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BACKGROUND: The Environmental Affordances Model (EAM) proposes that the effects of chronic stress on depression are moderated by unhealthy behaviors and race/ethnicity. The unique social structures and contexts of Hispanics/Latinos in the U.S. may influence such relationships. This study evaluated whether unhealthy behaviors weakened the relationship between allostatic load, a measure of chronic stress, and future elevated depressive symptoms among Hispanic Community Health Study/Study of Latinos participants. METHODS: Longitudinal data (2008-2011 and 2014-2017) from 11,623 participants were analyzed. The exposure was allostatic load, an index of twelve established biomarkers categorized using clinically relevant cut points, at Visit 1. Elevated depressive symptoms were operationalized as a score of ≥10 (out of 30) on the CES-D 10 at Visit 2. An index of unhealthy behaviors, with one point each for cigarette smoking, excessive/binge drinking, sedentary behavior, and poor diet quality at Visit 1, was examined as an effect modifier. Multivariable logistic regression, in the overall sample and among Mexicans specifically and adjusted for demographic characteristics and elevated depressive symptoms at Visit 1, was used to model allostatic load, unhealthy behavior index (range: 0-4), and their interaction in relation to elevated depressive symptoms at Visit 2. RESULTS: Overall, greater allostatic load was associated with higher odds of elevated depressive symptoms after at least 6 years (aOR = 1.06, 95% CI = 1.01, 1.10). Overall, individuals with greater allostatic load and an unhealthy behavior index = 1, compared to those with an unhealthy behavior index = 0, had lower odds of elevated depressive symptoms at follow-up (aß = -0.065, 95% CI = -0.12, -0.007). CONCLUSIONS: The relationship between chronic stress and depression was partially moderated among Hispanics/Latinos who engaged in unhealthy behavior, which may have reduced their risk of elevated depressive symptoms given more chronic stress.

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INTRODUCTION: This study examines smoke-free youth partnerships implementing the Teens Against Tobacco Use model developed by the American Lung Association. This innovative tobacco prevention strategy has not been evaluated rigorously. Students used peer teaching to educate youth about tobacco use and engaged in tobacco control advocacy activities. Participating high school and middle school youth were trained to develop and deliver tobacco prevention presentations to 4th-8th grade students in schools. STUDY DESIGN: To evaluate the efficacy of the presentations, matched pairs of classrooms willing to have 1 presentation were randomly assigned to receive either the presentation first (intervention condition) or later in the school year (control condition). SETTING/PARTICIPANTS: The study took place in a predominantly low-income Hispanic community. A total of 9 schools, 107 classes, and 2,257 students participated in the evaluation. MAIN OUTCOME MEASURES: Tobacco susceptibility was assessed with a brief survey administered to students in both intervention and control classrooms in 2014 and 2015 after the completion of presentations in intervention classrooms. Analyses completed in 2019 compared intervention and control classrooms on tobacco susceptibility. RESULTS: Intent-to-treat analyses indicated that classrooms receiving a tobacco prevention presentation had significantly lower tobacco susceptibility scores than classrooms that did not receive a presentation (12% vs 17%, p<0.01), representing a 37% reduction in the odds of tobacco susceptibility. Teens Against Tobacco Use presenters also completed tobacco retailer compliance checks and gained media coverage in advocating to regulate e-cigarettes in the same manner as other tobacco products. CONCLUSIONS: Findings suggest Teens Against Tobacco Use is an effective means of reducing tobacco susceptibility among 4th-8th graders in the immediate term. Longer-term outcome evaluations are needed to determine whether Teens Against Tobacco Use presentations can have a lasting impact on tobacco use. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02443025.

