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KEYS TO SUCCESS WITH LOW SESPoverty & Tobacco Use Reference GuideThe California Department of Health Services Tobacco Control Section is the first statewide program in the nation to address the impact of economic adversity on smoking prevalence. They have done so by funding project RESPECT (Resources and Education Supporting People Everywhere Controlling Tobacco) to serve Low Socio-Economic Status Californians as a Priority Population.RESPECT’s purpose is to provide public health agencies and community-based organizations with reliable information, respectful and relevant educational materials and strategic technical assistance to reduce the 30% smoking rate of California’s Low Socio-Economic Status (Low SES) community and to protect Californians from exposure to Second Hand Smoke. To that end, RESPECT and the California Tobacco Education Clearing House (TECC) Resource Library have compiled this seven-page Resource Guide of essential background information, statistics, tobacco-specific research, and educational activities related to low income populations. Each entry includes a “Call #” by which the item can be ordered from the TECC Resource Library, a journal cite with page and date, or a URL for direct internet access. Items are grouped into the following categories: POPULATION OVERVIEW .
This book takes the concepts of hidden rules of economic class and uses them to educate social workers, employers, and community organizations about the unique and sometimes hidden obstacles the impoverished and those raised in poverty face. It strongly presents the concept of "bridging" and mentoring and provides individual, organizational, and systemic strategies to improve services for clients, raise retention rates for new hires from impoverished backgrounds, and increase understanding of the differences in economic cultures and how those differences affect opportunities for success. The book includes sections advising social service agencies about the types of modifications they can make to better serve the poor, comprehensive research notes for each book chapter, and a bibliography for further reading. CALL# TECC RF 1073
This quarterly series features information and analyses of interest to researchers, policymakers, the media, and the general public. The intent is to enhance understanding of California's demographic trends and diversity, covering such topics as population growth, ethnic diversity, poverty, income, education, and household composition. The February 2004 issue covered recent trends in income and poverty. Email notification of newly released issues is available on the website. URL http://www.ppic.org/main/series.asp?i=13
The C-STATS website provides statewide- and county-level socioeconomic statistics for: income (below poverty level for ages 18+, and below poverty level with related children less than 18 years old); and educational attainment (9th grade, 9th-12th grades, high school graduate or equivalent, some college with no degree, associate degree, bachelor’s degree, graduate or professional degree, high school graduate or higher, bachelor’s degree or higher). This information would be helpful in learning more about the low-SES populations in counties. URL http://www.cstats.info
. The guide discusses poverty as it relates to lack of resources (financial, emotional, mental, spiritual, physical, support systems, relationships/role models, and knowledge of hidden rules). It details the hidden rules of economic class and the obstacles poverty can create in all types of interactions, and presents specific strategies for overcoming them. Chapters cover poverty definitions and resources; the roles of language and story; hidden rules among classes; characteristics of generational poverty; role models and emotional resources; support systems; discipline; instruction and improving achievement; and creating relationships. Also includes background information and statistics on poverty in the US, comprehensive research notes for each chapter, and a bibliography for further reading. CALL# TECC RF 1074
This guidebook presents resources to help deliver cancer control programs to the socioeconomically disadvantaged. Included are activities to reach the poor, pitfalls, several do's and don'ts in working with the poor and additional resources to consult. CALL# TECC RF 353
This article describes 10 techniques that can be incorporated into health education/community outreach programs serving low-income, language-diverse populations: 1) create a relationship; 2) focus on the people; 3) reduce the words; 4) emphasize action; 5) invite the whole family; 6) choose accessible, comfortable program sites; 7) choose appropriate times; 8) feature small group activities; 9) choose an appropriate length; and 10) spend money on supplies, not paper. URL http://www.csuchico.edu/cjhp/1/2/3-12-portis.pdf
