Jennifer Cantrell
Jennifer Cantrell
Scroll
Assistant Professor of Social and Behavioral Sciences
-
Professional overview
-
Jennifer Cantrell, DrPH, MPA, is an Assistant Professor in the Department of Social and Behavioral Sciences at the NYU School of Global Public Health. Her research investigates emerging trends in tobacco and nicotine use and industry marketing, and explores clinical, countermarketing and policy interventions to diminish tobacco's appeal and promote health equity.
Dr. Cantrell currently leads a National Cancer Institute (NCI)-funded grant (R01CA268932) that uses Multiphase Optimization STrategy (MOST) to optimize cessation treatment for smokers living with HIV in clinical care. This study uses MOST, implementation science and decision analysis to test four interventions targeting multilevel barriers to quitting for people living with HIV, with the aim of developing a cost-effective, scalable and sustainable treatment package delivered in HIV clinical care. In other funded research, Dr. Cantrell uses diverse data sources and methods to explore evolving tobacco and nicotine use patterns and the commercial determinants that drive use. Her research also examines innovative digital counter-marketing strategies with a focus on achieving optimal exposure levels and effective counter-messaging.
Dr. Cantrell is a Co-Investigator with the National Institute on Drug Abuse (NIDA)-funded R25 training grant on Optimization of Behavioral and Biobehavioral Interventions (PI: Linda Collins). She is Chair of Early Career Faculty Outreach for the NYU Center for the Advancement and Dissemination of Intervention Optimization (CADIO), which trains investigators in intervention optimization methodologies worldwide. She has also served on the Advisory Committees for the Treatment Network and the Health Equity Network for the Society for Research on Nicotine and Tobacco. Dr. Cantrell has published over 70 scientific articles and co-authored a chapter on “Communication, Marketing and Tobacco-related Disparities” in the NCI Monograph 22: A Socioecological Approach to Tobacco-related Disparities. Her research has been published in the American Journal of Public Health, Addiction, Nicotine & Tobacco Research and other leading journals, and featured in media outlets such as The Wall Street Journal, NPR, and The Boston Globe. She also received the highly competitive National Institutes of Health Loan Repayment Program award from the National Institute of Minority Health and Health Disparities for her work on tobacco disparities and health equity.
Prior to joining NYU GPH, Dr. Cantrell was a Managing Director and Scientist at Truth Initiative, a national non-profit research and education organization focused on tobacco use prevention and cessation, where she evaluated and conducted research on national anti-smoking mass media efforts, including the award-winning truth® campaign and the Centers for Disease Control’s Tips for Former Smokers campaign. As part of this work, she led the development of the winning proposal for the 2017 Berreth Award for Excellence in Public Health Communication. She earned her DrPH from Columbia University’s Mailman School of Public Health and her MPA from Columbia University School of International and Public Affairs. She completed postdoctoral training in the NIDA program for Behavioral Science Training in Drug Abuse Research at National Development Research Institutes in New York, NY. -
Areas of research and study
-
Alcohol, Tobacco and Driving PoliciesBehavioral ScienceHealth DisparitiesPopulation HealthPublic Health PolicySocial BehaviorsSocial epidemiology
-
Publications
Publications
Patterns of combustible tobacco use in U.S. young adults and potential response to graphic cigarette health warning labels
AbstractVillanti, A. C., Pearson, J. L., Cantrell, J., Vallone, D. M., & Rath, J. M. (n.d.).Publication year
2015Journal title
Addictive BehaviorsVolume
42Page(s)