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INTRODUCTION: Tobacco smoking and binge or excess drinking are unhealthy behaviors that frequently co-occur. Studies of Hispanics/Latinos have mostly been of Mexican Americans although there are substantial differences in smoking and drinking by heritage background. Associated with co-use by 5 subpopulations. METHODS: Cross-sectional data of 16,412 Hispanics/Latinos from Miami, the Bronx, Chicago and San Diego collected between 2008 and 2011 as part of the HCHS/SOL were analyzed. Smoking and alcohol consumption and demographic data were measured by self-report. Prevalence of smoking and alcohol consumption and co-use were reported. Logistic regression models examined the odds of co-use of smoking and binge or excess alcohol use by Hispanic/Latino background group. RESULTS: Men of Cuban (10.3%), Puerto Rican (8.9%), and Mexican (8.9%) background had the highest prevalence of co-use of smoking and binge drinking compared to men of Central American (6.1%) and Dominican (6.6%) background. Women of Dominican (16.4%) and Puerto Rican (19.7%) background had the highest prevalence of binge drinking compared to women of Central American (10%) and Cuban (8%) background and Puerto Rican (34.1%) and Cuban (21.8%) women were the most likely to report current smoking compared to women of Central American (8.3%) and Mexican (10.4%) background. Acculturation was not associated with co-use among men and women. Elevated depressive symptoms were positively associated with smoking and binge drinking among men, OR = 1.5 [1.2-2.0], and women, OR = 1.5 [1.1-2.2]. Puerto Rican women had increased odds of co-use of smoking and binge or excess drinking compared to Mexican American women, OR = 3.2 [1.5-6.6]. CONCLUSIONS: Puerto Rican and Dominican Latinas and Central American and South American men have a higher prevalence of co-use.

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INTRODUCTION: The purpose of this study is to estimate changes in the cigarette smoking prevalence among U.S. adults with and without depression from 2005 to 2014 by income and education level and overall. METHODS: This study examined data from adult respondents (aged ≥18 years) in the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals. Data from the years 2005 to 2014 were analyzed for a total analytic sample of n=378,733. The prevalence of past-month cigarette smoking was examined annually from 2005 to 2014 among adults with and without past-year major depression, overall and by income/education, using linear trend analyses. Data analysis occurred in 2017. RESULTS: The prevalence of smoking declined significantly from 2005 to 2014 among those with depression (37.62% to 34.01%; p<0.001) and without depression (23.99% to 19.87%; p<0.001). Yet, smoking remained nearly twice as common among those with depression during this period. Among adults with depression in the lowest income and education groups, the prevalence of smoking was more than double the prevalence of smoking among adults with depression in the highest income and education groups. CONCLUSIONS: Disparities in smoking prevalence are pronounced when depression and SES are considered simultaneously. Targeted public health and clinical efforts to reduce smoking among adult smokers of lower SES with depression are needed.

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BACKGROUND: Border Mexican Americans (MA) are exposed to poverty and under-education, all of which are predictors of cigarette smoking. METHODS: This study analyzed two epidemiologic surveys among border and non-border MA. In the border sample, interviews were conducted in urban areas of U.S.-Mexico border counties of California, Arizona, New Mexico, and Texas. The non-border sample consisted of respondents interviewed in Los Angeles, Houston, New York, Philadelphia, and Miami. Analyses were stratified by gender, adjusted for age and education, and modeled the effects of acculturation and binge drinking on cigarette smoking behavior. RESULTS: There were 2595 respondents, 1307 residing in border counties and 1288 from 5 other cities. There was no difference in cigarette smoking in the past 12 months between border and non-border MA among men (25.8% vs. 29.4%) or women (9.4% vs. 9.9%), respectively. Acculturation was not significantly related with cigarette smoking among men; however, women with high acculturation levels were more marginally likely to be past year smokers than those with low acculturation (RRR = 2.06, 95% CI 0.97-4.78). Binge drinking was associated with being past year smoker in both men (RRR = 3.54, 95% CI = 2.31-5.42) and women (RRR = 2.23, 95% CI 1.17-4.27), but not with being a former smoker. CONCLUSIONS: Border residence did not influence cigarette smoking behavior among Mexican Americans and both groups had significant associations between smoking and binge drinking.

