Understanding and reducing health disparities through social and behavioral research

在2015财年，我们分析了几个基于人群的数据集，以调查烟草使用模式和风险因素的差异，以及减少烟草使用的干预措施。我们发现，根据2012年全国青年烟草调查，西班牙裔青年比非西班牙裔白人青年更容易吸烟，而比非西班牙裔白人青年更不可能相信烟草产品对他们的健康有害。我们还发现，与非西班牙裔白人相比，从不吸烟的非西班牙裔黑人青年和目前吸烟者的美国原住民青年更有可能接触到烟草优惠券。这种暴露与(1)相信吸烟的社会益处(例如，使某人看起来很酷和合身)的可能性较高，(2)认为烟草产品对健康有害的可能性较低，(3)(在从不吸烟者中)尝试吸烟的可能性较高，以及(4)(在吸烟者中)在不久的将来打算购买香烟的可能性较高。在参与明尼苏达州青少年社区队列(MACC)研究的一组青少年和年轻人中也观察到了与接触烟草优惠券有关的类似发现。数据显示，接触烟草直邮营销(主要是烟草优惠券)与随后成为当前吸烟者和戒烟可能性较低相关。 我们还研究了新烟草产品的影响。根据MACC研究的数据，相当一部分年轻人对电子烟持有好感，这些好感与随后对吸烟者和不吸烟者进行的电子烟实验有关。其他分析表明，在这一人群中，电子烟的使用并不能促进戒烟。我们还发现，鼻烟(一种新型无烟烟草产品)的使用与随后成为当前吸烟者有关，而不会在年轻成年人口中促进戒烟或减少吸烟。 在干预方面，我们分析了明尼苏达州烟草税上调前后在61家便利店进行的购物数据。我们发现，在我们走访的商店中，卷烟价格的涨幅超过了增税，这表明烟草公司可能将涨价过度转嫁给消费者，以制造公众对增税的反对，同时提供优惠券/价格促销以缓解吸烟者进入高卷烟价格。最后，我们应用行为理论框架来分析基线调查数据，从而为在工会蓝领工人中增加戒烟福利使用的干预措施的发展提供信息。通过这项分析，我们确定了重要的信念(例如，与治疗疗效相关的态度，使用戒烟福利的金钱影响)，以形成设计有效的媒体宣传活动的基础，以在这一低收入、低教育水平的吸烟者群体中推广戒烟福利的使用。

In FY2015, we analyzed several population-based datasets to investigate disparities in tobacco use patterns and risk factors, as well as interventions to reduce tobacco use. We found that, according to the 2012 National Youth Tobacco Survey, Hispanic youth are more likely than non-Hispanic White youth to be susceptible to cigarette smoking, and are less likely than non-Hispanic White youth to believe that tobacco products are dangerous to their health. We also found that non-Hispanic Black youth never-smokers and Native American youth current-smokers are more likely to be exposed to tobacco coupons compared to their non-Hispanic White counterparts. This exposure is associated with (1) the higher likelihood of believing the social benefits of smoking (e.g., making someone look cool and fit in), (2) the lower likelihood of believing tobacco products are dangerous to health, (3) the higher likelihood to try smoking (among never smokers) and (4) the higher likelihood of intending to purchase cigarettes in the immediate future (among ever smokers). Similar findings related to exposure to tobacco coupons are also observed in a cohort of adolescents and young adults who participated in the Minnesota Adolescent Community Cohort (MACC) Study. The data showed that exposure to tobacco direct mail marketing (mostly tobacco coupons) is associated with subsequently becoming a current smokers and lower likelihood to quit smoking. We also studied the impact of new tobacco products. According to the data from the MACC Study, a considerable proportion of young adults hold favorable beliefs about electronic cigarettes, and these favorable beliefs are associated with subsequent experimentation with electronic cigarettes for smokers and non-smokers alike. Additional analysis showed the electronic cigarette use does not promote smoking cessation in this population. We also found that use of snus (a novel smokeless tobacco product) is associated with subsequently becoming a current smoker, and does not promote smoking cessation or reduction in the young adult population. In terms of interventions, we analyzed data from purchases conducted at 61 convenience stores before and after a Minnesota state tobacco tax increase. We found that prices for cigarettes increased above and beyond the tax increase among the stores we visited, suggesting tobacco companies may be over-shifting the price increase to consumer to create public opposition against tax increases, while providing coupons/price promotions to ease smokers into high cigarette prices. Lastly, we applied a behavioral theory framework to analyze baseline survey data to inform the development of an intervention to increase tobacco cessation benefit use among unionized blue-collar workers. Through this analysis, we identified important beliefs (e.g., attitudes related to treatment efficacy, monetary implications of using cessation benefits) to form the basis for designing an effective media campaign to promote tobacco cessation benefit use in this lower income, lower education group of smokers.