were least likely (3%). Aside from a marginally significant association with Hispanic population proportion, there was no other association between either store advertising characteristics or neighborhood demographics and stores' compliance check failure. Though our findings were null, the relationship between advertising and real youth sales may be more nuanced as compliance checks do not perfectly simulate the way youth attempt to purchase cigarettes.

Objective: We assessed changes in levels of support for smoke-free bars and restaurants among teens and young adults before and after implementation of a statewide smoke-free law., Methods: We measured support for smoke-free bars and restaurants among teens and young adults aged 16-24 years living in Minnesota (n=2,785) and five comparison states (n=404), up to 12 months before and up to six months after Minnesota's smoke-free law went into effect in October 2007. We compared changes in support among three subgroups-Minnesota participants who lived with a previous local smoke-free law, Minnesota participants who did not live with a previous local smoke-free law, and participants from the comparison states-before and after Minnesota's statewide smoke-free law went into effect., Results: Support for smoke-free restaurants and bars among participants in Minnesota and comparison states increased after Minnesota's smoke-free law went into effect. Minnesotans, both those living with and without a previous local smoke-free law, showed similar increases in support for smoke-free restaurants as participants in comparison states. However, Minnesotans living without a previous local law showed larger increases in support for smoke-free bars than both those in comparison states and those living in Minnesota with a previous local smoke-free law., Conclusions: Our study employed a more robust design than similar studies and focused on the teen and young adult population. Our results will help advocates and policy makers demonstrate how public support for smoke-free laws increases following smoke-free legislation, particularly among those who were not previously living with a local smoke-free law.

Background: Smoking in movies is prevalent. However, use of content analysis to describe trends in smoking in movies has provided mixed results and has not tapped what adolescents actually perceive., Purpose: To assess the prospective trends in the prevalence of smoking in movies as perceived by teenagers and identify predictors associated with these trends., Methods: Using data from the Minnesota Adolescent Community Cohort Study collected during 2000-2006 when participants were aged between 12 and 18 years (N=4735), latent variable growth models were employed to describe the longitudinal trends in the perceived prevalence of smoking in movies using a four-level scale (never to most of the time) measured every 6 months, and examined associations between these trends and demographic, smoking-related attitudinal and socio-environmental predictors. Analysis was conducted in 2009., Results: At baseline, about 50% of participants reported seeing smoking in movies some of the time, and another 36% reported most of the time. The prevalence of smoking in movies as perceived by teenagers declined over time, and the decline was steeper in those who were aged 14-16 years than those who were younger at baseline (p≤0.05). Despite the decline, teenagers still reported seeing smoking in movies some of the time. Teenagers who reported more close friends who smoked also reported a higher prevalence of smoking in movies at baseline (regression coefficients=0.04-0.18, p<0.01)., Conclusions: Teenagers' perception of the prevalence of smoking in movies declined over time, which may be attributable to changes made by the movie industry. Despite the decline, teenagers were still exposed to a moderate amount of smoking imagery. Interventions that further reduce teenage exposure to smoking in movies may be needed to have an effect on adolescent smoking., (Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the prevalence and predictors of the awareness of cigarette price increases following a cigarette tax increase, and assess the association of the tax increase and attempts to quit and reduce smoking among adolescents and young adults., Design: We used a prospective cohort design., Setting: Surveys were conducted in Minnesota before and after a $0.75 cigarette tax increase., Subjects: We surveyed 3167 adolescents and young adults, including a subsample of 781 past-30-day smokers., Measures: Outcome measures were awareness of cigarette price increases and, among past-30-day smokers, reported changes in smoking behaviors because of the tax increase. Predictors included demographics, social factors, and prior smoking behaviors., Analysis: We estimated the prevalence of the outcomes and their associations with the predictors using logistic regression., Results: Among all participants, 42% noticed an increase in cigarette prices after the tax increase, including 76% of past-30-day smokers. Being a heavier smoker, living with smokers, having more smoking close friends, and generally being aware of cigarette price changes prospectively predicted the awareness of the price increase after the tax increase. Among past-30-day smokers, 16.7% reported quit attempts and 24.1% reported reducing smoking because of the tax increase., Conclusion: Because fewer than half of the participants noticed the cigarette tax increase, media campaigns to raise awareness of tax changes may increase their effectiveness.

