Rachel Grana

University of California, San Francisco, San Francisco, California, United States

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Publications (37)142.94 Total impact

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    ABSTRACT: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. The Apple and Google Play app stores were searched using the terms "cannabis" and "marijuana." Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated "17+" years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated "high maturity" (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations.
    08/2015; 3(3):e81. DOI:10.2196/mhealth.4405
  • Sara Kalkhoran · Rachel A. Grana · Torsten B. Neilands · Pamela M. Ling ·
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    ABSTRACT: Objectives: To evaluate predictors of dual use of cigarettes with smokeless tobacco or e-cigarettes. Methods: Adult smokers (N = 1324) completed online cross-sectional surveys. Logistic regression evaluated predictors of dual use and cigarette quit attempts. Results: Smokeless tobacco dual use was associated with past attempts to quit smoking by switching to smokeless products. E-cigarette dual use was associated with using stop-smoking medication and strong anti-tobacco industry attitudes. Ever use of stop-smoking medication was associated with quit attempts among dual e-cigarette users and cigarette-only users. Conclusions: Dual users are more likely than cigarette-only users to endorse certain cessation-related attitudes and behaviors. This may provide an opportunity for clinicians or others to discuss evidence-based strategies for smoking cessation.
    American journal of health behavior 03/2015; 39(2). DOI:10.5993/AJHB.39.2.14 · 1.31 Impact Factor
  • Rachel Grana · Neal Benowitz · Stanton Glantz ·

