BACKGROUND:While racial microaggressions (behaviors and statements made toward a person with or without the intention of expressing prejudice) are associated with increased substance use among several racial groups, the relationship between racial microaggressions and substance use in Asian American adults is less defined. It is also unknown if ethnic identity strength (the quality of an individual's affiliation with their ethnic group) moderates any associations between racial microaggressions and substance use in Asian American adults. METHODS:We conducted a cross-sectional survey of English-speaking Asian American adults aged 18 years and older living in the United States (N = 523). Validated scales assessed distinct subsets of racial microaggressions and ethnic identity strength. We assessed former (ever use, but not in the past 30 days) and past 30-day tobacco, cannabis, and alcohol substance use. Adjusted logistic regression models examined associations between racial microaggression subscales and substance use outcomes, as well as potential moderation by ethnic identity strength. RESULTS:Participants' mean age was 42.9 years. The most reported ethnicities were Indian (15.7%), Filipino (14.5%), Japanese (13.6%), and Chinese (13.0%). Greater exposure to racial microaggressions was associated with higher odds of past 30-day tobacco, cannabis, and alcohol use, while associations with former substance use were less consistent. Ethnic identity strength did not significantly moderate these associations. CONCLUSIONS:Racial microaggressions are associated with multiple forms of substance use among Asian American adults. Clinical and public health interventions that address racial microaggressions may help improve substance-use-related health outcomes in this population.

BACKGROUND AND OBJECTIVES:Despite growing cannabis use rates among US rural-residing young adults, less research has examined associations of rural-urban residence with cannabis use influences (e.g., harm perceptions, peer use) or behaviors (e.g., use frequency, driving under the influence of cannabis [DUIC]). METHODS:Using 2023 online survey data from 1961 US young adults (aged 18-34) reporting past-month cannabis use (Mage = 26.86 [standard deviation = 4.61], 14.7% rural-residing, 38.2% racial/ethnic minority, 59.2% female), multivariable regressions controlling for sociodemographics and state non-medical cannabis legalization examined associations of (1) rural-urban residence with cannabis use influences (motives, perceptions, mental/physical health, parent/peer use, advertising exposure); and (2) rural-urban residence and use influences with use behaviors (past-month days of use, past 6-month DUIC, consequences). RESULTS:Rural (vs. urban) residence was associated with three use influences (i.e., greater coping motives, lower perceived harm of cannabis use, higher odds of a mental health diagnosis), more frequent cannabis use and DUIC, but fewer use consequences. All three influences were associated with more frequent use and having a mental health diagnosis was associated with more frequent DUIC. Greater coping motives and lower harm perceptions were associated with fewer consequences, and having a mental health diagnosis was associated with greater consequences. DISCUSSION AND CONCLUSIONS:Rural (vs. urban) young adults reported more frequent cannabis use and DUIC, which may be associated with low cannabis-related harm perceptions and using cannabis to cope with stress/mental health symptoms. SCIENTIFIC SIGNIFICANCE:Interventions targeting rural young adults that address mental health symptoms and risk perceptions, including DUIC-related risks, may be needed.

Introduction In 2006, a federal US court found several major tobacco companies guilty of violating civil racketeering laws for deceiving the public about the harms of cigarettes. After 16 years of legal battles, the court ordered 17 corrective statements to be placed in over 200 000 tobacco retailers who have contracts with the tobacco companies to educate the public on the truth about tobacco-related harms. This study examined if corrective statement compliance was equitable across neighbourhoods.Methods We conducted a pooled cross-sectional analysis of compliance audit data collected by a court-approved auditor hired by the tobacco companies (33 977 in-person audits in 29 131 tobacco retailers in all US states). We downloaded census tract-level socio-demographic data from the 2019 to 2023 American Community Survey and fitted multivariable multinomial logistic regression models testing associations between neighbourhood socio-demographic variables and major non-compliance (vs compliance) and minor non-compliance (vs compliance).Results Overall compliance was 80.4%. Audits indicated retailers located in neighbourhoods with the highest (vs lowest) percentage of Black residents had 2.21 (95% CI 1.94 to 2.52) times the odds of being major non-compliant (vs compliant). Inequities in major and minor non-compliance were also present by percentage of Hispanic/Latine residents and median household income.Discussion Compliance with the mandated display of corrective statements, which was intended to increase knowledge and educate the public about the harm of cigarettes and the tobacco industry's deception, was not equitable in this sample. Future policies should include requirements that policy implementation is equitably enforced to ensure all populations realise public health benefits.

