Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Objective This study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity. Methods We analysed data from young adults (18–24) from the US Population Assessment of Tobacco and Health Study in 2013 and 2014 (N=9110). First, we compared encoded exposure to cigarette, electronic cigarette (e-cigarette), cigar and smokeless tobacco ads between sexual minorities (lesbian/gay, bisexual and something else) versus heterosexual young adults. We then analysed encoded ad exposure across sexual orientation, racial and ethnic subgroups. Analyses controlled for demographic and tobacco use variables. Results Bisexual women had significantly higher prevalence of encoded exposure to cigarette and cigar ads compared with heterosexual women, and significantly higher prevalence of encoded e-cigarette ad exposure compared with both heterosexual and lesbian/gay women. There were no significant differences in encoded ad exposure between lesbian versus heterosexual women and between gay or bisexual men versus heterosexual men. Compared with heterosexual white counterparts, increased encoded ad exposures were reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads) and bisexual black women (cigarette and cigar ads). Compared with heterosexual non- Hispanic counterparts, increased encoded ad exposures were reported by bisexual Hispanic women (cigarette, e-cigarette and cigar ads) and heterosexual Hispanic men (cigarettes and cigar ads). Conclusion Sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads. Further research is needed to address the impact of tobacco ads among multiple minority individuals based on sex, sexual orientation, race and ethnicity.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: There are significant health technology gaps between Latinos and NH Whites, and between first and second generation Latinos. Objective: The purpose of this study is to examine disparities in online health information seeking behavior (HISB) and health information technology (HIT) use among Latinos, taking into account nativity and sub-ethnic affiliation. Methods: We analyzed US-born, non-Hispanic (NH) Whites and Latinos adults (N=49,259) in the 2015-16 National Health Interview Survey using a binary logistic regression controlling for individual difference level variables. Outcomes were Internet use, HISB (online health information-seeking and using a chat group for health information), and HIT (using a computer to schedule an appointment, filling a prescription, communicating with a provider). Results: We found that US-born Mexicans (OR=0.83, 95% CI: 0.70, 0.99), US-born Central/South Americans (OR=2.11, 95% CI: 1.11, 3.99), foreign-born Mexicans (OR=0.31, 95% CI: 0.26, 0.37), Foreign-born Puerto Ricans (OR=0.57, 95% CI: 0.43, 0.76), foreign-born Central/South Americans (OR=0.37, 95% CI: 0.29, 0.47), and foreign-born Other Latinos (OR= 0.33, 95% CI: 0.23, 0.48) had lower odds of using the Internet than US-born NH Whites. The relationship between subgroup affiliation and online health information seeking behavior varied by type of technology. US-born Mexicans (OR=0.76, 95%CI: 0.67, 0.87), foreign-born Mexicans (OR=0.38, 95% CI: 0.32, 0.44), foreign-born Puerto Ricans (OR=0.65, 95% CI: 0.49, 0.86), foreign-born Central/South Americans (OR=0.43, 95% CI: 0.35, 0.52) and foreign-born Other Latinos (OR=0.36, 95% CI: 0.27, 0.47) had lower odds of looking up health information online than US-born NH Whites. Controlling for age, sex, education, income to federal poverty level, and region foreign-born Mexicans (OR=0.48, 95% CI: 0.35, 0.67), foreign-born Central/South American (OR=0.53, 95% CI: 0.35, 0.80), and foreign-born Other Latino (OR=0.18, 95% CI: 0.08, 0.43) had lower odds of filling a prescription using a computer than US-born NH Whites. Foreign-born Mexicans (OR=0.57, 95% CI: 0.43, 0.75), foreign-born Central/South American (OR=0.68, 95% CI: 0.50, 0.94), and foreign-born Other Latino (OR=0.39, 95% CI: 0.23, 0.69) had lower odds of using a computer to schedule medical appointments than US-born NH Whites, while there was no significant relationship for other groups. US-born Mexicans (OR=0.81, 95% CI: 0.65, 1.00), US-born Other Latinos (OR=0.44, 95% CI: 0.21, 0.92), foreign-born Mexicans (OR=0.34, 95% CI: 0.24, 0.48), foreign-born Puerto Ricans (OR=0.47, 95% CI: 0.27, 0.81), foreign-born Central/South Americans (OR=0.58, 95% CI: 0.42, 0.83), and foreign-born Other Latinos (OR=0.36, 95% CI: 0.18, 0.72) have lower odds of emailing a healthcare provider than US-born NH Whites. Conclusions: We found Latino subgroups do not use health information channels equally, and attempts to target Latinos should take ethnicity and nativity into account. Clinical Trial: n/a

