Tobacco use behaviors among vulnerable populations

This dissertation consists of two objectives. Objective 1 of this research was to explore whether bullying victimization in the past 12 months is associated with smoking uptake among Maryland high school students who started smoking in the past year. Data were derived from Maryland Youth Risk Behavior Survey (YRBS) 2013. Eligible study subjects from the Maryland YRBS (N=6,457) were categorized into four groups based on their bullying victimization in the past 12 months: cyber victim only, school victim only, both cyber and school victim, and neither. For male students, 4.1% reported cyberbullying and 9.6% reported school bullying. A total of 11.2% of male students were victims of both cyber and school bullying in the past 12 months. For female students, 11.0% reported cyberbullying and 10.5% reported school bullying. A total of 19.5% of female students were victims of both cyber and school bullying in the past 12 months. Logistic regression analyses were conducted to examine the relationship between bullying victimization and current tobacco use, adjusting for demographic factors such as race/ethnicity, age, and gender. In fully adjusted model, victimization from both cyber and school bullying was statistically significantly related to current tobacco use (Adjusted Odds Ratio [AOR]=1.30, 95% Confidence Interval [CI]=1.13--1.50). However, victimization from either form of bullying alone was not statistically significantly related to current tobacco use, while controlling for demographic factors (cyber victim only; p=.998, school victim only; p=.701). These results indicate that victims of both cyber and school bullying are at greater risk for smoking uptake. Thus, prevention efforts aimed at reducing or preventing the uptake of smoking by victims of both cyber and school bullying are needed.;Objective 2 of this research was to explore the relationships between sexual orientation, menthol smoking, and smoking cessation measured by past-year quit attempt and intention to quit smoking using a nationally representative sample of U.S. adults ages 18 years or older. Since sexual minorities disproportionately smoke menthol cigarettes, examining such relationships is warranted to reduce menthol cigarette use in this population. Data were obtained from the National Adult Tobacco Survey 2012--2013. Respondents who had smoked more than 100 cigarettes in their lifetime and currently smoke cigarettes every day or some days were included. Of 4,245 respondents, 3,999 were heterosexual, and 246 described themselves as sexual minorities (i.e., Lesbian, Gay, or Bisexual). Eligible study subjects were then divided into two groups based on their use of menthol cigarettes: menthol smokers versus non-menthol smokers. Prevalence of menthol cigarette use was higher among sexual minorities than heterosexual individuals (37.8% vs. 30.6%, p=.018). Logistic regression analyses were conducted to examine the relationships between sexual orientation, menthol smoking, and cessation-related behavior and intention, adjusting for other factors. According to the research findings, the effects of menthol cigarette use on cessation-related behavior and intention did not differ depending on individual's sexual orientation. Smoking cessation treatments for menthol smokers based on sexual orientation may have little effects on smoking cessation outcomes. In light of high prevalence of menthol cigarette use in sexual minorities, future research is needed to suggest the most effective evidence-based smoking cessation treatment interventions for LGB menthol smokers.