Living in a neighborhood with greater tobacco retailer availability (TRA) is associated with tobacco use, and there are persistent neighborhood racialized and socioeconomic inequities in TRA. Zoning could be leveraged as an innovative policy tool to equitably reduce TRA. In this study, we simulated the effect of zoning policies on reducing inequities in TRA in Oklahoma City (OKC) and Tulsa (Oklahoma). We spatially joined locations of tobacco retailers, zoning areas, and census tract sociodemographic characteristics (year 2023). We conducted 500 simulations to randomly remove 5–90

INTRODUCTION:Tobacco retailer density and distance to tobacco retailers are understood to influence tobacco-related behaviors; however, there is no general agreement on how to best characterize or measure the tobacco retail environment (TRE). In this data-driven analysis, we examine similarities among neighborhood-level measures of the TRE and assess how the geographic resolution of the neighborhood units may affect them. AIMS AND METHODS:We used locations of likely tobacco retailers in the United States to calculate multiple retailer count, density, and distance measures. Measures were calculated at the Census block group, tract, and county (including county equivalents) levels of geographic aggregation. Spearman's correlation was used to evaluate the similarity among the TRE measures. RESULTS:At the block group and tract level, correlation among all TRE measures ranged from slightly negative (ρ = -0.03) to nearly perfect (ρ = 0.99). At both levels of aggregation, distance-based TRE measures were highly correlated (ρ > 0.76). At the block group level, the simple count of retailers was highly correlated with the density measures (ρ > 0.83), and at the tract level, simple count was moderately to highly correlated with the density measures (ρ > 0.5). Findings were generally similar at the county level; a notable deviation was that retailers per person were negatively correlated with all other TRE measures (range from ρ = -0.08 to ρ = -0.32). CONCLUSIONS:Some common measures were not correlated, suggesting they capture different aspects of the TRE; similarity among the various measures also varied by level of geographic aggregation. IMPLICATIONS:Because the TRE shapes people's tobacco-related behaviors, using appropriate measures to characterize it at a neighborhood level is paramount. Our work highlights both the similarities and differences among a set of common measures, thereby suggesting the measures may be capturing different aspects of the overall retail environment. Our findings regarding geographic level of aggregation underscore the importance of neighborhood definition in any TRE analysis.

ObjectiveTo examine inequities in tobacco retailer availability by neighbourhood-level socioeconomic, racial/ethnic and same-sex couple composition.Data sourcesWe conducted a 10 November 2022 search of PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus.Study selectionWe included records from Organisation for Economic Co-operation and Development member countries that tested associations of area-level measures of tobacco retailer availability and neighbourhood-level sociodemographic characteristics. Two coders reviewed the full text of eligible records (n=58), including 41 records and 205 effect sizes for synthesis.Data extractionWe used dual independent screening of titles, abstracts and full texts. One author abstracted and a second author confirmed the study design, location, unit of analysis, sample size, retailer data source, availability measure, statistical approach, sociodemographic characteristic and unadjusted effect sizes.Data synthesisOf the 124 effect sizes related to socioeconomic inequities (60.5% of all effect sizes), 101 (81.5%) indicated evidence of inequities. Of 205 effect sizes, 69 (33.7%) tested associations between retailer availability and neighbourhood composition of racially and ethnically minoritised people, and 57/69 (82.6%) documented inequities. Tobacco availability was greater in neighbourhoods with more Black, Hispanic/Latine and Asian residents (82.8%, 90.3% and 40.0% of effect sizes, respectively). Two effect sizes found greater availability with more same-sex households.ConclusionsThere are stark inequities in tobacco retailer availability. Moving beyond documenting inequities to partnering with communities to design, implement, and evaluate interventions that reduce and eliminate inequities in retail availability is needed to promote an equitable retail environment.PROSPERO registration numberCRD42019124984.