119-125AbstractIn the evolving landscape of tobacco use, it remains unclear how tobacco control efforts should be designed and promoted for maximum impact. The current study links the identification of latent classes of young adult combustible tobacco users with anticipated responses to graphic health warning labels (HWLs). Data were collected in January 2012 using an online address-based panel as part of the Legacy Young Adult Cohort Study, and analyses were conducted in 2013. Latent class analyses identified five groups of tobacco users in a national sample of 4,236 young adults aged 18-34. years: (1) little cigar/cigarillo/bidi (LCC) and hookah users (4%); (2) nonusers, open to smoking (3%); (3) daily smokers who self-identify as "smokers" (11%); (4) nondaily, light smokers who self-identify as "social or occasional smokers" (9%); and (5) nonusers closed to smoking (73%). Of the nonusers closed to smoking, 23% may be better characterized as at risk for tobacco initiation. Results indicate differences in the potential effectiveness of HWLs across classes. Compared to the daily "smokers," LCC and hookah users (RRR. =. 2.35) and nonusers closed to smoking (RRR. =. 2.33) were more than twice as likely to report that new graphic HWLs would make them think about not smoking. This study supports the potential of graphic HWLs to prevent young nonusers from using tobacco products. It suggests that the extension of prominent HWLs to other tobacco products, including LCCs and hookah tobacco, may also serve a prevention function.The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty
AbstractCantrell, J., Anesetti-Rothermel, A., Pearson, J. L., Xiao, H., Vallone, D., & Kirchner, T. R. (n.d.).Publication year
2015Journal title
AddictionVolume
110Issue
1Page(s)
152-161AbstractAims: This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors. Design: Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home. Setting: Eight large Designated Media Areas across the United States. Participants: A total of 2377 baseline smokers followed over three waves from 2008 to 2010. Measurements: Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes. Findings: Smokers in high poverty census tracts living between 500m and 1.9km from an outlet were over two times more likely to be abstinent than those living fewer than 500m from an outlet (P<0.05). Density within 500m of home was associated with reduced abstinence [odds ratio (OR)=0.94; confidence interval (CI)=0.90, 0.98) and lower pro-cessation attitudes (Coeff=-0.07, CI=-0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500m was associated with greater pro-cessation attitudes (OR=0.06; CI=0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes. Conclusions: In the United States, density of tobacco outlets within 500m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas.Tobacco retail outlet advertising practices and proximity to schools, parks and public housing affect Synar underage sales violations in Washington, DC
AbstractKirchner, T. R., Villanti, A. C., Cantrell, J., Anesetti-Rothermel, A., Ganz, O., Conway, K. P., Vallone, D. M., & Abrams, D. B. (n.d.).Publication year
2015Journal title
Tobacco controlVolume
24Page(s)
e52-e58AbstractObjective To examine the cross-sectional association between illicit sales of tobacco to minors, Washington DC tobacco outlet advertising practices, retail store type, the demographic make-up of the area surrounding each outlet, and the proximity of each outlet to high schools, recreational parks and public housing. Participants Seven hundred and fifty tobacco outlets in the DC area, n=347 of which were randomly selected for inspection by the Synar Inspection Program in 2009–2010. Main outcome measures The presence of tobacco advertisements on the interior and exterior of each outlet, and illicit tobacco sales to Synar Inspection Program youth volunteers. Results The presence of tobacco advertisements on the exterior of gas stations was much greater than on other retail store types (OR=6.68; 95% CI 4.05 to 11.01), as was the absence of any advertisements at bars or restaurants that sold tobacco (OR=0.33; 95% CI 0.22 to 0.52). Exterior tobacco advertisements were also more likely in predominantly African–American areas of the city (OR=3.11; 95% CI 2.28 to 4.25), and particularly likely on storefronts located closer to parks (OR=1.87; 95% CI 1.06 to 3.28). Illicit sales to minors were more common at gas stations (OR=3.01; 95% CI 1.5 to 6.3), outlets that displayed exterior tobacco advertisements closer to parks (OR=3.36; 95% CI 1.38 to 8.21), and outlets located closer to high schools in majority African– American block groups (OR=1.29; 95% CI 1.07 to 1.58). Conclusions Findings demonstrate that while illicit tobacco sales to minors are occurring at acceptably low rates by Synar standards, illicit sales vary considerably by retail store type, advertising approach and proximity to high schools, parks and African–American residential areas. Future work may help inform regulatory efforts to reduce youth access at the neighbourhood, city, state and national levels.A Multilevel Analysis of Gender, Latino Immigrant Enclaves, and Tobacco Use Behavior
AbstractCantrell, J. (n.d.).Publication year
2014Journal title
Journal of Urban HealthVolume
91Issue
