What is already known on this topic? Multiple studies have identified advantages of electronic su... more What is already known on this topic? Multiple studies have identified advantages of electronic survey administration (eg, using tablet computers with programmed logic skips and tobacco product images) over paper-and-pencil administration, including a reduction in logic inconsistences and item nonresponse, improved respondent recall, and better efficiency of data cleaning. What is added by this report? Administering the National Youth Tobacco Survey (NYTS) electronically in school classroom settings was feasible, was well accepted by respondents, and improved efficiency of survey administration. What are the implications for public health practice? Electronic administration of the NYTS reduces respondent burden and can lead to more timely and valid surveillance of tobacco product use among youths.
, CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study ... more , CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study assessed the impact of removing tobacco sales from CVS Health on cigarette smoking behaviors among U.S. adult smokers. Methods: CVS Health retail location data (2012−2016) were linked with data from the Behavioral Risk Factor Surveillance System, a phone-based survey of the non-institutionalized civilian population aged ≥18 years. Using a difference-indifferences regression model, quit attempts and daily versus nondaily smoking were compared between smokers living in counties with CVS stores and counties without CVS stores, before and after CVS's removal of tobacco sales. Control variables included individuals' sociodemographic and health-related variables, state tobacco control variables, and urban status of counties. Analyses were conducted in 2018. Results: During the 2-year period following the removal of tobacco sales from CVS Health, smokers living in counties with high CVS density (≥3.5 CVS stores per 100,000 people) had a 2.21% (95% CI=0.08, 4.33) increase in their quit attempt rates compared with smokers living in counties without CVS stores. This effect was greater in urban areas (marginal effect: 3.03%, 95% CI=0.81, 5.25); however, there was no statistically significant impact in rural areas. Additionally, there was no impact on daily versus nondaily smoking in either urban or rural areas. Conclusions: Removing tobacco sales in retail pharmacies could help support cessation among U.S. adults who are attempting to quit smoking, particularly in urban areas.
BACKGROUND: We investigated tobacco-related self-identity and risk perceptions among adolescent t... more BACKGROUND: We investigated tobacco-related self-identity and risk perceptions among adolescent tobacco users. METHODS: Data were analyzed for 20 675 US sixth- to 12th-graders from the 2016 National Youth Tobacco Survey. Students who reported past-30-day use of a specific tobacco product or ≥2 products but denied having used “any tobacco product” in the past 30 days were classified as not self-identifying as tobacco users. Tobacco product harm perceptions were further assessed across products. Descriptive and multivariable logistic regression analyses were performed. RESULTS: Among past-30-day users of ≥1 specific tobacco product type, those denying having used any tobacco products in the past 30 days included single-product users of roll-your-own and/or pipe tobacco (82.2%), electronic cigarettes (e-cigarettes) (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%), and cigarettes (26.5%) as well as poly-tobacco users (12.7%). The odds of denying using any tobacco produ...
What is already known on this topic? Cigarettes and smokeless tobacco are the most prevalent form... more What is already known on this topic? Cigarettes and smokeless tobacco are the most prevalent forms of tobacco used among adults. Furthermore, the use of emerging tobacco products such as e-cigarettes has increased among adults, particularly among current and former adult cigarette smokers. What is added by this report? In US states in 2016, as many as 1 in 4 adults were current cigarette smokers (West Virginia); 1 in 10 adults currently used smokeless tobacco products (Wyoming); and 1 in 15 adults currently used e-cigarettes (Oklahoma). What are the implications for public health practice? Continued implementation of proven population-based interventions can help reduce adult tobacco use across tobacco product types, particularly in states with the highest prevalence of use.
Understanding factors associated with youth e-cigarette openness and curiosity are important for ... more Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and...
MMWR. Morbidity and mortality weekly report, Jan 8, 2018
Tobacco use is the leading cause of preventable disease and death in the United States, and nearl... more Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pip...
Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2... more Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2014. We examined the association between e-cigarette advertisement exposure and current e-cigarette use among US middle school and high school students. Data came from the 2014 National Youth Tobacco Survey (n = 22 007), a survey of students in grades 6 through 12. The association between current e-cigarette use and exposure to e-cigarette advertisements via 4 sources (Internet, newspapers/magazines, retail stores, and TV/movies) was assessed. Three advertising exposure categories were assessed: never/rarely, sometimes, and most of the time/always. Separate logistic regression models were used to measure the association, adjusting for gender, race/ethnicity, grade, and other tobacco use. Compared with students who reported exposure to e-cigarette advertisements never/rarely, the odds of current e-cigarette use were significantly (P < .05) greater among those reporting exposure sometim...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2016
Beginning in the 1970s, US national surveys showed African American youth having a lower prevalen... more Beginning in the 1970s, US national surveys showed African American youth having a lower prevalence of cigarette smoking than white youth. Yet, during adulthood, African Americans have a smoking prevalence comparable to white adults. Data sources chosen can contribute in different ways to understanding tobacco use behaviors among African American youth and adults; this article is a review of national and/or state-based health surveys to examine their methodology, racial and ethnic classifications, and tobacco-use related measures. Eleven national and/or state based surveys were selected for review. Eight surveys were multitopic and included questions on tobacco use and three surveys were tobacco specific. Survey methods included telephone (4), household (3), and school (4). Three major characteristics examined for each survey were: (1) survey design and methods, (2) racial and ethnic background classification, and (3) selected tobacco smoking questions. Within these three characteri...
Introduction-National data indicate that the prevalence of non-cigarette tobacco product use is h... more Introduction-National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using noncigarette tobacco products and associated factors among U.S. young adults. Methods-In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. Results-Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus.
MMWR. Morbidity and mortality weekly report, Jan 4, 2015
Athletes are not a typical at-risk group for smoking combustible tobacco products, because they a... more Athletes are not a typical at-risk group for smoking combustible tobacco products, because they are generally health conscious and desire to remain fit and optimize athletic performance (1). In contrast, smokeless tobacco use historically has been associated with certain sports, such as baseball (2). Athletes might be more likely to use certain tobacco products, such as smokeless tobacco, if they perceive them to be harmless (3); however, smokeless tobacco use is not safe and is associated with increased risk for pancreatic, esophageal, and oral cancers (4). Tobacco use among youth athletes is of particular concern, because most adult tobacco users first try tobacco before age 18 years (5). To examine prevalence and trends in current (≥1 day during the past 30 days) use of combustible tobacco (cigarettes, cigars) and smokeless tobacco (chewing tobacco, snuff, or dip [moist snuff]) products among athlete and nonathlete high school students, CDC analyzed data from the 2001–2013 Nation...
MMWR. Morbidity and mortality weekly report, Jan 6, 2015
Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndr... more Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers. No risk-free level of SHS exposure exists. SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity. Although population exposure to SHS has declined over the past 2 decades, many nonsmokers remain exposed to SHS in workplaces, public places, homes, and vehicles.
Background: Family history is an important cardiovascular disease (CVD) risk factor. Preventive b... more Background: Family history is an important cardiovascular disease (CVD) risk factor. Preventive behaviors, including lifestyle modifications, can attenuate CVD risk. We studied the association between family history-based heart disease (HD) risk and CVD risk-reducing behaviors. Methods: Using data from the 2001 Healthstyles survey, we compared frequencies of CVD risk-reducing behaviors among adults without known CVD in categories defined by family historybased HD risk. We classified respondents' HD risk as average (no first-degree relatives with HD), moderate (one relative), or high (Ն two relatives). Behaviors studied included lifestyle modifications, cholesterol measurement, and aspirin use. Results: Of 3383 respondents without known CVD, 28% were classified as being at moderate risk and 15% as being at high risk for HD based on family history. Adjusted odds ratios indicated that moderate-and high-risk respondents were more likely to report having cholesterol measured within the previous 5 years (OR ϭ 1.39, 95%
Limited information exists regarding intermediate or long-term consequences of cardiac adverse ev... more Limited information exists regarding intermediate or long-term consequences of cardiac adverse events (CAEs) after smallpox vaccination. We conducted follow up at 5-12 months after vaccination of 203 US civilian vaccinees who reported a possible CAE. Among 31 of the 33 with confirmed CAEs, at least 1 health-related quality-of-life change persisted for ∼48%; ∼87% missed work (average, 11.5 days). Among 168 of the 170 case patients with other reported cardiovascular conditions, at least 1 health-related quality-of-life change persisted for ∼40%; almost 49% missed work (average, 10.2 days). Almost all vaccinees with possible CAEs were working the same number of hours at follow-up compared with before vaccination. Although intermediate-term consequences among possible postvaccination CAEs were not considered serious, lost days of work and a decline in health-related quality of life at the time of follow-up were common, resulting in personal economic and quality-of-life burden. To prepare the United States for the consequences of a possible terrorist attack using smallpox virus, the smallpox vaccine Dryvax (Wyeth Laboratories) was offered on a voluntary basis to civilian public health and health care workers and emergency responders (e.g., law enforcement and firemen), beginning 24 January 2003. Since then, the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and state health departments have conducted active and passive surveillance to detect adverse events after smallpox immunization [1]. On the basis of evidence from the historical smallpox eradication program, neurologic, dermatologic, ophthalmologic, and fetal complications were expected adverse events [2]. During the first 2 months after the first smallpox vaccination, unexpected ischemic cardiac events (ICEs), myocarditis and/or pericarditis (myo/pericarditis), and
The following introduction describes the context in which the national smallpox vaccination progr... more The following introduction describes the context in which the national smallpox vaccination program was implemented and highlights the significance of the key policy, programmatic, or scientific challenges, observations, and lessons learned that are presented in the articles that follow within this supplement to Clinical Infectious Diseases. Although the execution of this national program posed multiple complex and varied challenges, the focus of this supplement is on vaccine-associated adverse events and vaccine safety. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.