This web-based slide show illustrates how a family of four making $18,392 a year and living in poverty cannot afford even basic living expenses—rent, utilities, transportation, food, health care, and child care. Although tobacco products are not mentioned, it is clear that diverting any family income to purchase tobacco products would increase the family’s poverty and lower their standard of living. URL http://www.nccbuscc.org/cchd/povertyusa/tour2.htm PREVALENCE AND TOBACCO USE BEHAVIOR
This summary report is based on the 1999 and 2000 National Household Survey on Drug Abuse (NHSDA). This report focuses on the prevalence of tobacco use (cigarettes, smokeless tobacco, pipes, cigars) across different levels of income and education. The survey finds that 35% of persons with total combined family incomes of less than $9,000 reported smoking cigarettes during the past month compared with 29% of those from families with incomes between $20,000 and $39,999, and 19% of those from families with incomes of $75,000 or more. Rates of past month use of most tobacco products were higher among persons with lower levels of education than among those with higher levels of education. For example, 33% of persons who did not complete high school reported cigarette use compared with 28% of those with some college education, and 14% of those who completed four years of college. The relationship between income, educational level, and tobacco use was examined. Findings showed that among persons who had completed at least some college, past month cigarette use was generally higher among those from families with lower incomes than those from higher income families. Past month cigarette use was lowest at all income levels among college graduates. URL http://www.oas.samhsa.gov/2k2/Tob/tob.pdf
Tobacco exacts a disproportionate toll on individuals employed in working-class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. This paper provides an overview of recent advances that may reduce occupation-based disparities related to tobacco, followed by a discussion of research findings on the National Cancer Institute's Worksite Cancer Prevention: WellWorks 2 project, a successful social contextual intervention model that integrates smoking cessation and occupational health and safety. The paper also discusses the Organized Labor and Tobacco Control Network (http://www.laborandtobacco.org), a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health. The paper concludes by outlining future research and action priorities, as well as obstacles and opportunities for achieving these priorities.
This study explores smoking prevalence and smoking behavior in a multiethnic low-income HIV/AIDS population. The study site was an HIV/AIDS care facility in Houston, Texas, which serves a medically indigent and ethnically diverse population. Demographic, disease status, behavioral, and psychosocial data were assessed by the 348 study participants using a self-report survey. Prevalence of current cigarette smoking in the sample was 46.9%. Among participants with a lifetime history of smoking 100 or more cigarettes (62.8%), only 26.6% were currently abstinent, lower than the 48.8% rate seen in the general population. An analysis indicated that race/ethnicity, education level, age, and heavy drinking were significantly associated with smoking status. Hispanics were less likely to smoke than whites, younger participants were less likely to be current smokers than older participants, and heavy drinkers were more likely to be current smokers than those who were not heavy drinkers. As education level increased, the likelihood of smoking decreased, and the likelihood of quitting increased. The authors conclude that the high smoking prevalence in this HIV/AIDS population demonstrates the need for smoking cessation interventions targeted to the special needs of this patient group.
This literature review explores the higher smoking prevalence rates of blue collar workers versus the general population. It discusses occupational disparities, tobacco smoking, and health risks; secondhand smoke and the working environment (aerosol concentration and biomonitoring, chronic health effects, acute health effects); including blue-collar workers greater exposure to workplace toxins which can add to or even multiply their risks of adverse health effects from tobacco smoking. Among blue-collar workers, workers in the restaurant, bar, and gaming industries are exposed to much higher levels of secondhand smoke than are office workers, and are at increased risk of cancer and cardiovascular diseases even if they are non-smokers themselves. Over the past 20 years, the accumulating scientific evidence about smoking as an occupational hazard has prompted the implementation of various educational, economic, and legal tobacco control strategies. The author suggests that additional research is needed to 1) better characterize smoking prevalence among blue collar workers and what factors influence cessation among these workers, 2) improve the understanding of interactions between tobacco smoke and occupational injuries, and 3) evaluate the impact of state tobacco smoking bans on worker health and safety.