Introduction Predominantly Black, Hispanic or Latino, and lower-income communities are overexposed to tobacco. This study investigated the relationship between cigarette smoking and racial/ethnic and economic segregation using the Index of Concentration at the Extremes (ICE).Aims and Methods A nationally representative sample of 4091 (aged 18-34 years) was surveyed between September and October 2016. We calculated census-tract population estimates to form ICE measures for ethnicity, race, income, ethnicity and income, and race and income. Quintiles were determined, with Quintile 1 (Q1) representing the most Hispanic/Latino, Black, and lowest-income neighborhoods and Q5 representing the most non-Hispanic/Latino, White, and highest-income neighborhoods. State fixed effects logistic regression models, weighted for national representativeness, assessed the relationship between ICE measures and past 30-day cigarette use, controlling for individual smoking correlates (eg, income, race/ethnicity, tobacco use).Results For racial/ethnic segregation alone, individuals in neighborhoods with the highest proportions of Hispanic/Latino versus non-Hispanic/Latino (Q5 vs. Q1-Q4 range 1.47-1.79) and Black versus White residents had higher smoking risk (Q5 vs. Q1 [1.41] and Q2 [1.40]). For economic segregation, individuals in Q2 and Q3 neighborhoods had higher smoking risk than those in Q5 (Q5 vs. Q2 [1.60] and Q3 [1.73]), but smoking risk did not differ between Q1 and Q5.Conclusions In this sample, living in areas with the most Hispanic/Latino and Black residents was associated with the highest smoking risk, while living in areas with highest-income residents was associated with lowest smoking risk, even controlling for individual factors. Understanding the impact of ethnic, racial, and economic segregation on smoking behaviors informs targeted interventions to reduce tobacco overexposure.Implications The study's findings highlight the association between neighborhood socioeconomic factors and cigarette smoking. Racial and ethnic segregation is associated with higher smoking rates. The combined influence of racial, ethnic, and economic factors adds intricacy to the association between segregation and the risk of smoking. This research is significant as it provides valuable insights for designing focused interventions aimed at mitigating tobacco overexposure in predominantly Black, Hispanic/Latino, and low-income neighborhoods.

This cross-sectional study examines compliance with Tobacco 21 laws in New Jersey between 2019 and 2022.

BACKGROUND:Little research exists on simultaneous use of multiple substances that pose additive risk for negative health outcomes. We examine rates and sociodemographic and state cannabis legalization status correlates of simultaneous use (i.e., use > 1 substance on the same occasion) and mixing (e.g., co-administration of substances) of tobacco, alcohol, and cannabis among a U.S sample of adults who currently use alcohol and combustible tobacco products. METHODS:Using a survey panel, we recruited 1,300 U.S. adults who reported past 30-day use of alcohol and combustible tobacco between June to July 2021. We fit logistic regression models to examine associations between sociodemographic characteristics and cannabis legalization status with use of alcohol, tobacco, and cannabis. RESULTS:The majority (67%) of participants reported simultaneous alcohol and tobacco use. Over half (55.5%) of tobacco and alcohol co-users reported past 30-day cannabis use, 42.1% reported simultaneous tobacco and cannabis use, and 45% reported mixing tobacco and cannabis in the form of a blunt. Additionally, 36.5% reported simultaneous alcohol and cannabis use, and 33.1% reported simultaneous alcohol and blunt use. Age, race, gender, and income level were associated with simultaneous use of some substances. State cannabis legalization status was not significantly associated with outcomes. CONCLUSIONS:Overall, the prevalence of simultaneous use was high among this U.S. purposive sample of adults who reported current co-use of alcohol and tobacco products. Researchers should consider measuring simultaneous use of substances in samples of co-users, which may inform the efficacy of interventions focused on cessation or harm reduction of substance use.

Delta-8 THC (D8) is an intoxicating compound linked to poisonings and hospitalizations, and no federal laws prohibit its sale to minors. We examined retail D8 availability near public schools (n=231) in Fort Worth, Texas, where D8 sales are minimally regulated. Between September- October 2021, trained data collectors collected D8 availability data from 1,178 retailers with alcohol, tobacco, and/or consumable hemp licenses. We examined differences in product availability for retailers near (within 0.5 miles) schools vs. not near schools. There was a higher prevalence of retailers selling D8 near (vs. not near) schools (12.4% vs. 8.2%; chi-square test 5.84, p<0.05). Of the 231 public schools, 37.2% (n=86) had at least one D8 retailer nearby. Of the 86 schools with D8 retailers nearby, the cheapest products were for vaping (40.7%) and edibles (31.4%). There were school-level racialized and socioeconomic inequities in availability. Ongoing surveillance of D8 availability and laws are urgently needed.