Background: The goal of this study was to assess the effects of Minnesota's comprehensive, statewide smokefree law on young adults' perceived opportunities to smoke in restaurants and bars., Purpose: Differential effects of the law were examined for those living with and without previous local smokefree ordinances., Methods: Telephone surveys were conducted 6-12 months prior, 0-6 months prior, and 0-6 months after Minnesota's statewide smokefree law went into effect. Participants included young adults from a population-based cohort in Minnesota (n = 1446) and from four other Upper Midwest states that serve as a comparison (n = 238)., Results: A greater proportion of Minnesota participants (regardless of previous law) reported it was very hard for an adult to find a place to smoke in both restaurants and bars/clubs after the statewide law, compared to the comparison group. Effects were greater among Minnesota participants who did not live with a local smokefree ordinance previously., Conclusions: Within 6 months of Minnesota's statewide smokefree law, Minnesota young adults, even those who lived with a prior local smoking ordinance, believed it was more difficult for adults to find a place to smoke in restaurants and bars/clubs. Changing perceived opportunities to smoke in the state may be an initial step in changing social norms and smoking behaviors. These results suggest that statewide smokefree laws may provide additional barriers to smoking, beyond those obtained through local ordinances., (Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: We assessed the price variability of cigarettes by brand, neighborhood characteristics (racial/ethnic and youth composition, number of schools, and number of stores), and store type., Methods: Trained research staff purchased three different brands of cigarettes (premium, menthol, and discount-all produced by the same company) at 214 stores in one metropolitan area. We assessed associations between price and neighborhood/store characteristics through multivariate regression, using four price variables as dependent variables-the price of each brand of cigarettes and the mean price across the three brands., Results: We found that the price of cigarettes varied by neighborhood and store characteristics, although this variability differed by brand. For the same brand, the maximum price was 1.7 to 1.8 times higher than the lowest price. We found a positive association between the percentage of a neighborhood that was nonwhite and the price of discount and premium cigarettes as well as the overall mean price of cigarettes, but not with the price of the menthol brand. We found a negative association between the percentage of youth in a neighborhood and the price of premium cigarettes as well as the mean price, but not with the price of the other two brands. In addition, we found a greater likelihood of higher discount brand prices at independent vs. chain-operated stores., Conclusions: Our findings showed that cigarette prices do vary by brand, the youth and racial/ethnic composition in a neighborhood, and store type, suggesting that the tobacco industry might vary its marketing strategies based on brand as well as neighborhood and store characteristics.

Introduction: The purpose of this study is to 1) examine the variability in the prevalence of adolescent smoking in 60 geographic areas of Minnesota and 2) assess how variability in area-level smoking prevalence is associated with area-level sociodemographic characteristics., Methods: Smoking data were collected from 3,636 adolescents residing in 60 areas of the state of Minnesota. Area-level characteristics were obtained from the 2000 US Census. Coefficient of variation was calculated to assess variability in smoking prevalence across areas, and mean smoking prevalence was compared above and below the median for each area-level characteristic., Results: Substantial variation was found in adolescent smoking prevalence rates. Across the 60 areas, the percentage of adolescents that ever smoked varied from 13% to 53%, and the percentage of adolescents that smoked in the past 30 days ranged from 3% to 19%. Mean lifetime smoking prevalence was higher in areas with a higher percentage of residents with less than a high school education, a lower percentage of residents living in an urban area, lower median housing value and a lower median household income, a higher percentage of residents aged 16 years or older who were unemployed, and a higher percentage of residents with an income-to-poverty ratio less than 1.5. Similar results were found for past 30-day smoking prevalence among girls; however, no area-level characteristics were significantly associated with past 30-day smoking prevalence among boys., Conclusion: Results suggest that area-level characteristics may play an important role in adolescent smoking, particularly for girls.

We interviewed 732 smokers (from five US upper Midwestern states) via telephone in 2006 to examine young adult smoking patterns. We first defined two groups of intermittent smokers-low (who smoked for 1-14 days in the past 30 days) and high (who smoked for 15-29 days in the past 30 days), and then analyzed differences between these two groups and daily smokers. Low intermittent smokers were much less likely to consider themselves smokers, feel addicted, or smoke with friends than high intermittent smokers. Daily smokers were more likely to feel addicted and have trouble quitting smoking than high intermittent smokers. Implications, limitations, and ideas for future studies will be discussed.