MMWR. Morbidity and mortality weekly report, Jan 15, 2016
While significant declines in cigarette smoking have occurred among U.S. adults during the past 5... more While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic wh...
JAMA : the journal of the American Medical Association, 2005
On January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a prepared... more On January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a bioterrorism event.
Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Sinc... more Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Since November 2001, federal, state, and local public health partners implemented activities to prepare for a possible smallpox outbreak. The Centers for Disease Control and Prevention (CDC) produced and delivered training and educational materials for smallpox preparedness in many formats, developed detailed smallpox vaccine information statements about vaccine contraindications and vaccination site care, and established mechanisms to monitor and respond to adverse events after smallpox vaccination. The last included enhancements to the Vaccine Adverse Event Reporting System, a pregnancy registry for inadvertently vaccinated pregnant women, and a Clinician Telephone Information Line to collect reports about adverse events. The civilian responder vaccination program was conducted with rigorous safety procedures, and few historically recognized adverse events were observed. However, myocarditis and/or pericarditis was newly recognized as an adverse event caused by the New York City Board of Health vaccinia vaccine strain. This smallpox preparedness program put into place a number of measures to advance the United States' readiness for a smallpox outbreak that have assisted in preparedness for other threats. Variola virus, the cause of smallpox, is a Centers for Disease Control and Prevention (CDC) category A bioterrorism agent [1]. It is an agent of great concern, for the following reasons: (1) uncertainty exists about whether all of the variola virus stocks of the former Union of Soviet Socialist Republics can be accounted for; (2) the virus can be highly infectious in susceptible populations (i.e., those unvaccinated or without history of smallpox disease), which now include most of the world; and (3) its ∼30% case fatality rate ranks it as one of the most deadly infectious agents [2].
The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in t... more The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products (1). Cigarettes are the most commonly used tobacco product among U.S. adults, and about 480,000 U.S. deaths per year are caused by cigarette smoking and secondhand smoke exposure (1). To assess progress toward the Healthy People 2020 target of reducing the proportion of U.S. adults aged ≥18 years who smoke cigarettes to ≤12.0% (objective TU-1.1),* CDC analyzed data from the 2016 National Health Interview Survey (NHIS). In 2016, the prevalence of current cigarette smoking among adults was 15.5%, which was a significant decline from 2005 (20.9%); however, no significant change has occurred since 2015 (15.1%). In 2016, the prevalence of cigarette smoking was higher among adults who were male, aged 25-64 years, American Indian/Alaska Native or multiracial, had a General Education Development (GED) certificate, lived below the federal poverty level, lived in the Midwest or South, were uninsured or insured through Medicaid, had a disability/ limitation, were lesbian, gay, or bisexual (LGB), or had serious psychological distress. During 2005-2016, the percentage of ever smokers who quit smoking increased from 50.8% to 59.0%. Proven population-based interventions are critical to reducing the health and economic burden of smoking-related diseases among U.S. adults, particularly among subpopulations with the highest smoking prevalences (1,2). NHIS is an annual, nationally representative in-person survey of the noninstitutionalized U.S. civilian population. The NHIS core questionnaire is administered to a randomly selected adult in the household (the sample adult). In 2016, the NHIS was administered to 33,028 adults aged ≥18 years;
What is already known on this topic? Multiple studies have identified advantages of electronic su... more What is already known on this topic? Multiple studies have identified advantages of electronic survey administration (eg, using tablet computers with programmed logic skips and tobacco product images) over paper-and-pencil administration, including a reduction in logic inconsistences and item nonresponse, improved respondent recall, and better efficiency of data cleaning. What is added by this report? Administering the National Youth Tobacco Survey (NYTS) electronically in school classroom settings was feasible, was well accepted by respondents, and improved efficiency of survey administration. What are the implications for public health practice? Electronic administration of the NYTS reduces respondent burden and can lead to more timely and valid surveillance of tobacco product use among youths.
, CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study ... more , CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study assessed the impact of removing tobacco sales from CVS Health on cigarette smoking behaviors among U.S. adult smokers. Methods: CVS Health retail location data (2012−2016) were linked with data from the Behavioral Risk Factor Surveillance System, a phone-based survey of the non-institutionalized civilian population aged ≥18 years. Using a difference-indifferences regression model, quit attempts and daily versus nondaily smoking were compared between smokers living in counties with CVS stores and counties without CVS stores, before and after CVS's removal of tobacco sales. Control variables included individuals' sociodemographic and health-related variables, state tobacco control variables, and urban status of counties. Analyses were conducted in 2018. Results: During the 2-year period following the removal of tobacco sales from CVS Health, smokers living in counties with high CVS density (≥3.5 CVS stores per 100,000 people) had a 2.21% (95% CI=0.08, 4.33) increase in their quit attempt rates compared with smokers living in counties without CVS stores. This effect was greater in urban areas (marginal effect: 3.03%, 95% CI=0.81, 5.25); however, there was no statistically significant impact in rural areas. Additionally, there was no impact on daily versus nondaily smoking in either urban or rural areas. Conclusions: Removing tobacco sales in retail pharmacies could help support cessation among U.S. adults who are attempting to quit smoking, particularly in urban areas.
BACKGROUND: We investigated tobacco-related self-identity and risk perceptions among adolescent t... more BACKGROUND: We investigated tobacco-related self-identity and risk perceptions among adolescent tobacco users. METHODS: Data were analyzed for 20 675 US sixth- to 12th-graders from the 2016 National Youth Tobacco Survey. Students who reported past-30-day use of a specific tobacco product or ≥2 products but denied having used “any tobacco product” in the past 30 days were classified as not self-identifying as tobacco users. Tobacco product harm perceptions were further assessed across products. Descriptive and multivariable logistic regression analyses were performed. RESULTS: Among past-30-day users of ≥1 specific tobacco product type, those denying having used any tobacco products in the past 30 days included single-product users of roll-your-own and/or pipe tobacco (82.2%), electronic cigarettes (e-cigarettes) (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%), and cigarettes (26.5%) as well as poly-tobacco users (12.7%). The odds of denying using any tobacco produ...
What is already known on this topic? Cigarettes and smokeless tobacco are the most prevalent form... more What is already known on this topic? Cigarettes and smokeless tobacco are the most prevalent forms of tobacco used among adults. Furthermore, the use of emerging tobacco products such as e-cigarettes has increased among adults, particularly among current and former adult cigarette smokers. What is added by this report? In US states in 2016, as many as 1 in 4 adults were current cigarette smokers (West Virginia); 1 in 10 adults currently used smokeless tobacco products (Wyoming); and 1 in 15 adults currently used e-cigarettes (Oklahoma). What are the implications for public health practice? Continued implementation of proven population-based interventions can help reduce adult tobacco use across tobacco product types, particularly in states with the highest prevalence of use.
Understanding factors associated with youth e-cigarette openness and curiosity are important for ... more Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and...
MMWR. Morbidity and mortality weekly report, Jan 8, 2018
Tobacco use is the leading cause of preventable disease and death in the United States, and nearl... more Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pip...
Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2... more Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2014. We examined the association between e-cigarette advertisement exposure and current e-cigarette use among US middle school and high school students. Data came from the 2014 National Youth Tobacco Survey (n = 22 007), a survey of students in grades 6 through 12. The association between current e-cigarette use and exposure to e-cigarette advertisements via 4 sources (Internet, newspapers/magazines, retail stores, and TV/movies) was assessed. Three advertising exposure categories were assessed: never/rarely, sometimes, and most of the time/always. Separate logistic regression models were used to measure the association, adjusting for gender, race/ethnicity, grade, and other tobacco use. Compared with students who reported exposure to e-cigarette advertisements never/rarely, the odds of current e-cigarette use were significantly (P < .05) greater among those reporting exposure sometim...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2016
Beginning in the 1970s, US national surveys showed African American youth having a lower prevalen... more Beginning in the 1970s, US national surveys showed African American youth having a lower prevalence of cigarette smoking than white youth. Yet, during adulthood, African Americans have a smoking prevalence comparable to white adults. Data sources chosen can contribute in different ways to understanding tobacco use behaviors among African American youth and adults; this article is a review of national and/or state-based health surveys to examine their methodology, racial and ethnic classifications, and tobacco-use related measures. Eleven national and/or state based surveys were selected for review. Eight surveys were multitopic and included questions on tobacco use and three surveys were tobacco specific. Survey methods included telephone (4), household (3), and school (4). Three major characteristics examined for each survey were: (1) survey design and methods, (2) racial and ethnic background classification, and (3) selected tobacco smoking questions. Within these three characteri...
Introduction-National data indicate that the prevalence of non-cigarette tobacco product use is h... more Introduction-National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using noncigarette tobacco products and associated factors among U.S. young adults. Methods-In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. Results-Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus.
MMWR. Morbidity and mortality weekly report, Jan 4, 2015
Athletes are not a typical at-risk group for smoking combustible tobacco products, because they a... more Athletes are not a typical at-risk group for smoking combustible tobacco products, because they are generally health conscious and desire to remain fit and optimize athletic performance (1). In contrast, smokeless tobacco use historically has been associated with certain sports, such as baseball (2). Athletes might be more likely to use certain tobacco products, such as smokeless tobacco, if they perceive them to be harmless (3); however, smokeless tobacco use is not safe and is associated with increased risk for pancreatic, esophageal, and oral cancers (4). Tobacco use among youth athletes is of particular concern, because most adult tobacco users first try tobacco before age 18 years (5). To examine prevalence and trends in current (≥1 day during the past 30 days) use of combustible tobacco (cigarettes, cigars) and smokeless tobacco (chewing tobacco, snuff, or dip [moist snuff]) products among athlete and nonathlete high school students, CDC analyzed data from the 2001–2013 Nation...
MMWR. Morbidity and mortality weekly report, Jan 6, 2015
Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndr... more Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers. No risk-free level of SHS exposure exists. SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity. Although population exposure to SHS has declined over the past 2 decades, many nonsmokers remain exposed to SHS in workplaces, public places, homes, and vehicles.
Background: Family history is an important cardiovascular disease (CVD) risk factor. Preventive b... more Background: Family history is an important cardiovascular disease (CVD) risk factor. Preventive behaviors, including lifestyle modifications, can attenuate CVD risk. We studied the association between family history-based heart disease (HD) risk and CVD risk-reducing behaviors. Methods: Using data from the 2001 Healthstyles survey, we compared frequencies of CVD risk-reducing behaviors among adults without known CVD in categories defined by family historybased HD risk. We classified respondents' HD risk as average (no first-degree relatives with HD), moderate (one relative), or high (Ն two relatives). Behaviors studied included lifestyle modifications, cholesterol measurement, and aspirin use. Results: Of 3383 respondents without known CVD, 28% were classified as being at moderate risk and 15% as being at high risk for HD based on family history. Adjusted odds ratios indicated that moderate-and high-risk respondents were more likely to report having cholesterol measured within the previous 5 years (OR ϭ 1.39, 95%
Limited information exists regarding intermediate or long-term consequences of cardiac adverse ev... more Limited information exists regarding intermediate or long-term consequences of cardiac adverse events (CAEs) after smallpox vaccination. We conducted follow up at 5-12 months after vaccination of 203 US civilian vaccinees who reported a possible CAE. Among 31 of the 33 with confirmed CAEs, at least 1 health-related quality-of-life change persisted for ∼48%; ∼87% missed work (average, 11.5 days). Among 168 of the 170 case patients with other reported cardiovascular conditions, at least 1 health-related quality-of-life change persisted for ∼40%; almost 49% missed work (average, 10.2 days). Almost all vaccinees with possible CAEs were working the same number of hours at follow-up compared with before vaccination. Although intermediate-term consequences among possible postvaccination CAEs were not considered serious, lost days of work and a decline in health-related quality of life at the time of follow-up were common, resulting in personal economic and quality-of-life burden. To prepare the United States for the consequences of a possible terrorist attack using smallpox virus, the smallpox vaccine Dryvax (Wyeth Laboratories) was offered on a voluntary basis to civilian public health and health care workers and emergency responders (e.g., law enforcement and firemen), beginning 24 January 2003. Since then, the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and state health departments have conducted active and passive surveillance to detect adverse events after smallpox immunization [1]. On the basis of evidence from the historical smallpox eradication program, neurologic, dermatologic, ophthalmologic, and fetal complications were expected adverse events [2]. During the first 2 months after the first smallpox vaccination, unexpected ischemic cardiac events (ICEs), myocarditis and/or pericarditis (myo/pericarditis), and
The following introduction describes the context in which the national smallpox vaccination progr... more The following introduction describes the context in which the national smallpox vaccination program was implemented and highlights the significance of the key policy, programmatic, or scientific challenges, observations, and lessons learned that are presented in the articles that follow within this supplement to Clinical Infectious Diseases. Although the execution of this national program posed multiple complex and varied challenges, the focus of this supplement is on vaccine-associated adverse events and vaccine safety. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.