    Circulation 02/2015; 131(6):e342-e342. DOI:10.1161/CIRCULATIONAHA.114.012887 · 14.43 Impact Factor
  • Lauren K Lempert · Rachel Grana · Stanton A Glantz ·
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    ABSTRACT: How electronic cigarettes and similar products (e-cigarettes) are defined affects how they are regulated, particularly whether existing laws for cigarettes apply, including sales and marketing, youth access, smoke-free and taxation laws. We examined the text of 46 bills that define e-cigarettes enacted in 40 states and characterised how e-cigarettes and similar products were defined. States enact laws creating new product categories for e-cigarettes separate from the 'tobacco product' category (eg, 'alternative nicotine product,' 'vapour product,' 'electronic nicotine device'), with four states explicitly excluding e-cigarettes from 'tobacco products.' Twenty-eight states do not include e-cigarettes in their definitions of 'tobacco products' or 'smoking,' eight include e-cigarettes as 'tobacco products,' three include e-cigarettes in 'smoking.' Sixteen states' definitions of e-cigarettes require nicotine, and five states pre-empt more stringent local laws. Tobacco and e-cigarette industry representatives tried to shape laws that benefit their interests. Definitions separating e-cigarettes from other tobacco products are common. Similar to past 'Trojan horse' policies, e-cigarette policies that initially appear to restrict sales (eg, limit youth access) may actually undermine regulation if they establish local pre-emption or create definitions that divide e-cigarettes from other tobacco products. Comparable issues are raised by the European Union Tobacco Products Directive and e-cigarette regulations in other countries. Policymakers should carefully draft legislation with definitions of e-cigarettes that broadly define the products, do not require nicotine or tobacco, do not pre-empt stronger regulations and explicitly include e-cigarettes in smoke-free and taxation laws. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Tobacco control 12/2014; DOI:10.1136/tobaccocontrol-2014-051913 · 5.93 Impact Factor
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    Judith J Prochaska · Rachel A Grana ·
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    ABSTRACT: We examined electronic cigarette (EC) use, correlates of use, and associated changes in smoking behavior among smokers with serious mental illness in a clinical trial. Adult smokers were recruited during acute psychiatric hospitalization (N = 956, 73% enrollment among approached smokers) in the San Francisco Bay Area between 2009-2013. At baseline, participants averaged 17 (SD = 10) cigarettes per day for 19 (SD = 14) years; 24% intended to quit smoking in the next month. Analyses examined frequency and correlates of EC use reported over the 18-month trial and changes in smoking behavior by EC use status. EC use was 11% overall, and by year of enrollment, increased from 0% in 2009 to 25% in 2013. In multiple logistic regression, the likelihood of EC use was significantly greater with each additional year of recruitment, for those aged 18-26, and for those in the preparation versus precontemplation stage of change, and unlikely among Hispanic participants. EC use was unrelated to gender, psychiatric diagnosis, and measures of tobacco dependence at baseline. Further, over the 18-month trial, EC use was not associated with changes in smoking status or, among continued smokers, with reductions in cigarettes per day. Within a clinical trial with smokers with serious mental illness, EC use increased over time, particularly among younger adults and those intending to quit tobacco. EC use was unrelated to changes in smoking. The findings are of clinical interest and warrant further study.
    PLoS ONE 11/2014; 9(11):e113013. DOI:10.1371/journal.pone.0113013 · 3.23 Impact Factor
  • Lucinda England · Ganna Kostygina · Rachel A. Grana · Pamela Ling ·