Background: Reported prevalence of cigarette smoking among American Indian youth is higher than other racial/ethnic minorities, and limited data indicate that this disparity is especially pronounced in the Upper Midwest of the U.S. The purposes of this study are to measure traditional and recreational tobacco use among American Indian youth in an urban Upper Midwest area, and to identify social and environmental factors associated with recreational tobacco use (cigarette smoking)., Methods: A cross-sectional convenience sample of 336 American Indian youth aged 11-18 years was given a self-administered survey. Data were analyzed using bivariate chi-square tests and multivariate logistical stepwise regression., Results: Almost 37% reported some recreational smoking in the previous 30 days, with about three times as many in the group aged 16-18 years reporting smoking as in the group aged 11-13 years (p<0.0001). Social exposure to cigarette smoking was very strong; more than three fourths reported living with an adult who smokes, and 44% have a brother/a sister who smokes. Yet more than 65% report a household rule against their smoking, and 43% report a household rule against anyone smoking inside. Youth who smoke report buying cigarettes often and smoking on school property. Household rules against smoking and hearing of someone getting caught smoking at school have an independent negative association with likelihood of being a smoker., Conclusions: These results indicate that American Indian youth in this area report high use of recreational tobacco, and the statewide focus on youth smoking prevention has not eliminated the disparity in smoking levels between American Indian youth and Minnesota youth overall. These findings suggest several pathways to reduce cigarette smoking among urban American Indian youth.

Purpose: To identify distinct smoking trajectories during adolescence and assess how smoking-related factors relate to trajectory membership., Methods: The sample includes 3637 youth from across the state of Minnesota. Measures include tobacco use, smoking behaviors of parents and friends, youth smoking-related attitudes and beliefs, and home smoking policies. A cohort-sequential design was used to identify smoking trajectories, including five cohorts of youth (ages 12-16) followed for 3 years., Results: Six distinct trajectories of tobacco use were found: nonsmokers (54%), triers (17%), occasional users (10%), early established (7%), late established (8%), and decliners (4%). Several factors were associated with increased likelihood of being in a smoking trajectory group (vs. the nonsmoking group): parental smoking, friend smoking, greater perceptions of the number of adults and teenagers who smoke, and higher functional meaning of tobacco use. In contrast, higher perceived difficulty smoking in public places, negative perceptions of the tobacco industry, and home smoking policies were associated with less likelihood of being in one of the smoking trajectories (vs. the nonsmoking trajectory)., Conclusions: Adolescents exhibit diverse patterns of smoking during adolescence and tobacco-related influences were strong predictors of trajectory membership.

Objectives: To measure community-level changes in the methods youth use to obtain cigarettes over time and to relate these methods to the progression of smoking., Methods: We analyzed 2000-2003 data from the Minnesota Adolescent Community Cohort study, where youth (beginning at age 12), who were living in Minnesota at baseline, were surveyed every 6 months via telephone. We conducted mixed model repeated measures logistic regression to obtain probabilities of cigarette access methods among past 30-day smokers (n=340 at baseline)., Results: The probability of obtaining cigarettes from a commercial source in the past month declined from 0.36 at baseline to 0.22 at the sixth survey point while the probability of obtaining cigarettes from a social source during the previous month increased from 0.54 to 0.76 (p for both trends=0.0001). At the community level, the likelihood of adolescents obtaining cigarettes from social sources was inversely related to the likelihood of progressing to heavy smoking (p<0.001)., Conclusions: During this time, youth shifted to greater reliance on social sources and less on commercial sources. A trend toward less commercial access to cigarettes accompanied by an increase in social access may translate to youth being less likely to progress to heavier smoking.