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INTRODUCTION: No studies have examined the longitudinal relationship between e-cigarette use and elevated depressive symptoms among young adults. The main objective of the current study was to establish a potential bi-directional relationship between e-cigarette use and elevated depressive symptoms among college students in Texas, across a 1 year period of time. METHODS: A survey of 5445 college students in Texas was conducted with 6-month and 1-year follow-ups. A longitudinal cross-lagged model was used to simultaneously examine the bi-directional relationships between current, or past 30-day, e-cigarette use and elevated depressive symptoms across the three study waves. Depressive symptoms were measured using a 10-item Center for Epidemiologic Studies Depression Scale (CES-D) with a cutpoint of ≥ 10 to measure elevated depressive symptoms. Covariates included baseline age, gender, college type (2- or 4-year), and other alternative tobacco products used. RESULTS: E-cigarette use did not predict elevated depressive symptoms at 6-month and 1-year follow-ups. However, depressive symptoms predicted e-cigarette use at both 6-month and 1-year follow-ups. CONCLUSIONS: The current study indicates that depressive symptoms predict subsequent e-cigarette use and not vice versa. Future studies are needed to replicate current findings and also further establish the mechanisms for causality, which could inform Food and Drug Administration regulatory planning. IMPLICATIONS: There has been recent evidence for cross-sectional associations between e-cigarette use and elevated depressive symptoms and mental health problems. There have been no studies examining these associations using longitudinal designs. This study established a temporal relationship, such that elevated depressive symptoms predicted e-cigarette use 6 months later among college students. Future research is needed to establish the mechanisms of association as well as causality.

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BACKGROUND: Older persons are more vulnerable to tobacco mortality and less likely to make quit attempts. Less is known, however, about the role of race and ethnicity on quit rates in the U.S. Using a nationally representative data source of older adults in U.S., we aimed to study racial and ethnic differences in smoking cessation rates. METHODS: We used data from all waves of the Health and Retirement Study (HRS) between 1992-2012. The HRS is a longitudinal nationally representative survey of adults over the age of 50 in the United States. We followed current smokers at baseline (year 1992) until time to first quit. Race/ethnicity was the main predictor; gender, age, education, marital status, count of chronic medical conditions, depressive symptoms, and drinking at baseline were control variables. Cox regression was used for analysis of time to quit. RESULTS: Hazard ratios of quitting during the first ten (Hazard ratio = 1.51, p < 0.05) and 20 years (Hazard ratio = 1.46, p < 0.05) were larger for Latinos over the age of 50 compared to Whites. In addition, hazard ratios of quitting during the first 20 years (Hazard ratio = 1.19, p < 0.05) were larger for Blacks over the age of 50 compared to Whites. These findings were partially explained by cigarette consumption intensity, such that Latinos were lighter smokers and therefore more likely to quit than Whites. CONCLUSION: Latinos and Blacks were more likely than Whites to quit smoking cigarettes within 20 years. However, this finding may be explained by cigarette consumption intensity.

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BACKGROUND: There is a well-established link between cigarette smoking and depression; less is known about the potential association between alternative tobacco products, such as hookah, cigars, smokeless tobacco, and electronic cigarette (e-cigarette use) with depression. The Food and Drug Administration (FDA) is now regulating tobacco products and is interested in tobacco product use among those with mental health problems and other special populations such as college students. METHODS: Cross-sectional statewide convenience sample study of 5438 college students in 24 colleges and universities in Texas. Past 30-day use of hookah, cigar, smokeless tobacco, cigarette, and e-cigarette use were measured by self-report. Depressive symptoms were measured by the 10-item short form of the Center for Epidemiologic Studies scale. RESULTS: Only e-cigarette use was positively associated with depressive symptoms, even after accounting for all other tobacco products and socio-demographics. There were no significant interactions between race/ethnicity or gender with each of the tobacco products on depressive symptoms. CONCLUSIONS: E-cigarette use was positively associated with depressive symptoms among college students in Texas. Further research is needed to determine causality, which may inform FDA regulatory planning.

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OBJECTIVE: Social support interventions have demonstrated limited effectiveness for preventing smoking relapse. The stress-buffering hypothesis may be a useful framework by which to understand social support in smoking cessation interventions. The current study evaluated the interrelations among social support, stress, and smoking cessation in both moderation and mediation models. METHODS: Participants (N=139) were enrolled in a smoking cessation study at the safety-net hospital in Dallas, Texas. During the week prior to a scheduled quit attempt, general social support was measured using the Interpersonal Support Evaluation List (ISEL) questionnaire and smoking-specific social support was measured via repeated smartphone-based ecological momentary assessments (EMA). Post-quit stress was repeatedly assessed via smartphone. Logistic regression analyses evaluated potential interaction effects of pre-quit social support and post-quit stress on the likelihood of achieving biochemically-verified 7-day point prevalence abstinence at 4 weeks post-quit. Mediation models were evaluated to determine if post-quit stress mediated the association between pre-quit social support and smoking cessation. RESULTS: Participants were predominantly Black (63.3%) and female (57.6%); and 55% reported an annual household income of <$12,000. Analyses indicated that pre-quit social support did not significantly interact with post-quit stress to influence smoking cessation. However, post-quit stress did mediate associations between social support variables and smoking cessation. CONCLUSIONS: Findings indicated that social support impacts smoking cessation through its influence on post-quit stress among socioeconomically disadvantaged adults participating in cessation treatment. Increasing social support for the specific purpose of reducing stress during a quit attempt may improve smoking cessation rates in disadvantaged populations.