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    ABSTRACT: Objective: Describe the evolution of strategies used by tobacco companies to minimize concerns about nicotine addiction and to promote medicinal and hedonic benefits of nicotine. Methods: Qualitative analysis of previously secret tobacco industry documents from the Legacy Tobacco Documents Library (legacy.library.ucsf.edu), triangulated with data from national newspapers, trade press, and the Internet from the 1970s through the present. Results: The industry has worked for decades to promote the benefits of nicotine and downplay its addictiveness. Strategies included promoting comparisons between nicotine addiction and addiction to socially acceptable substances such as caffeine and chocolate. These comparisons appeared in highly-publicized scientific meetings and in numerous scientific publications, and in interviews with the press. In addition, tobacco companies have funded and published scientific studies of the benefits of nicotine on cognition and other areas of performance and mood regulation, promoting the benefits of nicotine on performance using examples accessible to the public such as driving a car or flying a plane, and, finally, funding and publishing scientific studies of the medicinal benefits of nicotine for neurological disorders such as Alzheimer’s and Parkinson’s diseases. Discussion: The tobacco industry has implemented strategies to promote the benefits of nicotine to scientific and lay audiences, and to minimize concerns about nicotine addiction. These strategies complement the recent introduction of novel nicotine containing tobacco products and electronic cigarettes. These efforts may normalize nicotine use, encourage uptake of nicotine containing products, or continued long term use of nicotine.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objective The goal of this study was to summarise the websites of electronic cigarette (e-cigarette) manufacturers in China and describe how they market their products. Methods From March to April 2013, we used two search keywords ‘electronic cigarette’ (Dian Zi Xiang Yan in Chinese) and ‘manufacturer’ (Sheng Chan Chang Jia in Chinese) to search e-cigarette manufacturers in China on Alibaba, an internet-based e-commerce business that covers business-to-business online marketplaces, retail and payment platforms, shopping search engine and data-centric cloud computing services. A total of 18 websites of 12 e-cigarette manufacturers in China were analysed by using a coding guide which includes 14 marketing claims. Results Health-related benefits were claimed most frequently (89%), followed by the claims of no secondhand smoke (SHS) exposure (78%), and utility for smoking cessation (67%). A wide variety of flavours, celebrity endorsements and e-cigarettes specifically for women were presented. None of the websites had any age restriction on access, references to government regulation or lawsuits. Instruction on how to use e-cigarettes was on 17% of the websites. Conclusions Better regulation of e-cigarette marketing messages on manufacturers’ websites is needed in China. The frequent claims of health benefits, smoking cessation, strategies appealing to youth and women are concerning, especially targeting women. Regulators should prohibit marketing claims of health benefits, no SHS exposure and value for smoking cessation in China until health-related, quality and safety issues have been adequately addressed. To avoid e-cigarette use for initiation to nicotine addiction, messages targeting youth and women should be prohibited.
    Tobacco Control 10/2014; DOI:10.1136/tobaccocontrol-2014-051840 · 5.93 Impact Factor
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    Rachel Grana · Neal Benowitz · Stanton A Glantz ·

    Circulation 05/2014; 129(19):1972-86. DOI:10.1161/CIRCULATIONAHA.114.007667 · 14.43 Impact Factor
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    Rachel A Grana · Pamela M Ling · Neal Benowitz · Stanton Glantz ·