The purpose of this study was to identify patterns of tobacco initiation, current use, and smoking cessation and their correlates in the adult American Indian population in the Twin Cities, using community-based participatory research methods. A total of 300 American Indians aged 18 years or older participated in in-person interviews. Participants were recruited to fill age-gender quotas that reflect the demographic distribution of American Indians in Minnesota. Almost everyone in this sample had smoked cigarettes recreationally: Only 12% had smoked fewer than 100 cigarettes, and nearly two-thirds (62%) reported that they were current smokers. Only 29% of ever-smokers had quit smoking. More than two-thirds (68%) of current smokers would like to quit, and most of them (53% of all smokers) had tried unsuccessfully to quit in the previous 12 months. Our results show a level of current smoking and low cessation rates among American Indians in the Twin Cities area that reflect a crisis for public health and for the Indian community.

Many adolescent smokers rely significantly on retail tobacco sources to initiate or maintain their smoking behavior. Though promising, the results from various interventions aimed at curtailing retail tobacco access have been mixed. In the present study, 14 communities were randomly assigned to intervention and control groups in an attempt to determine the long-term effect of local youth access laws and policies on adolescent smoking. The intervention continued for 32 months. Assessments were conducted at baseline (1991) and at years 3, 5, and 7. The intervention was based on a community-organizing approach that mobilized community members to support adoption and enforcement of local ordinances to restrict minors' access to commercial sources of tobacco. The major outcome measure for the study was cross-sectional prevalence of daily tobacco use among all students in grades 8, 9, and 10 in each community, measured by a self-administered student survey. A short-term significant intervention effect was observed and reported previously. That difference between intervention and control communities was maintained through the year 5 assessment but had dissipated by the year 7 assessment, very likely related to adoption of ordinances by control communities. Restricting commercial access to tobacco through local ordinances is effective in reducing adolescent smoking both immediately after the intervention (year 3) and 2 years later (year 5). Longer-term results are still inconclusive, because control communities adopted ordinances similar to those in the intervention communities.

Background: Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior., Methods: Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking., Results: The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking (p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models., Conclusions: Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.

Purpose: This study examines the relationship between smoking-related parental, family, and home factors with adolescents' cigarette use., Design: Cross-sectional surveys of adolescents, via a self-administered questionnaire in classrooms, and their parents, via a telephone interview, were conducted., Setting: Fifteen suburban and rural communities within Minnesota., Subjects: The study sample included 8th, 9th, and 10th grade public school students and their parents., Measures: The dependent variable was monthly tobacco use among students. The independent measures were parental, family, and home smoking-related characteristics. There were 1343 parent-child dyads with completed surveys., Results: The final, multivariate logistic regression model found the following variables to be independently related to higher smoking rates among adolescents: child's grade (odds ratio [OR] = 3.03 for 10th vs. 8th), parents' permissiveness of adult smoking (OR = 1.80), parents' having higher normative estimates of how many people smoke (OR = 1.70), parents' decreased likelihood of punishing their teenager for smoking (OR = 1.65), smoking by an adult living in the home (OR = 1.99), and sibling smoking (OR = 8.95). Lack of communication about consequences for breaking family smoking rules was associated with lower smoking rates among adolescents (OR = .49)., Conclusion: The results of this study highlight the importance of parental smoking norms and attitudes and smoking role models in the home. It is important that smoking prevention strategies target and include the entire family. Limitations of the study are its cross-sectional design and that the sample was primarily white.

Objectives: This study tests whether there is an association between high visibility of smoking, perceived acceptability of smoking, and where youth smoke., Methods: Surveys of 9,762 students in grades 8-10 and 1,586 parents in 15 Minnesota communities asked about the frequency of and opinions of adult and youth smoking in various indoor and outdoor public places. Chi-square analysis and ANOVAs compared smokers and nonsmokers., Results: More smoking than nonsmoking youth reported often seeing adults and teens smoking in all locations. Forty-two percent of students often noticed adults and 35% often noticed teens smoking outdoors, also the most frequent location where teens report smoking. Students perceived adult and teen smoking as more acceptable in restaurants, recreation centers, and outdoor gathering places. More student smokers than nonsmokers believe that smoking is acceptable for both adults and teens. Of the parent sample, 52% often observed adults and 36% often observed youth smoking outdoors. Nonsmoking parents observed adult and teen smoking more often than parents who smoke., Conclusions: The data support an association between the frequency that youth observe smoking in various locations and the perception that smoking is socially acceptable by smoking status. Policies that restrict smoking in various locations will reduce both visibility and perceived acceptability of smoking in those locations.