5Page(s)
928-939AbstractResearch suggests that immigrant enclaves positively influence health behaviors such as tobacco use through supportive social networks and informal social control mechanisms that promote healthy behavioral norms. Yet, the influence of social cohesion and control on tobacco use may depend on smoking-related norms, which can vary by gender. This study examines the influence of neighborhood Latino immigrant enclave status on smoking and cessation among Hispanic men and women. Data from the Los Angeles Family and Neighborhood Survey was combined with census data to assess the relationship between immigrant enclaves, gender, and smoking using multilevel regression. The effect of the Hispanic enclave environment on smoking differed by gender. Living in an enclave had a harmful effect on tobacco use among Hispanic men, marginally increasing the likelihood of smoking and significantly reducing cessation. This effect was independent of neighborhood socioeconomic status, nativity, and other individual demographics. Neighborhood immigrant concentration was not associated with smoking or cessation for Hispanic women. Research, interventions, and policies aimed at reducing smoking among Hispanics may need to be gender responsive to ensure effectiveness as well as health and gender equity.Cameras for public health surveillance: A methods protocol for crowdsourced annotation of point-of-sale photographs
AbstractIlakkuvan, V., Tacelosky, M., Ivey, K. C., Pearson, J. L., Cantrell, J., Vallone, D. M., Abrams, D. B., & Kirchner, T. R. (n.d.).Publication year
2014Journal title
JMIR Research ProtocolsVolume
3Issue
2AbstractBackground: Photographs are an effective way to collect detailed and objective information about the environment, particularly for public health surveillance. However, accurately and reliably annotating (ie, extracting information from) photographs remains difficult, a critical bottleneck inhibiting the use of photographs for systematic surveillance. The advent of distributed human computation (ie, crowdsourcing) platforms represents a veritable breakthrough, making it possible for the first time to accurately, quickly, and repeatedly annotate photos at relatively low cost. Objective: This paper describes a methods protocol, using photographs from point-of-sale surveillance studies in the field of tobacco control to demonstrate the development and testing of custom-built tools that can greatly enhance the quality of crowdsourced annotation. Methods: Enhancing the quality of crowdsourced photo annotation requires a number of approaches and tools. The crowdsourced photo annotation process is greatly simplified by decomposing the overall process into smaller tasks, which improves accuracy and speed and enables adaptive processing, in which irrelevant data is filtered out and more difficult targets receive increased scrutiny. Additionally, zoom tools enable users to see details within photographs and crop tools highlight where within an image a specific object of interest is found, generating a set of photographs that answer specific questions. Beyond such tools, optimizing the number of raters (ie, crowd size) for accuracy and reliability is an important facet of crowdsourced photo annotation. This can be determined in a systematic manner based on the difficulty of the task and the desired level of accuracy, using receiver operating characteristic (ROC) analyses. Usability tests of the zoom and crop tool suggest that these tools significantly improve annotation accuracy. The tests asked raters to extract data from photographs, not for the purposes of assessing the quality of that data, but rather to assess the usefulness of the tool. The proportion of individuals accurately identifying the presence of a specific advertisement was higher when provided with pictures of the product's logo and an example of the ad, and even higher when also provided the zoom tool (χ2 2=155.7, P<.001). Similarly, when provided cropped images, a significantly greater proportion of respondents accurately identified the presence of cigarette product ads (χ2 1=75.14, P<.001), as well as reported being able to read prices (χ2 2=227.6, P<.001). Comparing the results of crowdsourced photo-only assessments to traditional field survey data, an excellent level of correspondence was found, with area under the ROC curves produced by sensitivity analyses averaging over 0.95, requiring on average 10 to 15 crowdsourced raters to achieve values of over 0.90. Results: Further testing and improvement of these tools and processes is currently underway. This includes conducting systematic evaluations that crowdsource photograph annotation and methodically assess the quality of raters' work. Conclusions: Overall, the combination of crowdsourcing technologies with tiered data flow and tools that enhance annotation quality represents a breakthrough solution to the problem of photograph annotation, vastly expanding opportunities for the use of photographs rich in public health and other data on a scale previously unimaginable.Cantrell et al. Respond