MMWR. Morbidity and mortality weekly report, Jan 15, 2016
While significant declines in cigarette smoking have occurred among U.S. adults during the past 5... more While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic wh...
JAMA : the journal of the American Medical Association, 2005
On January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a prepared... more On January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a bioterrorism event.
Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Sinc... more Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Since November 2001, federal, state, and local public health partners implemented activities to prepare for a possible smallpox outbreak. The Centers for Disease Control and Prevention (CDC) produced and delivered training and educational materials for smallpox preparedness in many formats, developed detailed smallpox vaccine information statements about vaccine contraindications and vaccination site care, and established mechanisms to monitor and respond to adverse events after smallpox vaccination. The last included enhancements to the Vaccine Adverse Event Reporting System, a pregnancy registry for inadvertently vaccinated pregnant women, and a Clinician Telephone Information Line to collect reports about adverse events. The civilian responder vaccination program was conducted with rigorous safety procedures, and few historically recognized adverse events were observed. However, myocarditis and/or pericarditis was newly recognized as an adverse event caused by the New York City Board of Health vaccinia vaccine strain. This smallpox preparedness program put into place a number of measures to advance the United States' readiness for a smallpox outbreak that have assisted in preparedness for other threats. Variola virus, the cause of smallpox, is a Centers for Disease Control and Prevention (CDC) category A bioterrorism agent [1]. It is an agent of great concern, for the following reasons: (1) uncertainty exists about whether all of the variola virus stocks of the former Union of Soviet Socialist Republics can be accounted for; (2) the virus can be highly infectious in susceptible populations (i.e., those unvaccinated or without history of smallpox disease), which now include most of the world; and (3) its ∼30% case fatality rate ranks it as one of the most deadly infectious agents [2].
The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in t... more The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products (1). Cigarettes are the most commonly used tobacco product among U.S. adults, and about 480,000 U.S. deaths per year are caused by cigarette smoking and secondhand smoke exposure (1). To assess progress toward the Healthy People 2020 target of reducing the proportion of U.S. adults aged ≥18 years who smoke cigarettes to ≤12.0% (objective TU-1.1),* CDC analyzed data from the 2016 National Health Interview Survey (NHIS). In 2016, the prevalence of current cigarette smoking among adults was 15.5%, which was a significant decline from 2005 (20.9%); however, no significant change has occurred since 2015 (15.1%). In 2016, the prevalence of cigarette smoking was higher among adults who were male, aged 25-64 years, American Indian/Alaska Native or multiracial, had a General Education Development (GED) certificate, lived below the federal poverty level, lived in the Midwest or South, were uninsured or insured through Medicaid, had a disability/ limitation, were lesbian, gay, or bisexual (LGB), or had serious psychological distress. During 2005-2016, the percentage of ever smokers who quit smoking increased from 50.8% to 59.0%. Proven population-based interventions are critical to reducing the health and economic burden of smoking-related diseases among U.S. adults, particularly among subpopulations with the highest smoking prevalences (1,2). NHIS is an annual, nationally representative in-person survey of the noninstitutionalized U.S. civilian population. The NHIS core questionnaire is administered to a randomly selected adult in the household (the sample adult). In 2016, the NHIS was administered to 33,028 adults aged ≥18 years;
Uploads
Papers by Linda Neff