Trends in sources of cigarettes among adolescents were assessed using data from a teen cohort (2000-2006). Five sources--bought from store, got from other teen, stole from others, bought from others, and got from an adult--were measured over time by age. The most common source among all ages was other teens. Fewer teens bought cigarettes from stores, with a downward trend for all ages. Among all ages there was an upward trend in stealing, with younger teens more likely to steal cigarettes. In addition to targeting cigarette sales, interventions are needed to target other youth cigarette sources.

Abstract Background Despite declines over recent years, youth tobacco and other substance use rates remain high. Latino youth are at equal or increased risk for lifetime tobacco, alcohol, marijuana, and other illicit drug use compared with their white peers. Family plays an important and influential role in the lives of youth, and longitudinal research suggests that improving parenting skills may reduce youth substance use. However, few interventions are oriented towards immigrant Latino families, and none have been developed and evaluated using a community-based participatory research (CBPR) process that may increase the effectiveness and sustainability of such projects. Therefore, using CBPR principles, we developed a randomized clinical trial to assess the efficacy of a family-skills training intervention to prevent tobacco and other substance use intentions in Latino youth. Methods/Design In collaboration with seven Latino community-serving agencies, we will recruit and randomize 336 immigrant families, into intervention or delayed treatment conditions. The primary outcome is youth intention to smoke 6 months post intervention. The intervention consists of eight parent and four youth sessions targeting parenting skills and parent–youth relational factors associated with lower smoking and other substance use in youth. Discussion We present the study protocol for a family intervention using a CBPR randomized clinical trial to prevent smoking among Latino youth. The results of this trial will contribute to the limited information on effective and sustainable primary prevention programs for tobacco and other substance use directed at the growing US Latino communities. Trial registration ClinicalTrials.gov: NCT01442753

Introduction: New tobacco and nicotine products such as snus, hookah, and electronic cigarettes have risen in popularity in recent years. Use of these products among young adults is of particular interest given that experimentation with new products is common in young adulthood. Methods: We conducted latent class analysis among a population-based sample of young adults to identify separate classes based on use of 6 types of tobacco or nicotine products: snus, hookah, electronic cigarettes, cigarillos, snuff, and cigarettes. We then examined how identified classes differed on demographic characteristics and marijuana and alcohol use. Results: We identified 5 classes: the largest group (60%) was characterized as reporting no or limited use of any of the products, while the smallest group (7%) was characterized by use of many types of products (poly-users). Of the 3 middle classes, 2 were the same size (10%) and were characterized by primarily using 2 of the products: one class used snus and snuff, and the other used cigarillos and hookah; the third class (13%) was characterized by primarily cigarette smoking. Numerous differences were seen across classes, including the poly-users being less likely to be college students/graduates and more likely to be male and use marijuana and alcohol. Conclusions: We found that young adults can be grouped into 5 subgroups based on types of tobacco/nicotine products they do and do not use. A poly-use group that uses all types of tobacco products is concerning, particularly given high levels of marijuana and alcohol use reported in this group. [ABSTRACT FROM PUBLISHER]

Trends in sources of cigarettes among adolescents were assessed using data from a teen cohort (2000–2006). Five sources—bought from store, got from other teen, stole from others, bought from others, and got from an adult—were measured over time by age. The most common source among all ages was other teens. Fewer teens bought cigarettes from stores, with a downward trend for all ages. Among all ages there was an upward trend in stealing, with younger teens more likely to steal cigarettes. In addition to targeting cigarette sales, interventions are needed to target other youth cigarette sources. [ABSTRACT FROM AUTHOR]