Cantrell, J., Kreslake, J., Ganz, O., Pearson, J. L., Vallone, D. M., Anesetti-Rothermel, A., Xiao, H., & Kirchner, T. R. (n.d.). In American journal of public health (1–).Publication year
2014Volume
104Issue
4Page(s)
e1-e2Perceptions and perceived impact of graphic cigarette health warning labels on smoking behavior among U.S. young adults
AbstractVillanti, A. C., Cantrell, J., Pearson, J. L., Vallone, D. M., & Rath, J. M. (n.d.).Publication year
2014Journal title
Nicotine and Tobacco ResearchVolume
16Issue
4Page(s)
469-477AbstractIntroduction: In 2011, the Food and Drug Administration published a final rule requiring cigarette packages and advertisements to include graphic health warning labels (HWLs) with new warning statements. Implementation of this rule has been stalled by legal challenge. This study assessed correlates of smoking-related intentions related to graphic HWLs among current cigarette smokers and nonsmokers in a national sample of U.S. young adults aged 18-34. Methods: Data were collected from 4,236 participants aged 18-34 using an online panel in January 2012 for the Legacy Young Adult Cohort Study. Analyses were weighted to provide nationally representative estimates. Our main outcome was assessed with a single item: "Do you think that new warning labels with graphic pictures would make you think about not smoking?" Results: Twenty-two percent of the young adults were current cigarette smokers. Fifty-three percent endorsed that new graphic HWLs would make them think about not smoking (40% among current smokers compared with 56% among nonsmokers). Among nonsmokers, those aged 18-24, females, Hispanics, and those who were aware of graphic cigarette HWLs were more likely to report intention to not smoke related to graphic HWLs. Among current smokers, intending to quit within the next 6 months was correlated with intention resulting from graphic HWLs. Hispanic ethnicity and intention to quit within 30 days were strong correlates of intention in light, nondaily, and self-identified social/occasional smokers. Conclusions: This study supports previous findings that graphic HWLs play an important role in preventing smoking, in addition to encouraging cessation in young adults.Geospatial exposure to point-of-sale tobacco: Real-time craving and smoking-cessation outcomes
AbstractKirchner, T. R., Cantrell, J., Anesetti-Rothermel, A., Ganz, O., Vallone, D. M., & Abrams, D. B. (n.d.).Publication year
2013Journal title
American journal of preventive medicineVolume
45Issue
4Page(s)
379-385AbstractBackground: Little is known about the factors that drive the association between point-of-sale marketing and behavior, because methods that directly link individual-level use outcomes to real-world point-of-sale exposure are only now beginning to be developed. Purpose: Daily outcomes during smoking cessation were examined as a function of both real-time geospatial exposure to point-of-sale tobacco (POST) and subjective craving to smoke. Methods: Continuous individual geospatial location data collected over the first month of a smoking-cessation attempt in 2010-2012 (N=475) were overlaid on a POST outlet geodatabase (N=1060). Participants' mobility data were used to quantify the number of times they came into contact with a POST outlet. Participants recorded real-time craving levels and smoking status via ecological momentary assessment (EMA) on cellular telephones. Results: The final data set spanned a total of 12,871 days of EMA and geospatial tracking. Lapsing was significantly more likely on days with any POST contact (OR=1.19, 95% CI=1.18, 1.20), and increasingly likely as the number of daily POST contacts increased (OR=1.07, 95% CI=1.06, 1.08). Overall, daily POST exposure was significantly associated with lapsing when craving was low (OR=1.22, 95% CI=1.20, 1.23); high levels of craving were more directly associated with lapse outcomes. Conclusions: These data shed light on the way mobility patterns drive a dynamic interaction between individuals and the POST environment, demonstrating that quantification of individuals' exposure to POST marketing can be used to identify previously unrecognized patterns of association among individual mobility, the built environment, and behavioral outcomes.Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment
AbstractCantrell, J., Vallone, D. M., Thrasher, J. F., Nagler, R. H., Feirman, S. P., Muenz, L. R., He, D. Y., & Viswanath, K. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
1AbstractBackground: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22-1.62), and intention to quit (OR = 1.30, 95% CI = 1.10-1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.Marketing little cigars and cigarillos: Advertising, price, and associations with neighborhood demographics
AbstractCantrell, J., Kreslake, J. M., Ganz, O., Pearson, J. L., Vallone, D., Anesetti-Rothermel, A., Xiao, H., & Kirchner, T. R. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
10Page(s)
1902-1909AbstractObjectives. We have documented little cigar and cigarillo (LCC) availability, advertising, and price in the point-of-sale environment and examined associations with neighborhood demographics. Methods. We used a multimodal real-time surveillance system to survey LCCs in 750 licensed tobacco retail outlets that sold tobacco products in Washington, DC. Using multivariate models, we examined the odds of LCC availability, the number of storefront exterior advertisements, and the price per cigarillo for Black & Mild packs in relation to neighborhood demographics. Results. The odds of LCC availability and price per cigarillo decreased significantly in nearly a dose-response manner with each quartile increase in proportion of African Americans. Prices were also lower in some young adult neighborhoods. Having a higher proportion of African American and young adult residents was associated with more exterior LCC advertising. Conclusions. Higher availability of LCCs in African American communities and lower prices and greater outdoor advertising in minority and young adult neighborhoods may establish environmental triggers to smoke among groups susceptible to initiation, addiction, and long-term negative health consequences.Metropolitan Social Environments and Pre-HAART/HAART Era Changes in Mortality Rates (per 10,000 Adult Residents) among Injection Drug Users Living with AIDS
AbstractFriedman, S. R., West, B. S., Pouget, E. R., Hall, H. I., Cantrell, J., Tempalski, B., Chatterjee, S., Hu, X., Cooper, H. L., Galea, S., & Des Jarlais, D. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
2AbstractBackground: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. Methods: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. Results: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. Conclusions: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered.Effects of a smoking cessation intervention in a homeless population: A pilot study
AbstractShelley, D., Cantrell, J., Wong, S., & Warn, D. (n.d.).Publication year
2010Journal title
American Journal of Health BehaviorVolume
34Issue
5Page(s)
544-552AbstractObjective: To test the feasibility and effect of a smoking cessation intervention among sheltered homeless. Methods: Homeless smokers were enrolled in a 12-week group counseling program plus pharmacotherapy (n=58). Results: The mean number of sessions attended was 7.2; most participants used at least one type of medication (67%); and 75% completed 12-week end-of-treatment surveys. Carbon-monoxide-verified abstinence rates at 12 and 24 weeks were 15.5% and 13.6% respectively. Conclusion: Results support the feasibility of enrolling and retaining sheltered homeless in a smoking cessation program. Counseling plus pharmacotherapy options may be effective in helping sheltered homeless smokers quit.The effect of linking community health centers to a state-level smoker's quitline on rates of cessation assistance
AbstractShelley, D., & Cantrell, J. (n.d.).Publication year
2010Journal title
BMC health services researchVolume
10AbstractBackground. Smoking cessation quitlines are an effective yet largely untapped resource for clinician referrals. The aim of this study was to assess the effect of a fax referral system that links community health centers (CHCs) with the New York State Quitline on rates of provider cessation assistance. Methods. This study was conducted in four CHCs using a quasi experimental study design. Two comparison sites offered usual care (expanded vital sign chart stamp that prompted providers to ask about tobacco use, advice smokers to quit, assess readiness, and offer assistance (4As)) and two intervention sites received the chart stamp plus an office-based fax referral link to the New York State