School of Public Health
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item STATE-LEVEL STRUCTURAL RACISM AND ALCOHOL AND TOBACCO USE BEHAVIORS IN A NATIONAL PROBABILITY SAMPLE OF AFRICAN AMERICANS(2023) Woodard, Nathaniel; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Structural racism is how society maintains and promotes racial discrimination through established and interconnected systems. Structural racism is a historical driver of health disparities, including those in the area of cancer. One pathway posited for this effect is through the promotion of maladaptive coping behaviors, such as alcohol and tobacco use. This dissertation empirically assessed the association between state-level structural racism and alcohol and tobacco use behaviors among African Americans, including within various subgroups of African Americans based on age, gender, and household income. This project analyzed secondary self-report data collected from a national probability sample of 1,946 African Americans in the Religion and Health in African Americans (RHIAA) Study. Existing measures of state level structural racism were merged into the RHIAA dataset including a composite index of structural racism assessed using five dimensions (i.e., residential segregation, and economic, employment, education, and incarceration disparities). Analyses were performed in SPSS Version 28 using hierarchical linear and logistic regression models. In the first study, two models (Model A and Model B) were constructed for each of four outcomes, frequency of alcohol consumption (measured in days per month), frequency of binge drinking (measured in the number of occurrences per month), smoking status (current smoker or not a current smoker), and smoking frequency (never smoked, former smoker, currently smoke on some days, and currently smoke every day). Model A used the composite structural racism index measure to model the four alcohol and tobacco use measures and Model B analyzed the disaggregated dimensions of structural racism rather than the composite measure. All hierarchical analyses controlled for confounding variables (i.e., participant gender, age, education, income, and employment status). In the second study, analyses using the dimension-level approach in Model B from study one were repeated in subgroups stratified by participant age, gender, and income for the frequency of binge drinking and smoking status behaviors. Statistical comparisons of the slope estimates between corresponding subgroups (e.g., younger and older age) were used to test the moderation effects of age, gender, and income on the association between structural racism and alcohol and tobacco use behaviors. Results from these studies generally indicated a positive association between state level structural racism, especially in the incarceration dimension, and binge drinking and tobacco use behaviors. Stratified analyses generally did not support age, gender, or income as moderating variables of the association between structural racism and binge drinking and tobacco use behaviors. Current findings demonstrate a need for further research on structural racism and health and progress in structural racism measurement, including further emphasis of dimension-level measurement and analysis. Findings from the current dissertation highlight the importance of addressing structural racism, especially in incarceration, to reduce alcohol and tobacco use behaviors among African Americans and help address existing health disparities.Item Examining the State-Level, and Racial and Ethnic Impact of Cigarette Taxes on Youth Smoking and Cessation(2022) Shinaba, Muftau; Boudreaux, Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The objective of this study is to examine the relationship between per-pack cigarette taxes at the state level and smoking behavior among youth in the United States, based on race and ethnicity. State-level Youth Behavioral Risk Surveys (YRBS) from 2017 and 2019, as well as Tax Burden on Tobacco (TBOT) data, were used to analyze current (past 30-day) cigarette use and quit attempts among high school students, stratified by race/ethnicity and adjusting for age and sex. The findings found that overall odds of cigarette use were lower with higher cigarette taxes across states. The findings look to further evaluate a key tobacco control policy from both an economic and public health perspective.Item Mentholation affects the cigarette microbiota by selecting for bacteria resistant to harsh environmental conditions and selecting against potential bacterial pathogens(Springer Nature, 2017-02-15) Chopyk, Jessica; Chattopadhyay, Suhana; Kulkarni, Prachi; Claye, Emma; Babik, Kelsey R.; Reid, Molly