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The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population.

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INTRODUCTION: The Food and Drug Administration has the authority to regulate tobacco product constituents, including nicotine, to promote public health. Reducing the nicotine content in cigarettes may lead to lower levels of addiction. Smokers however may compensate by smoking more cigarettes and/or smoking more intensely. The objective of this study was to test whether individual differences in the level of nicotine dependence (as measured by the Fagerstrom Test of Cigarette Dependence [FTCD]) and/or the rate of nicotine metabolism influence smoking behavior and exposure to tobacco toxicants when smokers are switched to reduced nicotine content cigarettes (RNC). METHODS: Data from 51 participants from a previously published clinical trial of RNC were analyzed. Nicotine content of cigarettes was progressively reduced over 6 months and measures of smoking behavior, as well as nicotine metabolites and tobacco smoke toxicant exposure, CYP2A6 and nicotinic CHRNA5-A3-B4 (rs1051730) genotype were measured. RESULTS: Higher baseline FTCD predicted smoking more cigarettes per day (CPD), higher cotinine and smoke toxicant levels while smoking RNC throughout the study, with no interaction by RNC level. Time to first cigarette (TFC) was associated with differences in compensation. TFC within 10 min was associated with a greater increase in CPD compared to TFC greater than 10 min. Neither rate of nicotine metabolism, nor CYP2A6 or nicotinic receptor genotype, had an effect on the outcome variables of interest. CONCLUSIONS: FTCD is associated with overall exposure to nicotine and other constituents of tobacco smoke, while a short TFC is associated with an increased compensatory response after switching to RNC.

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BACKGROUND: Prostate cancer incidence and mortality are substantially higher in Black than in white men. Prostate cancer screening remains controversial. This study was conducted to assess the impact of, and racial differences in, prostate cancer screening on prostate cancer mortality. METHODS: This was a case-control study of Black and White men in eight hospitals. Cases were deaths related to prostate cancer; controls were hospital-based subjects that were frequency-matched to cases based on age and race. Multivariable logistic regression was used to test the association between screening and prostate cancer mortality. RESULTS: Cases had fewer PSA (prostate-specific antigen) tests than controls (1.73 vs. 3.98, p<0.001). White controls had higher rates of PSA tests than other sub-groups. There was no difference in PSA testing between Black cases and controls. Mean co-morbidity was 10.3 in cases and 2.63 in controls. Prostate cancer mortality was 55 to 57% lower among the screened persons. Individuals who died of prostate cancer related causes were less likely to have received PSA testing (OR=0.65; 95% Cl 0.56-0.75). CONCLUSIONS: The odds of dying from prostate cancer were lower among white men receiving screening tests. Having less co-morbidity was associated with lower odds of mortality in both races. This study raises the possibility that screening for prostate cancer with the PSA test may be more effective in white than in Black men.

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OBJECTIVES: We assessed risk of cigarette smoking initiation among Hispanics/Latinos during adolescence by migration status and gender. METHODS: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) surveyed persons aged 18 to 74 years in 2008 to 2011. Our cohort analysis (n = 2801 US-born, 13 200 non-US-born) reconstructed participants' adolescence from 10 to 18 years of age. We assessed the association between migration status and length of US residence and risk of cigarette smoking initiation during adolescence, along with effects of gender and Hispanic/Latino background. RESULTS: Among individuals who migrated by 18 years of age, median age and year of arrival were 13 years and 1980, respectively. Among women, but not men, risk of smoking initiation during adolescence was higher among the US-born (hazard ratio [HR] = 2.10; 95% confidence interval [CI] = 1.73, 2.57; P < .001), and those who had resided in the United States for 2 or more years (HR = 1.47; 95% CI = 1.11, 1.96; P = .01) than among persons who lived outside the United States. CONCLUSIONS: Research examining why some adolescents begin smoking after moving to the United States could inform targeted interventions.