Quitline. The fax referral system links patients to a free proactive telephone counseling service. Provider adherence to the 4 As was assessed with 263 pre and 165 post cross sectional patient exit interviews at all four sites. Results. Adherence to the 4As increased significantly over time in the intervention sites with no change from baseline in the comparison sites. Intervention sites were 2.4 (p < .008) times more likely to provide referrals to the state Quitline over time than the comparison sites and 1.8 (p < .001) times more likely to offer medication counseling and/or a prescription. Conclusions. Referral links between CHCs and state level telephone quitlines may facilitate the provision of cessation assistance by offering clinicians a practical method for referring smokers to this effective service. Further studies are needed to confirm the efficacy of fax referral systems and to identify implementation strategies that work to facilitate the utilization of these systems across a wide range of clinical settings.Implementing a fax referral program for quitline smoking cessation services in urban health centers: A qualitative study
AbstractCantrell, J., & Shelley, D. (n.d.).Publication year
2009Journal title
BMC Family PracticeVolume
10AbstractBackground. Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. Methods. The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. Results. Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. Conclusions. Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.Purchasing patterns and smoking behaviors after a large tobacco tax increase: A study of Chinese Americans living in New York City
AbstractCantrell, J., Hung, D., Fahs, M. C., & Shelley, D. (n.d.).Publication year
2008Journal title
Public Health ReportsVolume
123Issue
2Page(s)
135-146AbstractObjectives. Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase. Methods. We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive householdbased survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects. Results. A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase. Conclusions. Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.Shelley et al. respond
Shelley, D., Cantrell, M. J., Moon-Howard, J., Ramjohn, D. Q., & VanDevanter, N. (n.d.). In American journal of public health (1–).Publication year
2008Volume
98Issue
1Page(s)
5The $5 man: The underground economic response to a large cigarette tax increase in New York City
AbstractShelley, D., Cantrell, J., Moon-Howard, J., Ramjohn, D. Q., & Van Devanter, N. (n.d.).Publication year
2007Journal title
American journal of public healthVolume
97Issue
8Page(s)
1483-1488AbstractObjectives. We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase. Methods. Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City. Results. A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation. Conclusions. Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.Physician and dentist tobacco use counseling and adolescent smoking behavior: Results from the 2000 National Youth Tobacco Survey
AbstractShelley, D., Cantrell, J., Faulkner, D., Haviland, L., Healton, C., & Messeri, P. (n.d.).Publication year
2005Journal title
PediatricsVolume
115Issue
3Page(s)
719-725AbstractObjective. The present study describes patterns of tobacco use counseling among physicians and dentists as reported by adolescents and determines the association between provider advice to quit and cessation activities among current smokers. Methods. Data were analyzed from the 2000 National Youth Tobacco Survey, an anonymous, self-administered, school-based survey. The National Youth Tobacco Survey was administered to a nationally representative sample of 35 828 students in grades 6 to 12 in 324 schools. Results. Thirty-three percent of adolescents who visited a physician or a dentist in the past year reported that a physician counseled them about the dangers of tobacco use, and 20% reported that a dentist provided a similar message. Among students who smoked in the past year, 16.4% received advice to quit from a physician and 11.6% received advice to quit from a dentist. Physician or dentist advice to quit was correlated with 1 or more quit attempts in the past 12 months. Conclusion. On the basis of adolescent reports, physician and dentist practice patterns remain well below recommended guidelines. Results suggest that provider advice to quit is associated with cessation activity. Additional studies are needed to confirm whether the low prevalence of brief provider tobacco use counseling is a missed opportunity to affect adolescent smoking behavior.