This study assesses reading level, tobacco knowledge, attitudes, and practices of tobacco use among 600 pregnant adult and adolescent women in the public health system in north Louisiana. The results found that knowledge about the effects of smoking and concern about the health effect of smoking on their baby varied significantly by reading level, with participants with higher reading levels having more knowledge and greater concern. Smoking practices did not vary by reading level even when race, age, and living with a smoker were controlled. Race was a significant determinant of smoking practices, with more white women reporting currently smoking during pregnancy than African Americans (34% vs. 8%). The authors conclude that reading level was related to knowledge about health effects of smoking. Women with higher reading levels were also more concerned about the adverse health effects of smoking on themselves and their babies. The most significant determinant of smoking was race (with whites smoking significantly more than African Americans). ECONOMICS: POVERTY, COSTS, PRICES, AND TAXES
This University of California, San Diego, study postulates that Latino smokers may be more sensitive to cigarette prices and examines the effect that an increase in cigarette excise taxes might have on Latino smoking prevalence. The authors simulated changes in Latino smoking, morbidity, mortality, and quality-adjusted life years that would result from a range of actual and proposed cigarette excise-tax increases using a range of cigarette price-elasticity estimates specific to Latino smokers. They concluded that if Latino smokers are more responsive to changes in cigarette prices than other smokers, Latino smokers also stand to gain a disproportionate share of the health benefit from an excise tax increase.
This fact sheet discusses how lower-income groups benefit from measures to reduce smoking, including increased state cigarette taxes. Topics addressed include low-income voter support for tobacco tax increases; how state tobacco tax increases can improve the health of low income smokers and their families due to increased quit rates and reduction in secondhand smoke; and how increased state tobacco taxes can prevent low income youth from becoming regular smokers. URL http://www.tobaccofreekids.org/research/factsheets/pdf/0147.pdf
This study analyzes how expenditures on tobacco affect consumption of other goods, estimating the patterns of substitution between tobacco products and other expenditures. Data were from the Consumer Expenditure Survey (1995–2001) and from regional price data and state cigarette prices. Expenditures for tobacco, food, alcohol, housing, apparel, transportation, health care, and all other goods were calculated for smoking and nonsmoking households and by income level. The following demographic factors were examined for smokers and low income households: age, race, gender, educational level, geographic region, marital status, families with persons under age 18 and over 64, and family size. The results showed that, for smoking households, average expenditures on tobacco products were nearly 4% of total expenditures and more than $1,000 annually. For those in low income households, cigarette spending was roughly similar to that spent on out-of-pocket health care expenditures ($1,056) or apparel ($1,138). In all income and low income samples, smokers spent roughly the same annual amount on smoking ($1,036 versus $1,018), which was in contrast with the fact that most other expenditure categories increased with income. Smokers spent less on housing and almost two times the greater budget share on alcohol compared to nonsmokers. For households in which some members smoke, smoking expenditures eliminated other purchases, which may affect other household members, as well as the smoker. Results also indicated that as the price of cigarettes rises, households increased the quantity of food purchased as a substitute for reduced smoking, and, in some samples, reduced the quantity of apparel and housing purchased.
This edition of the PBS series, "To the Contrary," is the sixth installment in a series depicting the devastating impact of smoking on women and minority communities. Focusing on women of low-socioeconomic status (SES), the video takes an in-depth look at how high smoking rates, poverty, and low educational levels are interrelated issues. In both urban and rural low-SES communities, a complex combination of factors contributes to high smoking prevalence rates, including generations of family tobacco use, lack of educational information, and lack of access to health care resources. Low-SES community advocates and educators discuss factors strongly associated with women of low-SES status, such as stress, anxiety, and depression, and explore how in poorer areas smoking can be used as a coping mechanism and a way to manage a lack of opportunities. This program provides tobacco education training to lay health educators who are members of the low-SES community and know how to communicate with this group and where to find them. The show concludes with a brief panel discussion of these and other tobacco-related issues facing low-SES communities, including national smoking prevalence rates for blue- vs. white-collar workers, how the education gap plays a role, and how depression and anxiety are strongly associated with smoking prevalence in this population. Funded by a grant from the American Legacy Foundation, originally aired November 12, 2004. The video circulates with an information packet containing fact sheets and resource lists. Call# TECC V514 TPT Socio-Economic SECONDHAND SMOKE