Introduction: American Indians have the highest smoking rates in the United States, yet few randomized controlled trials of culturally specific interventions exist. This study assessed American Indians’ opinions about evidence-based treatment and attitudes toward participating in clinical trials. Methods: Six focus groups were conducted based on smoking status (current/former smoker), sex, and elder status (55 years and older or younger). Meetings were held at local American Indian community organizations. This project was accomplished in partnership with the American Indian Community Tobacco Projects, a community–academic research partnership at the University of Minnesota. Thematic qualitative data analyses were conducted. Results: Participants desired the following: (a) programs led by trained American Indian community members, (b) the opportunity to connect with other American Indian smokers interested in quitting, and (c) programs promoting healthy lifestyles. Strategies desired for treatment included (a) free pharmacotherapy, including nicotine replacement therapy (NRT); (b) nominal incentives, e.g., gift cards for groceries; and (c) culturally specific program components such as American Indian images, education on traditional tobacco use, and quit-smoking messages that target the value of family and include narratives or story telling in recruitment and program materials. Biochemical verification of smoking abstinence, such as salivary cotinine or carbon monoxide breathalyzers, is likely acceptable. Standard treatment or delayed treatment control groups were viewed as potentially acceptable for randomized study designs. Conclusions: Rigorously conducted randomized controlled trials of culturally specific smoking cessation interventions are sorely needed but will only be accomplished with the commitment of funders, researchers, and collaborative trusting relationships with the community. [ABSTRACT FROM PUBLISHER]

The article presents a study which examines the tendency for youth on buying cigarettes against getting them for free and the factors related with each obtainment method. The study uses data from 812 youth who are 12-17 years old and employs variables including demographics, smoking behaviors, and smoking condition of parents/siblings/friends. It reveals that 84% of the youth got their last cigarette for free, while 16% bought their last cigarette.

Purpose. To examine correlates of smoking policies in a stratified sample of small worksites in Minnesota and to determine knowledge and attitudes of the owners and managers regarding the Minnesota Clean Indoor Air Act (MCIAA) rules that newly applied to their businesses. Design. Cross-sectional survey. Setting. Minnesota offices and factories/warehouses with 5 to 50 employees. Subjects. Owners or managers of offices and factories/warehouses; sample size = 233; response rate = 66%. Measures. Existence and strength of worksite smoking policies. Analysis. Comparison of factories/warehouses and offices in metropolitan and greater Minnesota using chi square and linear and logistic regression analyses. Results. Approximately two-thirds of the worksites claimed to have a smoking policy, but only 26% of the total sample had a policy in writing. Worksites that offered health insurance to their employees were more likely to have a written policy (p < .0001), as were offices in the metro area compared with other worksites (p = .003). Policies of both types of outstate worksites were stronger compared with those at metro sites, and offices had stronger policies than factories and warehouses in the metro area. Only about one-third of the businesses had heard of the MCIAA rule changes. Conclusion. Most small businesses in Minnesota do not have a smoking policy in writing and thus their employees are at risk of exposure to secondhand smoke at work. [ABSTRACT FROM AUTHOR]

Objectives. This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. Methods. A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. Results. Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. Conclusions. This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates. [ABSTRACT FROM AUTHOR]

Objectives. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. Methods. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. Results. Of 10 000 total employees in treatment work sites, 2401 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45) for smoking and r = .55 for weight). Conclusions. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile. [ABSTRACT FROM AUTHOR]

The hypothesis that weight concerns are related to less successful smoking cessation and greater relapse among ex-smokers was prospectively evaluated. A population-based sample of 4981 working women and men 17 to 71 years of age was surveyed at 32 work sites. Current and previous weight loss efforts and smoking behavior were self-reported at baseline and 2 years later. Dieting and weight concerns were unrelated to smoking cessation or relapse. However, female smokers who had previously participated in a formal weight control program were three times more likely to quit smoking than those without a history of participation (25% vs 11%; odds ratio = 3.25, 95% confidence interval = 1.86, 5.67). Weight concerns and dieting efforts do not appear to inhibit smoking cessation or increase relapse in adults. [ABSTRACT FROM AUTHOR]

