The Epidemiology of Virginia Youth Tobacco Use

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The Epidemiology of Virginia Youth Tobacco Use

• Christine Kaestle

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What do we know about patterns of youth tobacco
use in Virginia?

• The epidemiological perspective
• Agent
• factor required for a disease to occur
• Host
• where agent causes disease
• Vector
• the organism that distributes the agent
• Environment
• in which all operate

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What do we know about patterns of youth tobacco
use in Virginia?

• The epidemiological perspective
• Agent
• tobacco products
• Host
• youth
• Vector
• sources (companies, sales, peers, adults)
• Environment
• Virginia

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Agent

• Factor causing disease
• Tobacco products
• Type (delivery)
• Safer
• Price
• All interact to influence likelihood of use

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Host

• Where agent causes disease
• Youth who smoke or ingest tobacco, or are exposed
  to secondhand smoke
• motivation to start/quit
• Addiction
• Attitudes/knowledge
• Youths who will die prematurely 152,000

Source VTSF
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Host s VYTS report from VTSF

• Virginia Youth Tobacco Survey
• Representative middle and high school 2001, 2003,
  2005, 2007
• results available at VTSF webpagehttp//www.vtsf
  .org/data/youth-tobacco-survey.asp
• Ever used any tobacco products has fallen overall
• 56 in 2001
• 45 in 2003 and 2005
• 39 in 2007

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Vector

• Organism that transports agent to host
• Tobacco companies and distributers
• Marketing
• Lobbying
• Other/ nearby smokers (peers, family)
• Adults

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Environment Virginia

• Larger economic, cultural, historical forces
• Policies
• Media
• Research
• Smoking around them
• Neighborhoods
• Family

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Epidemiologic model

• Examines the agent, host, vector and environment
  and related trends, but
• focus interactions between them
• where we are most likely to be able to disrupt
  transmission (prevention)

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Epidemiologic model interaction of multiple
forces and levels
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Youth obtaining tobacco
agent (tobacco)
Interaction between youth and sources
environment (Virginia)
host (youth)
vector (sources)
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Gender and cigarette sources

• Girls less likely to try to purchase
• When they do, succeed more than boys
• Does this increased ease of access through adults
  carry over into noncommercial settings?

Sources Castrucci, 2002 Hinds, 1992 Johnston,
2004 DiFranza, 1996 Klonoff, 1997
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Methods

• Respondents from 2005 Virginia Youth Tobacco
  Survey who had acquired cigarettes in the last
  month (N356)
• Respondents were asked how they usually got their
  cigarettes

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Results source-host interactions

• Adults play substantial role in how over 25 of
  the adolescents smokers get cigarettes
• about 17 usually purchase cigarettes from
  businesses owned by adults
• over one in ten usually get their cigarettes from
  an adult in a social situation

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Results source-host interactions

• Compared to girls, boys had
• higher odds of purchasing cigarettes
• lower odds of getting cigarettes for free from
  peers
• Less than half the odds of being given cigarettes
  from an adult

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Results source-host interactions

• Confirms for Virginia previous national findings
  that venders are less likely to ask girls for
  proof of age
• Finds that girls more likely to receive
  cigarettes for free, particularly from adults
• Attention needed on role of adults in providing
  cigarettes to girls in social settings

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Epidemiologic model interaction of multiple
forces and levels
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Youth and Neighborhoods
agent (tobacco)
Interaction between youth and environment
environment (Virginia)
host (youth)
vector (sources)
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Targeting High Risk Virginia Neighborhoods for
Prevention Education

• Are education programs reaching neighborhoods
  with the highest risk youth and greatest need for
  prevention?
• Do characteristics associated with smoking also
  predict receiving smoking prevention education in
  schools?

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Methods

• 2,208 from 2005 Virginia Youth Tobacco Survey
• Current smoker
• Tobacco education in school
• Merged census data about neighborhoods
• Percent Black
• Urban
• Socioeconomic Disadvantage Scale (a 0.96)
• single parent families
• families in poverty
• unemployed
• of homes with no vehicle

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Results Odds Ratios Current Smoking
Older and white adolescents had higher odds.
Adolescents in rural or disadvantaged areas had
higher odds.
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Results Odds Ratios for Smoking Education
Older adolescents had higher odds of education,
race was not associated. Urban status was also
not associated with education. Adolescents in
disadvantaged areas had lower odds of tobacco
education in school.
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Conclusion

