Correlates of smoking during COVID-19 in the LGBTQI + cancer survivor population.

PURPOSE: Stressors brought on by the pandemic may have further encouraged lesbian, gay, bisexual, transgender, queer, and intersex plus (LGBTQI +) cancer survivors to smoke. The purpose of this study is to examine factors associated with smoking among LGBTQI + cancer survivors during the pandemic. METHODS: We used a secondary data analysis of OUT: The National Cancer Survey. We conducted logistic regression analysis to examine the associations between psychological distress, binge drinking, and socio-demographic factors with ever use and current use of cigarettes, other tobacco, and nicotine products. RESULTS: Of the 1629 participants in our sample, 53% used in their lifetime and 13% reported current use. Correlates of increased ever use included being of older age (AOR = 1.02; 95% CI: 1.01, 1.03) and binge drinking (AOR = 2.47; 95% CI: 1.17, 5.20) while correlates of decreased ever use were among those with a graduate or professional degree (AOR = 0.40; 95% CI: 0.23, 0.71). Correlates of increased current use included being of Latine descent (AOR = 1.89; 95% CI: 1.07, 3.36), binge drinking (AOR = 3.18; 95% CI: 1.56, 6.48), without health insurance (AOR = 2.37; 95% CI: 1.10, 5.10), and being disabled (AOR = 1.64; 95% CI: 1.19, 2.26) while correlates of decreased current use were among cisgender women (AOR = 0.30; 95% CI: 0.12, 0.77), being of younger age (AOR = 0.98; 95% CI: 0.96, 0.99), and having a graduate or professional degree (AOR = 0.33; 95% CI: 0.15, 0.70). CONCLUSIONS: Our findings demonstrate that a proportion of LGBTQI + cancer survivors continue to smoke during the pandemic despite the increased risk involved with smoking. Furthermore, individuals with intersecting marginalized identities experience additional stressors that may have been further exacerbated by the conditions of the pandemic that encourage them to smoke. IMPLICATIONS FOR CANCER SURVIVORS: Quitting smoking after a cancer diagnosis can decrease the chances of recurrence and a new primary malignancy. In addition, practitioners and researchers should advocate towards examining and addressing systemic forms of oppression in institutions that LGBTQI + cancer survivors navigate during the pandemic.

COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample.

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress. METHODS: An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates. RESULTS: COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes. LIMITATIONS: We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms. CONCLUSIONS: These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

Are excluding e-cigarettes a loophole in the smokefree public housing rule?

The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.

Adherence to COVID-19 Guidelines among Current, Former, and Never Smokers.

Objectives: In this paper, we explore the adherence patterns to US Centers for Disease Control and Prevention (CDC) COVID-19 mitigation guidelines among current, former, and never smokers. Methods: We used an online cross-sectional survey of adults 18 years or older in 5 northeastern states of the US (N=1084). Results: Unadjusted analyses revealed that current smokers reported lower adherence to the CDC guidelines than former smokers (27.5 vs 29.4, p<.05). After accounting for sociodemographic covariates, this finding was no longer statistically significant. However, compared to former smokers, never smokers reported wearing their mask less often (OR=0.65; 95% CI=0.45-0.94) and current smokers were less likely to report always practicing illness-related hygiene skills (OR=0.60; 95% CI=0.39-0.93).Conclusions: Never smokers had poorer adherence to CDC guidelines than former smokers, namely wearing their masks, and current smokers were less likely to always follow the hygiene recommendations. Results should inform future public health efforts in targeting current smokers with lower adherence to CDC guidelines and learning from the ability of former smokers to demonstrate high adherence.

Associations between alcohol and cannabis use before and during the COVID-19 pandemic: Results of a community survey.

The COVID-19 pandemic has impacted individuals around the world, creating unprecedented challenges. Due to lockdowns and social distancing measures, many people have turned to contactless modes of obtaining alcohol and other substances (e.g., home delivery). This study investigated associations between alcohol and cannabis use before and during the initial months of the COVID-19 pandemic and factors associated with use. An online, cross-sectional survey with a non-probability sample (N = 1126) was conducted in Northeast states during June-July 2020. Outcomes examined prevalence of alcohol and cannabis use for the overall sample and predictors of use in individuals who used substances. In the overall sample, we found that alcohol and cannabis use decreased from before to during the pandemic. For individuals who drank alcohol, higher pre-pandemic drinking, mid-range household income, and obtaining alcohol through home delivery were associated with higher alcohol drinking during the pandemic. For individuals who used cannabis, higher pre-pandemic cannabis use and obtaining cannabis through home delivery were associated with higher cannabis use during the pandemic. Overall, from before to during the pandemic, we found a decrease in the proportion of individuals who used substances and no changes in quantity for individuals who continued to use substances. Home delivery was associated with greater use of alcohol and marijuana, supporting a need for further research on risk factors for heavier substance use.

Medical Mistrust, Perceived Discrimination, and Race: a Longitudinal Analysis of Predictors of COVID-19 Vaccine Hesitancy in US Adults.

The current manuscript has two aims. First, we examined whether race and ethnicity, perceived discrimination, medical mistrust, and other demographic factors were predictors of COVID-19 vaccine hesitancy and vaccine behavior. Second, we sought to assess whether medical mistrust and perceived discrimination mediate the relationship between race and ethnicity and vaccine behavior. Specifically, we hypothesized that individuals of color had increased COVID-19 vaccine hesitancy as compared to White individuals and perceived discrimination and medical mistrust mediated this relationship. Results revealed that when accounting for sociodemographic characteristics and COVID-19-related variables those with greater medical mistrust were more likely to have vaccine hesitancy. Additionally, after accounting for medical mistrust, Black non-Hispanic/Black Hispanic/White Hispanic individuals had lower odds of having the COVID-19 vaccine compared to White non-Hispanic individuals. Furthermore, combined perceived discrimination and medical mistrust indirectly mediated the relationship between race and ethnicity and having the COVID-19 vaccine. The findings of this study indicate the need for public health efforts to address sentiments of medical mistrust and experiences of perceived discrimination when combating COVID-19 vaccine hesitancy, especially within communities of color.

Persistence of airway inflammation in smokers who switch to electronic cigarettes.

As opposed to smoking cessation with nicotine-replacement therapy and/or varenicline, nicotine-containing e-cigarette use does not improve some airway inflammatory markers. https://bit.ly/3FyqIt9.

Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey.

BACKGROUND: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. OBJECTIVE: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. METHODS: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon's Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. RESULTS: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=-0.24, 95% CI -0.44 to -0.05) and nonusers (B=-0.57, 95% CI -0.76 to -0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=-0.16, 95% CI -0.30 to -0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. CONCLUSIONS: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.