C.; Smyth, Eoghan M.; Hittle, Lauren E.; Paulson, Joseph N.; Cruz-Cano, Raul; Pop, Mihai; Buehler, Stephanie S.; Clark, Pamela I.; Sapkota, Amy R.; Mongodin, Emmanuel F.There is a paucity of data regarding the microbial constituents of tobacco products and their impacts on public health. Moreover, there has been no comparative characterization performed on the bacterial microbiota associated with the addition of menthol, an additive that has been used by tobacco manufacturers for nearly a century. To address this knowledge gap, we conducted bacterial community profiling on tobacco from user- and custom-mentholated/non-mentholated cigarette pairs, as well as a commercially-mentholated product. Total genomic DNA was extracted using a multi-step enzymatic and mechanical lysis protocol followed by PCR amplification of the V3-V4 hypervariable regions of the 16S rRNA gene from five cigarette products (18 cigarettes per product for a total of 90 samples): Camel Crush, user-mentholated Camel Crush, Camel Kings, custom-mentholated Camel Kings, and Newport Menthols. Sequencing was performed on the Illumina MiSeq platform and sequences were processed using the Quantitative Insights Into Microbial Ecology (QIIME) software package. In all products, Pseudomonas was the most abundant genera and included Pseudomonas oryzihabitans and Pseudomonas putida, regardless of mentholation status. However, further comparative analysis of the five products revealed significant differences in the bacterial compositions across products. Bacterial community richness was higher among non-mentholated products compared to those that were mentholated, particularly those that were custom-mentholated. In addition, mentholation appeared to be correlated with a reduction in potential human bacterial pathogens and an increase in bacterial species resistant to harsh environmental conditions. Taken together, these data provide preliminary evidence that the mentholation of commercially available cigarettes can impact the bacterial community of these products.Item THE INFLUENCE OF WATERPIPE LOUNGE MENU LABELING ON INTENTION TO QUIT SMOKING AND PERCEIVED HARM, RISK AND ADDICTION AMONG YOUNG ADULT WATERPIPE TOBACCO SMOKERS IN THE UNITED STATES(2020) Kidanu, Azieb; Feldman, Robert H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the US, young adults 18 to 24 years of age have experienced the most notable decline in smoking rates from 24.4% in 2005 (Mariolis et al., 2006) to 7.8% in 2018 (Creamer, 2019). However, alternative tobacco products, such as waterpipes (also known as hookahs), are increasingly becoming the first product used by tobacco-naïve young adults and may be a gateway to nicotine addiction (Meier, Tackett, Miller, Grant, & Wagener, 2015). Tobacco surveillance measures show that among young adults in the US, 44.3% reported ever use (lifetime) and 10.7% current use (every day and someday) of waterpipe tobacco (Kasza et al., 2017). Although public health best practices for communicating the harms of tobacco use are well-established in traditional products, such as cigarettes, there is a critical knowledge gap on how to properly communicate the harms of waterpipe tobacco smoking (WTS) to current and potential consumers. In this dissertation, two independent studies were conducted to examine the effect of health-related information on waterpipe lounge menus on intention to quit smoking, as well as perceived relative harm, perceived risk of health consequences and perceived relative addiction.The overall results of Study 1 and Study 2 were consistent with prior research showing that brief health warning messages and nicotine content may increase intention to quit smoking, as well as perceived harm and risk of health consequences (Mays, Tercyak, et al., 2016). In addition, the research expands this evidence by demonstrating that the waterpipe lounge menu is a viable location for delivery of health education messages and product labeling. These findings may be used in future research to design further health communication experiments for WTS, as well as support practice and policy decisions for health warning messages and product labeling specific to waterpipe tobacco.Item Menthol Tobacco Sales Restrictions at the Local Level: Community Perceptions, Lessons Learned, and Policy Evaluation(2019) D'Silva, Joanne; Fryer, Craig S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Menthol cigarettes are a significant public health concern. While sales of regular cigarettes have declined in recent years, menthol cigarette sales are increasing. Known for their minty taste and cooling effects, menthol cigarettes are a starter product for youth. The tobacco industry has a long history of predatory