Introduction Significant progress has been made in reducing maternal exposure to tobacco smoke and subsequent adverse birth outcomes, however, reductions may require strategies that reduce the availability of tobacco retailers. In this study, we investigated the relationship between tobacco retailer density and birth outcomes across the USA and predicted the potential impact of a tobacco retailer density cap on these outcomes. Methods Annual US county (n=3105), rates of preterm birth, low birth weight, small-for-gestational age, all-cause infant mortality and sudden infant death syndrome (SIDS) were calculated using National Vital Statistics System data. Tobacco retailers were identified from the National Establishment Time-Series Database. We used Poisson regression to estimate the effect of capping retailer density at 1.4 retailers per 1000 population, controlling for county demographics and air pollution, using propensity score weighting. Results Tobacco retailer density was positively associated with most adverse birth outcomes. We estimate that a nationwide cap on tobacco retailer density, implemented in 2016, would have resulted in a reduction of 4275 (95% CI 2210 to 6392) preterm births, 6096 (95% CI 4421 to 7806) small-for-gestational-age births, 3483 (95% CI 2615 to 4378) low birthweight births, 538 (95% CI 345 to 733) all-cause infant deaths and 107 (95% CI 55 to 158) SIDS deaths in that year. Conclusion Higher rates of adverse birth outcomes were seen in counties with high tobacco retailer density compared with those with low density. These results provide further support for regulating tobacco retail density to reduce adverse health outcomes associated with tobacco use.

Delta-8 THC (D8) is an intoxicating compound linked to poisonings and hospitalizations, and no federal laws prohibit its sale to minors. We examined retail D8 availability near public schools (n=231) in Fort Worth, Texas, where D8 sales are minimally regulated. Between September-October 2021, trained data collectors collected D8 availability data from 1,178 retailers with alcohol, tobacco, and/or consumable hemp licenses. We examined differences in product availability for retailers near (within 0.5 miles) schools vs. not near schools. There was a higher prevalence of retailers selling D8 near (vs. not near) schools (12.4% vs. 8.2%; chi-square test 5.84, p<0.05). Of the 231 public schools, 37.2% (n=86) had at least one D8 retailer nearby. Of the 86 schools with D8 retailers nearby, the cheapest products were for vaping (40.7%) and edibles (31.4%). There were school-level racialized and socioeconomic inequities in availability. Ongoing surveillance of D8 availability and laws are urgently needed.

PURPOSE:Despite the passage of federal Tobacco 21 (T21) policies, underage tobacco use remains a problem. Retailers play a critical role in enforcing T21 policies as they control access to tobacco products at the point of sale. Given the importance of retailer compliance in the success of T21 policies, this study aimed to investigate how clerks navigate situations when underage buyers attempt to purchase tobacco products by using comments captured during underage purchase attempts in a multi-state study. METHODS:Comments (n = 1157) from underage buyers (n = 58) were captured from August 2019 to September 2023. We used a thematic coding approach to develop themes. RESULTS:Three primary themes emerged: (1) "Are you old enough to smoke?" - Age Verification Procedures, (2) "Okay, you're almost [21]. Close enough." - Evading Minimum Age of Sale Policies, and (3) "Not for you." - Enforcement of T21 Policies. Many clerks complied with and enforced T21 policies at the point of sale; however, themes showed how some clerks evaded these policies to complete sales to underage buyers. CONCLUSION:Findings reveal a need to strengthen T21 enforcement and increase retailer education for T21 policies.