Purpose: To identify trajectories of smoking behaviors of a cohort of youth followed through young adulthood from 2000 to 2013.Design: The Minnesota Adolescent Community Cohort study, a population-based cohort study.Setting: Nationwide, originating in the Midwestern United States.Participants: Cohort of youth surveyed for 14 years beginning at ages 12 to 16 (N = 4241 at baseline; 59% recruitment rate).Measures: Main variable of interest was the number of days smoked in the past 30 days. Also included time-varying and time-invariant covariates.Analysis: We utilized growth mixture modeling to group individuals into trajectories over time.Results: We identified 5 distinct trajectories: nonsmokers (59.5%), early-onset regular smokers (14.2%), occasional smokers (11.5%), late-onset regular smokers (9.4%), and quitters (5.3%). Adjusted models showed that early- and late-onset regular smokers (compared to nonsmokers) had lower odds of attending or graduating from a 4-year college ( P < .05). Participants in all smoking classes compared to nonsmokers had greater odds of having more close friends who smoked ( P < .05).Conclusion: Our results show that individuals in their teens through young adulthood can be classified into 5 smoking trajectories. More people in this age range remained abstainers than found in most previous studies; however, a sizable group was identified as regular smokers by the time they reached young adulthood. Interventions targeted at teens, including those that address social and environmental influences, are clearly still needed to prevent escalation of smoking as they move toward young adulthood. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Smoking restrictions in recreational settings are established to promote anti-smoking norms and reduce exposure to secondhand smoke. Outdoor smoke-free policies are increasing, yet little is known about the perceptions of such restrictions. Methods: Data were collected from a population-based sample of young adults (n=2289) in upper Midwestern United States. Cross-sectional multivariate logistic regression was used to assess predictors of the perceived difficulty to smoke in outdoor park areas. Results: Living in an area with a smoke-free park policy was associated with a 1.4 times higher odds of perceiving difficulty to smoke compared to those living in an area without such a policy, after controlling for past month smoking, physical activity, age, and gender. Both smokers and non-smokers living in an area with a smoke-free park policy had higher odds of perceiving difficulty to smoking in park areas (OR=1.6 and 1.3 respectively) compared to smokers and non-smokers living in areas without such policies. Conclusion: Banning smoking in park areas was associated with a heightened perception of difficulty in smoking for young adult smokers and non-smokers. [Copyright &y& Elsevier]

Background: In recent years, local governments have strengthened laws to prohibit smoking in bars and restaurants to promote patron and employee health. Because of concerns that clean indoor air policies could have negative economic effects on some hospitality businesses, some cities have adopted partial clean indoor air policies (e.g., exempting bars). Purpose: This paper considers how partial and comprehensive smokefree policies affected bar and restaurant revenue, using quarterly data reported to the Minnesota Department of Revenue. Methods: Data from ten Minnesota cities from 2003 to 2007 were used to conduct a time-series analysis in 2009, adjusting for the population size of each city. Results: Bars and restaurants governed by either partial or comprehensive policies had slightly higher revenues than those not regulated by any local clean indoor air policy. Bars and restaurants governed by partial local bans reported 0.009% higher total revenue (p=0.5) and 0.052% higher liquor sales revenue (p=0.003) than those not covered by a ban. Bars and restaurants governed by comprehensive local bans reported 0.026% higher total revenue (p=0.05) and 0.018% higher liquor sales revenue (p=0.35). Conclusions: These findings suggest that smoking bans, whether comprehensive or partial, do not have a negative effect on bar and restaurant total or liquor revenues and may be associated with slightly higher revenue compared to not having a clean indoor air policy. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence and predictors of the awareness of cigarette price increases following a cigarette tax increase, and assess the association of the tax increase and attempts to quit and reduce smoking among adolescents and young adults. Design: We used a prospective cohort design. Setting: Surveys were conducted in Minnesota before and after a $0.75 cigarette tax increase. Subjects: We surveyed 3167 adolescents and young adults, including a subsample of 781 past-30-day smokers. Measures: Outcome measures were awareness of cigarette price increases and among past- 30-day smokers, reported changes in smoking behaviors because of the tax increase. Predictors included demographics, social factors, and prior smoking behaviors. Analysis: We estimated the prevalence of the outcomes and their associations with the predictors using logistic regression. Results: Among all participants, 42% noticed an increase in cigarette prices after the tax increase, including 76% of past-30-day smokers. Being a heavier smoker, living with smokers, having more smoking close friends, and generally being aware of cigarette price changes prospectively predicted the awareness of the price increase after the tax increase. Among past-30-day smokers, 16.7% reported quit attempts and 24.1 % reported reducing smoking because of the tax increase. Conclusion: Because fewer than half of the participants noticed the cigarette tax increase, media campaigns to raise awareness of tax changes may increase their effectiveness. [ABSTRACT FROM AUTHOR]