    Circulation 05/2014; 129(19):e490-2. DOI:10.1161/CIRCULATIONAHA.114.008545 · 14.43 Impact Factor
  • Rachel A Grana · Pamela M Ling ·
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    ABSTRACT: Electronic cigarettes (e-cigarettes) have been increasingly available and marketed in the U.S. since 2007. As patterns of product adoption are frequently driven and reinforced by marketing, it is important to understand the marketing claims encountered by consumers. To describe the main advertising claims made on branded e-cigarette retail websites. Websites were retrieved from two major search engines in 2011 using iterative searches with the following terms: electronic cigarette, e-cigarette, e-cig, and personal vaporizer. Fifty-nine websites met inclusion criteria, and 13 marketing claims were coded for main marketing messages in 2012. Ninety-five percent of the websites made explicit or implicit health-related claims, 64% had a smoking cessation-related claim, 22% featured doctors, and 76% claimed that the product does not produce secondhand smoke. Comparisons to cigarettes included claims that e-cigarettes were cleaner (95%) and cheaper (93%). Eighty-eight percent stated that the product could be smoked anywhere and 71% mentioned using the product to circumvent clean air policies. Candy, fruit, and coffee flavors were offered on most sites. Youthful appeals included images or claims of modernity (73%); increased social status (44%); enhanced social activity (32%); romance (31%); and use by celebrities (22%). Health claims and smoking-cessation messages that are unsupported by current scientific evidence are frequently used to sell e-cigarettes. Implied and overt health claims, the presence of doctors on websites, celebrity endorsements, and the use of characterizing flavors should be prohibited.
    American journal of preventive medicine 04/2014; 46(4):395-403. DOI:10.1016/j.amepre.2013.12.010 · 4.53 Impact Factor
  • Rachel A Grana · Lucy Popova · Pamela M Ling ·

    JAMA Internal Medicine 03/2014; 174(5). DOI:10.1001/jamainternmed.2014.187 · 13.12 Impact Factor
  • Sungkyu Lee · Rachel A Grana · Stanton A Glantz ·
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    ABSTRACT: As elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes. Data from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13-18 years were analyzed with logistic regression. A total of 9.4% (8.0% ever-dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever-e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39-1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09-.12). Some Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.
    Journal of Adolescent Health 11/2013; 54(6). DOI:10.1016/j.jadohealth.2013.11.003 · 3.61 Impact Factor
  • Sara Kalkhoran · Rachel A. Grana · Pamela Ling ·
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    ABSTRACT: Background: Dual use of cigarettes and smokeless tobacco products (particularly snus) and of cigarettes and e-cigarettes is increasing in the U.S. These products are often promoted as safer and for use in smoke-free environments. E-cigarettes are also marketed as beneficial in quitting smoking. Methods: 1412 current smokers completed online cross-sectional surveys in November 2011. Univariate and multivariate logistic regression models evaluated associations between perceived harm of tobacco products, willingness to try smokeless tobacco, quitting behaviors and (a) dual use of cigarettes and smokeless tobacco products, or (b) dual use of cigarettes and e-cigarettes. Results: 1210 smokers were cigarette only users, 76 were dual users with smokeless tobacco, and 124 were dual users with e-cigarettes. In multivariate models, dual use with smokeless tobacco was associated with younger age, male gender, and having attempted to quit smoking by switching to smokeless products (OR=15.38 95%CI [7.99, 29.59]). Dual use with e-cigarettes was associated with ever using nicotine replacement therapy (OR=1.99 [1.32,3.01]) and having made an attempt to quit smoking in the past year (OR=1.60 [1.06,2.43]. Willingness to try smokeless tobacco when one is unable to smoke was associated with both smokeless tobacco product dual use (OR=1.29 [1.13,1.47]) and e-cigarette dual use (OR=1.14 [1.04,1.24]). Conclusions: Compared to cigarette-only smokers, dual users may perceive and use non-cigarette products as they are marketed - for when they cannot smoke and with utility for smoking cessation. E-cigarette use by a cigarette smoker may signal interest in quitting.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    Amanda Fallin · Rachel Grana · Stanton A Glantz ·
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    ABSTRACT: Background The Tea Party, which gained prominence in the USA in 2009, advocates limited government and low taxes. Tea Party organisations, particularly Americans for Prosperity and FreedomWorks, oppose smoke-free laws and tobacco taxes. Methods We used the Legacy Tobacco Documents Library, the Wayback Machine, Google, LexisNexis, the Center for Media and Democracy and the Center for Responsive Politics (opensecrets.org) to examine the tobacco companies’ connections to the Tea Party. Results Starting in the 1980s, tobacco companies worked to create the appearance of broad opposition to tobacco control policies by attempting to create a grassroots smokers’ rights movement. Simultaneously, they funded and worked through third-party groups, such as Citizens for a Sound Economy, the predecessor of AFP and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Tea Party organisations. As of 2012, the Tea Party was beginning to spread internationally. Conclusions Rather than being a purely grassroots movement that spontaneously developed in 2009, the Tea Party has developed over time, in part through decades of work by the tobacco industry and other corporate interests. It is important for tobacco control advocates in the USA and internationally, to anticipate and counter Tea Party opposition to tobacco control policies and ensure that policymakers, the media and the public understand the longstanding connection between the tobacco industry, the Tea Party and its associated organisations.
    Tobacco control 02/2013; 23(4). DOI:10.1136/tobaccocontrol-2012-050815 · 5.93 Impact Factor
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    Rachel A Grana ·