marketing to African Americans, who are more likely to smoke menthol cigarettes, have lower quit rates, and experience higher tobacco-related mortality than white smokers. Because flavored cigarettes are appealing to youth, the 2009 Tobacco Control Act banned the sale of flavored cigarettes; however, menthol was exempted. Due to federal inaction on menthol, localities are enacting restrictions to address this social justice issue. In 2017, Minneapolis, Minnesota was among the first U.S. jurisdictions to restrict menthol sales to tobacco shops and liquor stores. Grounded in the Social Ecological Model, this dissertation utilized multiple methods to increase our understanding of the experience and impact of the Minneapolis menthol policy. Study 1 examined African American adult smoker perceptions and found that many menthol smokers perceived menthol to be as harmful or more harmful than non-menthol cigarettes and emphasized the role of tobacco industry targeting to African American communities and youth. Participants also indicated mixed support for menthol policy restrictions. Study 2 identified key factors that led to policy passage and included an in-depth assessment of critical steps in policy-making from policy formulation through adoption. The active engagement of youth and support of members of communities most impacted by menthol tobacco-related disparities were identified as critical to the policy’s successful adoption. Study 3 evaluated the impact of the menthol policy on the retail environment and found reduced menthol availability and decreased menthol marketing at the point-of-sale two months following policy implementation. Unintended consequences of the policy were also observed; two tobacco shops were added to convenience stores and continued to sell menthol tobacco. Results from these studies provide critical insights from several phases of the policy process. Findings can inform other jurisdictions around the country interested in pursuing menthol restrictions to reduce the burden of tobacco use and advance health equity for priority populations.Item Co-occurring Tobacco and Marijuana Use among Young Adults: A Sequential Explanatory Mixed Methods Study(2018) Seaman, Elizabeth Lucy; Fryer, Craig S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Tobacco use is the greatest cause of preventable death in the United States and an important health behavior to study among young adults. Prior research has suggested that there is an association between tobacco and marijuana use. Studying these two substances together can provide important insight into patterns of young adult tobacco and marijuana initiation and continuation. This dissertation employed a Sequential Explanatory Mixed Methods design to study tobacco and marijuana co-use among young adults 21-30 years old. Quantitative data analyses used National Health and Nutrition Examination Survey (NHANES) data to assess prevalence of cigarette and marijuana co-use (Aim 1), and characteristics of co-users (Aim 2) over a 10-year period (2005-2014). Prevalence of past-month cigarette use decreased from 30.9% in 2005-2006 to 23.7% in 2013-2014 (p = 0.024) while both past-month marijuana use (average 18.0%) and past-month co-use (average 9.8%) remained stable between 2005 and 2014. Prevalence of past-month co-use differed significantly by gender (p < 0.001) and racial and ethnic group (p < 0.001). Education level, marital status, race and ethnicity, ratio of income to the poverty level, depressive symptoms, non-marijuana illicit drug use, alcohol use, and household tobacco exposure differentiated co-users from neither users in a multinomial regression. Results from analyses of NHANES data, prior literature, and theoretical constructs were used to develop a guide for 20 in-depth interviews with young adult co-users living in the state of Maryland (Aim 3). Interviewees reported two modes of co-use: simultaneous and sequential. Participants reporting using tobacco as a replacement for marijuana in situations where they cannot access or use marijuana, suggesting the two products play similar yet distinct roles in co-use. Influences across levels of the Social Ecological Model were salient in young adults’ co-use. Quantitative results and qualitative findings were interpreted together, and five mixed methods meta-inferences emerged as important in understanding co-use. The co-use of tobacco and marijuana is an important behavioral phenomenon to study among young adults. Tobacco and marijuana co-users have unique characteristics compared to tobacco-only and marijuana-only users. Qualitatively, co-users described patterns of product use and replacement that illustrate the complexity of co-use behaviors.