Smoking rates are down in the United States, but not for people of color, workers making less than $20,000 a year or those without a high school diploma. These disparities in tobacco use are exacerbated by new trends in vaping, which experts say may lure teens to conventional smoking.
Students at the University of Washington School of Public Health’s Tobacco Studies Program are researching cessation strategies targeting populations disproportionately affected by the tobacco epidemic.
Ms. Shahida Shahrir, a doctoral student in the department of health services, is looking at strategies for veterans infected with HIV and trying to understand their smoking habits. She is also investigating the drugs prescribed to help them quit smoking, and whether pharmacotherapies differ from those used with uninfected veterans.
“They express the want and need to quit smoking just as much as the general population,” Ms. Shahrir says. “While their smoking prevalence is higher, we’re still trying to understand why.”
Ms. Shahrir hypothesizes that lack of access to pharmacotherapies, such as Varenicline, and the simultaneous abuse of alcohol, injection drug use and mental health disorders may be reasons for elevated smoking. Her research suggests that cessation rates may improve by combining interventions that address both smoking and unhealthy alcohol use among HIV-infected patients.
Smokers living with HIV are at higher risk of developing lung cancer and are more likely than nonsmokers with HIV to develop bacterial pneumonia, chronic obstructive pulmonary disease, or COPD, and heart disease, according to the Department of Health and Human Services (DHHS).
Ms. Katherine Garcia-Rosales, from the department of epidemiology, is also looking at populations at risk for HIV infection. Focusing on men who have sex with men and transgender women in Lima, Peru, she’s investigating whether tobacco, alcohol or other illicit drug use are risk factors for transmission of the virus.
Other students in the Tobacco Studies Program are exploring how communities in Washington state are ‘handcuffed’ by chronic underfunding and preemptive state laws.
Such laws “have long been supported by the tobacco industry and are completely contrary to advancing public health,” says Mr. Jacob Delbridge, a master’s student focusing on health systems and policy.
A Washington State Supreme Court ruling in 2005 played a role in determining the state’s preemptive status, barring the enactment of any local tobacco control measures. “These preemptive laws prevent local health departments from adopting more comprehensive, protective and innovative local policies to address the persistent and emerging tobacco-related health issues plaguing their communities.”
Washington state is one of only two states with preemption in all four main policy areas of tobacco control, including advertising, licensure, smoke-free indoor air and youth access. “Basically, we’re the most heavily preempted state in the country, tied with Michigan,” Mr. Delbridge says.
He worked with the Washington State Department of Health last summer to explore what local municipalities can do to address tobacco-related health disparities, given the current law of preemption. He also conducted case studies of other states that had rescinded or revised their preemption laws.
Among his key learnings, Mr. Delbridge says there is a lack of understanding – even among state legislators – of what preemption is, and what its consequences are. He found that states were more likely to address the issue of preemption as part of other legislation. For example, states issuing a bill to raise the minimum age to 21 may simultaneously permit locals to take more protective actions.
“From licensing to taxation and from restrictions on sales to prevention and cessation programming, tobacco policies are multifaceted,” Mr. Delbridge says. “It is a dynamic policy area that will continue to have serious implications for the health of current and future generations.”