• Although adolescents in rural and disadvantaged
  neighborhoods had higher odds of smoking, tobacco
  education programs do not penetrate to reach
  these higher risk students.
• Mismatch between indicators of need for tobacco
  prevention education and the actual targeting of
  those services.
• Issue exacerbating health inequalities

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Epidemiologic model interaction of multiple
forces and levels
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Historical/cultural context
agent (tobacco)
Interaction between agent and environment in VA
is critical for understanding policy
environment (Virginia)
host (youth)
vector (sources)
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Historical interaction

• Positive feedback loop
• Birthplace of American tobacco industry
• Tobacco culture developed over centuries

agent (tobacco)
environment (Virginia)
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Historical/cultural context

• English colonists arrived in Jamestown in 1607
• Native Americans using wild tobacco
• In 1612, John Rolfe introduced milder variety of
  tobacco
• Very profitable for export
• Virginia colony would have failed

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Historical/cultural context

• No banks in colonial Virginia
• Currency was rare
• Barter economy
• Tobacco used like money
• cash crop
• Tobacco certificates from public warehouses also
  used like money

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Increased dependence on tobacco
Permeated economy and social structure Wages
of soldiers, clergymen and government officials
paid in tobacco
Production of tobacco spread down the James,
York, and Rappahannock Rivers, through all
Tidewater Virginia Labor intensive spurred
slave trade in Virginia
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Dependent state economy

• Led to first regulations rapid growth led to too
  much supply, price dropped
• to stabilize price, 1730 law controlled
  quality/quantity of Virginia tobacco
• Did not work well
• Federal role now
• 1935 Tobacco Inspection Act

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The Tobacco War

• 1776 American Revolution
• Virginia farmers ? in debt to British
• British tobacco taxes
• Financing the war
• 5 million pounds of Virginia tobacco collateral
  for the loan from France
• tobacco exports built US credit abroad
• after, tobacco taxes help repay war debt

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Virginia rolls along

• Virginia played big role in huge expansion of
  cigarette smoking
• 1880 Virginian James Bonsack invented a machine
  to roll cigarettes
• Much cheaper
• ? growth in smoking

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What about recent interactions?

• Both positive negativeagent X environment
  interactions

agent (tobacco)
?
environment (Virginia)
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Tobacco in Virginia Today

• Still important crop, but
• tobacco-growing now in Southside and Southwest
  Virginia
• Most Virginia processing plants and warehouse
  auctions have closed

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Recent laws minors restaurants (-)

• 1986 Virginia prohibits sale of to anyone less
  than 16 (orig fine 25)
• 1991 legal age changed from 16 to 18
• Dec. 1, 2009 smoking restricted in restaurants

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Virginia State Tax ( and -)

• As of January 2008
• 30 per pack
• Counties and cities may impose 2 to 15
• Virginia 47th of all states in amount taxed
• Still a good source of revenue

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Tobacco Settlement ( and -)

• 1999 settlement awards Virginia over 4 billion
• Impact on local tobacco industry is mixed
• Virginia legislature allocated
• 50 to tobacco farmers
• 10 to anti-smoking efforts (Virginia Tobacco
  Settlement Fund)
• 40 other state initiatives

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Supports and incentives ()

• Tobacco Indemnification and Community
  Revitalization Commission
• 1.2 billion from settlement to tobacco growers
• 800,000 on economic redevelopment
• Tobacco-dependent localities
• Local governments and nonprofits can apply for
  grants to spur economic growth and development

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Virginia Tobacco Settlement Foundation (-)

• To reduce and prevent youth tobacco use
• Classroom education
• Multimedia marketing
• Research
• Law enforcement

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Virginia Tobacco Prevention Spending

• CDC 2009 Spending Target 103.2 million
• Tobacco Prevention Spending 13.6 million
• Prev. Spending of CDC Target 13.2
• Prev. Spending Rank (1 high) 36
• Compare to
• 438.5 million per year spent on Virginia
  marketing

Source http//www.tobaccofreekids.org/reports/set
tlements/
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Versus Virginia Tobacco Revenue

• 2009 Tob. Settlement Rev. 132 million
• 2009 State Tob. Tax Rev. 178 million
• Total State Tob. Rev. 310 million
• (Tobacco Prev. Spending 13.6 million)
• Tobacco Prev. Spending 4.4 of Tob. Rev.

Source http//www.tobaccofreekids.org/reports/set
tlements/
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Conclusion

• Epidemiologic model comprehensive approach to
  tobacco epidemic
• stimulate research (esp. interactions)
• accounts for countering forces
• provide critical contexts for trends and patterns
• Recognizes multiple levels
• guide optimal program development and evaluation