Research on the social determinants of vaccine uptake often occur between racial/ethnic groups and not within groups. Though minoritized individuals face inequalities across the board, these are also not evenly distributed amongst minoritized individuals within groups. Using the National Health Interview Survey data, we examined disparities in flu vaccine uptake across racial/ethnic groups in the United States (US). We examined (a) NH (non-Hispanic) White (n = 32,655), (b) NH Asian (n = 2335), (c) NH African American (n = 5137), and (d) Hispanic (n = 5718) respondents who lived in the United States using the combined 2017 and 2018. We used multivariable logistic regression to predict flu vaccination (yes/no) both in models comparing racial/ethnic groups and within groups. Less than 50% of any of the four major racial/ethnic groups in the US received a flu vaccination in 2017–18. Flu vaccine uptake varied within racial and ethnic groups. These results suggest that increasing vaccination may require a complex, multi-faceted perspective that considers subgroups more directly.

Preconception health (PCH) focuses on taking steps before a pregnancy to safeguard the health of the woman and future baby. Although recommendations to improve PCH target all people of reproductive age, research shows most interventions and messages focus primarily on women, which may contribute to existing normative beliefs that women are more responsible for protecting children’s health. In this study, we explore society’s gendered expectations of responsibility for engaging in recommended PCH behaviors (i.e., avoiding smoking, drinking, and environmental toxins). An applied thematic analysis of online survey responses from U.S. men and women (N = 573) identified five main themes and related subthemes: body and health, shared responsibility, choice and moral obligation, gender stereotypes, and doubt and uncertainty. Both men and women frequently referenced biological connections between prospective parents and offspring as justification for PCH behaviors. When challenging PCH recommendations, respondents mentioned excessive control of women and men’s secondary role in reproduction. Overall, gender stereotypes were more commonly expressed in relation to men yet reflected both traditional and contemporary male roles (i.e., as supporters, co-parents). When judging personal responsibility, women commonly viewed PCH behaviors as the ‘duty of a good mother’. Implications for PCH communication research and practice are discussed.

Potentially harmful chemicals are detectable in e‐cigarette secondhand vapor (hereafter SHV), contrary to advertising and marketing claims that it contains “only water vapor.” We assessed public knowledge about the presence of chemicals in SHV and associations between knowledge and perceived harms of exposure to SHV. We conducted an online survey of a nationally representative sample of 1,449 U.S. adults (GfK's KnowledgePanel) from October to December 2013. Respondents were asked whether e‐cigarette vapor contains only water vapor, contains tar, or contains formaldehyde (true/ false/ do not know). Responses to these three items were recoded (1 = incorrect, 2 = do not know, and 3 = correct) and averaged into a knowledge scale. They were also asked if they perceived breathing SHV to be harmful to one's health (two‐item scale) and comparative harm of breathing SHV versus breathing secondhand smoke (SHS). Multiple regression analyses were weighted to the U.S. adult population and adjusted for potential confounders. Most respondents (58–75%) reported not knowing whether SHV contained only water vapor, if SHV contained tar, and if it contained formaldehyde. African‐American respondents (vs. white) and current smokers (vs. nonsmokers) had lower levels of knowledge about chemicals in SHV. Adjusting for covariates, correct knowledge about chemicals in SHV was associated with higher perceived harms about SHV for one's health and perceived comparative harm of SHV versus SHS. These findings suggest a need to provide accurate information about the presence of chemicals in SHV (e.g., using product ingredient labels or public education).