    Journal of Adolescent Health 02/2013; 52(2):135-136. DOI:10.1016/j.jadohealth.2012.11.007 · 3.61 Impact Factor
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    ABSTRACT: OBJECTIVE: The current study evaluated the overall public health impact of the 'Shaping Up My Choices' (SMC) programme, a 10-week school-based nutrition education curriculum developed for third-grade students, using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. DESIGN: Randomized controlled trial to evaluate the programme and secondary analysis of archival data to describe dissemination. Data were collected from programme records, teacher surveys and student pre-, post- and 3-month follow-up surveys. SETTING: Public elementary schools in California. SUBJECTS: An evaluation sample (938 students and nineteen teachers) and a dissemination sample (195 245 students and 7359 teachers). RESULTS: In the evaluation sample, differences between the control and intervention groups were observed for nutrition knowledge, self-efficacy, outcome expectancies, and intakes of vegetables, fruit (girls only), soda, and low-nutrient high-energy foods from pre- to post-survey. Group differences in change in knowledge, outcome expectancies and vegetable intake were sustained through the 3-month follow-up (efficacy). One hundred per cent of intervention teachers in the evaluation sample implemented all of the lessons (implementation). The dissemination sample represented 42 % of third-grade students (reach) and 39 % of third-grade classrooms in public elementary schools in California during 2010-2011 (adoption). Thirty-seven per cent of third-grade teachers in the dissemination sample reordered SMC materials during the subsequent school year (2011-2012; maintenance). CONCLUSIONS: The SMC programme demonstrates the potential for moderate to high public health impact.
    Public Health Nutrition 12/2012; 17(02):1-9. DOI:10.1017/S1368980012005186 · 2.68 Impact Factor
  • Rachel A. Grana · Pamela Ling ·
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    ABSTRACT: Background: Electronic cigarettes (or e-cigarettes) are novel nicotine delivery products advertised widely and aggressively on the internet. The products and their marketing are currently unregulated. This study identified the marketing messages and selling features on e-cigarette retail websites. Methods: One-hundred websites were identified using anonymized iterative searches, using terms such as electronic cigarette, e-cigarette, and e-cig. The top 50 results of each search were examined to identify the top 100 unique retail Web sites. Sites were content analyzed by four independent coders. Results: Six main messages were identified:1) using e-cigarettes has health benefits compared to using tobacco cigarettes, 2) e-cigarettes can be used to circumvent clean indoor air laws, 3) e-cigarette vapor is less harmful than secondhand smoke, 4) e-cigarettes can be used to quit smoking tobacco cigarettes 5) e-cigarettes are the new and modern way to smoke and 6) using e-cigarettes is cheaper than smoking tobacco cigarettes. Novel features of websites included instructional how-to videos, testimonial videos, celebrity endorsements, holiday promotions, and affiliate programs recruiting consumers to become e-cigarette sellers. Discussion: E-cigarette marketing websites frequently include health and cessation claims and features with youth appeal that could have negative effects on public health if they deter or undermine cessation or recruit novices to start using nicotine. Health claims should be supported by objective data (not produced or funded by e-cigarette manufacturers) and youth appeals should be eliminated.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Background: Public Service Announcements (PSAs) encouraging tobacco cessation or avoidance may produce unintended outcomes, including reactance---resistance to the message and attempts to re-establish control, and boomerang effects---unintended attitudes or behaviors against the message. Though frustration at smoking or tobacco companies may be persuasive, reactance and boomerang effects are not. Methods: Seventy-five current and former adult smokers evaluated anti-tobacco message concepts in 8 online focus groups in summer 2011. Qualitative grounded theory analysis was used to identify the main types of reactions to the message concepts. Results: Reactions to anti-smoking message concepts comprised five main themes 1) anger at being stigmatized, 2) disagreement with government control over individual freedom or tobacco companies 3) desire to quit but feeling unable to quit, coupled with resistance to labeling oneself addicted 4) expressions of support and pride for participants who discussed their own quit attempts 5) frustration at tobacco companies for being dishonest. For example, in response to an anti-tobacco ad concept containing tobacco warning labels, participants frequently complained about governmental interference in their lives. A message including this is your brain on nicotine evoked anger, contrasts with street drugs, and claims that smoking was a habit, not an addiction. Conclusion: Focus group participants expressed conflicted attitudes about their smoking status and desire or ability to quit. The social stigma of smoking is a strong factor in smokers' attitudes towards smoking, quitting, cigarette alternatives and regulation. Identifying thematic and linguistic mechanisms leading to reactance and boomerang effects can improve campaign messaging.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Rachel A. Grana · Pamela Ling ·
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    ABSTRACT: Background: Smokeless tobacco products and electronic cigarettes (e-cigarettes) have been promoted to smokers to use in smoke-free environments. Some studies have found that smokers who also use other tobacco products are less motivated to quit than cigarette-only smokers. Methods: Random time-location samples of young adults attending bars and nightclubs in San Diego, CA completed cross sectional surveys in 2011. Current (past 30-day) smokers' data (n=619) were analyzed to examine the relationship between use of traditional smokeless tobacco, snus, hookah, little cigars and e-cigarettes and reporting having made a quit attempt in the past year. Results: Forty-three percent of participants were female, mean age was 24 years, and 72.8% were in college/ had graduated college. Participants reflected California's race/ethnic representation with 34% Hispanic, 46% white and 20% other races/ethnicities. Past 30 day use of smokeless tobacco was 6.6%, snus 5.5%, hookah 24.9%, little cigars 12.9% and e-cigarettes 9.9%. Past 30-day use of an e-cigarette was statistically significantly associated with having made a quit attempt in the past year (χ2 = 4.049, df=1, p=0.04). Use of any other tobacco product was not statistically significantly associated with having made a past year quit attempt. Having used snus was associated with reporting expecting to be smoking in the next year (χ2 = 6.56, df=2, p=0.04). Discussion: Young adult smokers in this sample tried other tobacco products at disproportionately high rates. Although e-cigarettes have not been approved for smoking cessation, young adult smokers who have tried to quit may be more likely to try them.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Youn Ok Lee · Arnab Mukherjea · Rachel Grana ·

    Tobacco control 08/2012; 22(2). DOI:10.1136/tobaccocontrol-2012-050557 · 5.93 Impact Factor

Publication Stats

908 Citations
142.94 Total Impact Points


  • 2011-2015
    • University of California, San Francisco
      • • Division of General Internal Medicine
      • • Department of Medicine
      San Francisco, California, United States
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2009
    • Keck School of Medicine USC
      Los Angeles, California, United States
  • 2006-2007
    • University of Southern California
      • Department of Preventive Medicine
      Los Ángeles, California, United States