This article is the first in a series of articles highlighting tobacco as a social justice issue for AAPI communities. This article focuses on secondhand smoke exposure and other health issues in single resident occupancy (SRO) hotels in San Francisco's Chinatown. URL http://www.aapcho.com/links/APPEAL.Winter04.News.pdf
Secondhand smoke (SHS) exposure was measured among 242 children with asthma who live in homes where at least one person smokes. Subjects were identified through clinics, schools, community agencies, and hospitals serving low-income, medically underserved communities in Los Angeles. Parents were surveyed about smoking behaviors in the household, children's SHS exposure, and attitudes towards smoking and smoking behavior change. Overall reported levels of household smoking and SHS exposure were low, with a significant amount of household smoking taking place outside rather than inside the home. Over 47% of the respondents reported absolute restrictions against smoking in the home, and these restrictions were associated with lower reported levels of smoking, SHS exposure, and air nicotine and urine cotinine concentrations. TOBACCO SALES AND MARKETING
This study explores how the tobacco industry considers social class and gender in its efforts to market cigarettes in the US, particularly to socially disadvantaged young women. Data were collected through a systematic online search of UCSF Tobacco Documents Library and Tobacco Documents Online. An analysis of 135 documents found that the two largest US cigarette manufacturers consider "working class" young adults to be a critical market segment to promote growth of key brands. Through their own market research, these companies discovered that socially disadvantaged young women do not necessarily desire a "feminine" cigarette brand. The authors note that this is the first study in the literature to reveal how the tobacco industry targets working class women, based on tobacco industry documents. Considering the tobacco industry’s efforts, alongside the persistent and growing disparities in cigarette smoking by social class, and the narrowing of differences in smoking by gender, it is concluded that additional tobacco control resources ought to be directed toward working class women.
Individuals of lower socioeconomic status smoke at higher rates than those of higher socioeconomic status. Because of this disparity, the National Cancer Institute called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations. This study observed tobacco industry marketing in six Boston area communities (two of high socioeconomic position and four of low position, total of 41 observations) and in selected print publications that circulated in those communities during a 22-month period in 2000–2002. The results showed that, on average, there were fewer tobacco advertisements in the higher socioeconomic communities compared to the lower socioeconomic communities. In the low-socioeconomic communities, there were more than three times as many brand advertisements as youth access signs. Although brand advertisements outnumbered smoke-free signs, on average, there was no difference in the ratio of brand advertisements to smoke-free signs in low- and high-socioeconomic communities. The tobacco industry is actively present in community settings, particularly in communities with a low-socioeconomic profile. Tobacco control researchers and advocates need to continue to monitor the tobacco industry's behavior at the community level and develop strategies to counter this behavior. CESSATION
Using a two-group quasi-experimental study, this study evaluated the impact of a quit and win contest on quitting among low-income tobacco users and identified contest elements used by successful quitters. A volunteer sample of 248 low-income tobacco users was recruited from quit and win contest registrants (treatment group). A random sample of 290 low-income tobacco users who had not entered the contest was recruited using random digit dialing (control group). Telephone interviews were conducted with both groups at baseline, three, six, and 12 months. Seven-day point prevalence measured self-reported quitting, and urine cotinine assessed confirmed quitting. On average, quit and win study participants were 3.5 times more likely than controls to self-report quitting and 12.8 times more likely to demonstrate confirmed quitting after controlling for baseline differences in stage of change, age, education, and marital status. The use of specific contest elements was not related to successful quitting. The authors conclude that the overall quit rates in the treatment group were higher than those in the control group and that the results are promising given that low-income tobacco users are generally less likely to succeed in quitting.
This study evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and the usual care enhanced by six computer-assisted telephone counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care. A randomized clinical trial comparing the two approaches was conducted in three Michigan community health centers. The majority of the study population (233 adult smokers with telephones) were white (64%) women (70%) with annual incomes of less than $10,000 (79%) and with prescriptions for nicotine replacement therapy (>90%). At three months, quit rates were 8.1% in the usual-care group and 21% in the telephonic-counseling group. The results indicated that smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephone-counseling is provided. State and Medicaid managed care plans should consider investing in both office-based nurse and centralized telephonic-counseling services for low-income smokers.
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