Engaging in COVID-19 preventive behaviors (e.g., wearing masks) can be particularly important for cancer survivors to avoid infectious disease. This cross-sectional study aimed to examine preventive behaviors of Black and White cancer survivors residing in North Carolina during the COVID-19 pandemic. From February through September 2022, we recruited 548 cancer survivors from the University of North Carolina Health Registry/Cancer Survivorship Cohort. Participants completed a retrospective survey about their COVID-preventive behaviors between March 2020 and December 2020 (Time 1) and within the last 30 days (Time 2). We examined differences and changes over time in the prevalence of behaviors by race. At Time 1, Black cancer survivors had a higher prevalence of wearing gloves (adjusted prevalence ratio [aPR], 2.99; 95

Objective Retailer licencing fees are a promising avenue to regulate tobacco availability. However, they face strong opposition from retailers and the tobacco industry, who argue significant financial impacts. This study compares the impacts of different forms of tobacco licence schemes on retailers’ profits in Scotland. Methods We calculated gross profits from tobacco sales in 179 convenience stores across Scotland using 1 099 697 electronic point-of-sale records from 16 weeks between 2019 and 2022. We estimated different fees using universal, volumetric and separate urban/rural schemes. We identified the point at which 50% of retailers would no longer make a gross profit on tobacco sales for each scheme and modelled the financial impact of 10 incremental fee levels. The financial impact was assessed based on changes in retailers’ tobacco gross profits. Differences by neighbourhood deprivation and urban/rural status were examined. Results The gross profit from tobacco per convenience store averaged £15 859/year. Profits were 2.29 times higher in urban (vs rural) areas and 1.59 times higher in high-deprivation (vs low-deprivation) areas, attributable to higher sales volumes. Tobacco gross profit decreased proportionally with increasing fee levels. Universal and urban/rural fees had greater gross profit reductions in rural and/or less deprived areas, where profits were lower, compared with volumetric fees. Conclusion The introduction of tobacco licence fees offers a potential opportunity for reducing the availability of tobacco retailers. The likely impact of a tobacco licence fee is sensitive to the type of licence scheme implemented, the level at which fees are set and the retailers’ location in relation to neighbourhood deprivation and rurality.

INTRODUCTION:The 2018 U.S. Farm Bill unintentionally resulted in the proliferation of derived intoxicating cannabis vape products (DICVPs), raising concerns about associated health risks. To inform prevention efforts, this study analyzed the product attributes and marketing features of DICVPs sold online, particularly features that could attract youth or lower risk perception. METHODS:In 2023, product attributes and descriptions of 490 flavored DICVPs were extracted from two online retail websites. In 2024, two trained coders thematically coded product descriptions for their product marketing features. RESULTS:Overall, 95 unique brands and 26 unique intoxicating cannabinoids were identified. The most frequent marketing features overall were vape product design and use (99.0%), including vaping satisfaction, discreetness, convenience, and use instructions. Regulation and compliance messages (91.6%) were also prevalent, including lab testing for additives and/or chemicals, health warnings, hemp-derived labels, references to the Farm Bill, and U.S. Food and Drug Administration approval statements. Other prominent themes included: flavor and sensation claims (79.6%, i.e., flavor variety, fruit flavors); psychoactive effect claims (43.3%, e.g., potency or expected user experience); product quality claims (38.4%, e.g., "quality," "natural," "purity"); and other positive effect claims (33.9%, e.g., mood enhancement, relaxation). DISCUSSION:The DICVP online marketplace is highly fragmented with a variety of brands and intoxicating compounds. Common marketing strategies promoting appealing flavors and positive vaping experiences may increase their appeal to young people. Features related to product legality and quality may reduce perceived risks and barriers to using products. Continuous monitoring of the DICVP marketplace is needed to inform policymaking.

Objective: People who use both alcohol and combustible tobacco have an increased risk of developing cancer. Few interventions have been developed to inform people about the risks of co-use. This study developed and tested messages about the risks of alcohol and combustible tobacco co-use among adults. Method: In June to July 2021, we surveyed 1,300 U.S. adults who had used both alcohol and combustible tobacco products within the past 30 days. After reporting their awareness of diseases caused by tobacco and alcohol co-use, participants were randomly assigned to four between-subjects experiments that manipulated specific cancer health effects versus the word cancer; cancer health effects versus noncancer health effects; different descriptions of co-use (e.g., using alcohol and tobacco..., drinking alcohol and smoking tobacco...); and co-use versus single-use messages. Participants saw one message for each experiment and rated each message using a validated perceived message effectiveness (PME) scale. Results: Awareness of health effects caused by alcohol and tobacco co-use ranged from moderately high for throat cancer (65.4%) to moderately low for colorectal cancer (23.1%). Messages about cancer health effects increased PME more than messages about noncancer health effects (B = 0.18, p = .01). Messages about some specific cancers, including oral cancer (B =-0.20, p = .04) and colorectal cancer (B =-0.22, p = .02), decreased PME more than messages with only the word cancer. No significant differences were identified for descriptions of co-use or co-use versus single-use messages. Conclusions: Messages about some cancer health effects of co-using alcohol and tobacco may be effective when communicating the harms of both drinking alcohol and using tobacco. (J. Stud. Alcohol Drugs, 86, 140-148, 2025)