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INTRODUCTION: In the present study, we investigated associations among cigarette smoking, smoking cessation treatment, and depressive symptoms in Hispanic/Latino adults. METHODS: The multisite prospective population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (aged 18-74) from diverse backgrounds (n = 16,412) in 4U.S. communities (Chicago, San Diego, Miami, and Bronx). Households were selected using a stratified 2-stage probability sampling design and door-to-door recruitment, and sampling weights calibrated to the 2010U.S. Population Census. Hispanic/Latino individuals of Dominican, Central American, South American, Cuban, Mexican, and Puerto Rican background were considered. Cigarette smoking, smoking cessation treatment, and depressive symptoms were measured by self-report. RESULTS: Results indicated that current smokers had greater odds for significant depressive symptoms (CES-D score ≥ 10) than never smokers in all Hispanic background groups [odds ratio (OR) > 1.5]. Depressed persons were not more likely to receive prescribed smoking cessation medications from a doctor (OR = 1.43, 95% CI = 0.98-2.08), take over-the-counter medications (OR = 1.11, 95% CI = 0.75-1.66), or receive psychotherapy (OR = 1.02, 95% CI = 0.57-1.85). CONCLUSIONS: In conclusion, these findings suggest that the positive association between smoking status and depressive symptoms is present in all examined Hispanic/Latino background groups.

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OBJECTIVES: We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults. METHODS: The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding. RESULTS: Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men. CONCLUSIONS: Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.

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There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among older children and adolescents and Puerto Ricans, groups at risk for both conditions. Data came from wave 3 of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000 to 2004. Logistic regressions for correlated data (Generalized Estimating Equation) were conducted, with asthma predicting suicidal ideation and behavior among participants 11 years or older. After adjustment for survey design; age; sex; poverty; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders; cigarette smoking; and stressful life events, asthma was positively associated with suicidal ideation and behavior among the Puerto Rican older children and adolescents. Public health interventions targeting Puerto Rican older children and adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.

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Asthma and mental health problems, such as depression, anxiety and behavior disorders, are common among youth and are significant sources of morbidity. There is a consistent association between asthma and anxiety/depression and a less consistent association between asthma and behavior disorders. Possible biological and psychological mechanisms may include inflammatory processes as well as the stress of having to live with a life-threatening condition. Future studies are warranted with longitudinal designs to establish temporality as well as measures of potential confounds. Biological and psychological measures would complement the longitudinal design to further establish causality. In addition, more information on the degree to which asthma and mental health have reciprocal influences on each other over time - and the mechanisms of these relationships - are needed in order to develop more effective intervention strategies to improve asthma control and mental health among those with both.

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OBJECTIVES: To describe the health status and risk indicator trends in a representative sample of US health care workers aged 45 years and older. METHODS: Using pooled data from the 1997 to 2009 National Health Interview Survey, logistic regression analyses were performed to determine whether age-group specific morbidity risks differed within occupational subgroups of the health care workforce (N = 6509). Health and morbidity trends were examined via complex survey adjusted and weighted chi-squared tests. RESULTS: Rates of functional limitation and hypertension increased among diagnosing/assessing health care workers. The prevalence of hearing impairment, cancer, and hypertension was two to three times greater in health-diagnosing/assessing workers aged 60 years and older than in younger workers. Health care service workers were up to 19 times more likely to be obese than workers who diagnose/assess health. CONCLUSIONS: Healthier workplaces and targeted interventions are needed to optimize the ability to meet health care demands of this aging workforce.

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There is a consistent positive and significant association between secondhand smoke exposure and mental health outcomes in the literature. There are potential genetic and behavioral confounders (e.g., psychological stress, maternal depression, and family functioning) were discussed, as well as potential causal neurobiological pathways (e.g., dopamine system). Further neurobiological research to establish causal pathways is needed as well as the integration of positive observational findings into clinical and public health prevention practices.

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OBJECTIVE: To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population. METHODS: Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations. RESULTS: Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others. CONCLUSIONS: Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.

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