ObjectivePlaces with more tobacco retailers have higher smoking prevalence levels, but whether this is because retailers locate where people who smoke live or whether tobacco availability prompts tobacco use is unknown. In this study, we compare the role of consumer demand with that of tobacco supply in longitudinal, area-based associations of tobacco retailer density with smoking prevalence.MethodsWe merged annual adult smoking prevalence estimates derived from the USA Behavioural Risk Factor Surveillance System data with annual county estimates of tobacco retailer density calculated from the National Establishment Time Series data for 3080 counties between 2000 and 2010. We analysed relationships between retailer density and smoking in 3080 counties, using random intercept cross-lagged panel models and employing two measures of tobacco retailer density capturing the number of likely tobacco retailers in a county divided by either the population or land area.ResultsBoth density models provided evidence of significant demand and supply effects; in the population-based model, the association of smoking prevalence in 1 year with tobacco retailer density in the next year (standardised coefficient=0.038, p<0.01) was about double the association between tobacco retailer density with subsequent smoking prevalence (0.017, p<0.01). The reverse was true in the land area-based model, where the supply effect (0.042, p<0.01) was more than 10 times stronger than the demand effect (0.003, p<0.01).ConclusionsPolicies that restrict access to retail tobacco have the potential to reduce smoking prevalence, but pairing such policies with interventions to reduce consumer demand remains important.

Living in a neighborhood with a high count of tobacco retailers (i.e., tobacco retailer availability, TRA) is associated with youth and adult tobacco use behaviors. As such, policies that reduce TRA have been identified as an important intervention for reducing tobacco use and achieving an equitable tobacco endgame. Zoning regulations could be leveraged as an innovative policy tool to reduce inequities in TRA, especially in states that may preempt local tobacco retail licensing. This study analyzed TRA inequities by zoning designations and sociodemographic characteristics in Oklahoma City and Tulsa (Oklahoma, USA) in 2023. We obtained locations of all licensed tobacco retailers in OKC and Tulsa and downloaded spatial zoning files containing all zoning designations (e.g., C-3, Community Commercial). We created quintiles of 2019-2023 American Community Survey census tract ethnic, racial, and socioeconomic characteristics. We spatially joined these data and calculated the total count of tobacco retailers within zoning designations and across all census tracts. To identify zoning-based inequities, we fit linear regression models examining associations between sociodemographic quintiles of census tracts and the total count of tobacco retailers in each zoning designation in a tract. Across both cities, tobacco retailer counts were generally higher in neighborhoods with greater percentages of Black and Hispanic or Latine residents, lower percentages of White residents, higher income inequality, lower median household income, and higher percentages of residents living below the federal poverty line. Among tracts with commercial zones near residential areas, tracts with the highest (vs. lowest) percentage of residents living below the federal poverty line had 1.4 more retailers (SE, 0.3, p < 0.001) in OKC. This pattern was similar in Tulsa though not significant. In contrast, TRA in tracts with commercial zoning near residential areas was lower in tracts with the highest (vs. lowest) percentage of White residents (OKC: B = -1.1; SE, 0.3, p < 0.01; Tulsa: B = -3.0; SE, 0.8, p < 0.001) and highest (vs. lowest) median household income (OKC: B = -1.4; SE, 0.3, p < 0.001; Tulsa: B = -1.9; SE, 0.8, p < 0.05). For places that are prohibited from implementing licensing-based policies to reduce TRA, zoning laws may be the only viable policy approach to reducing TRA, which may also reduce inequities in tobacco use, promoting health equity.