Pamela M Ling

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

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Publications (126)310.39 Total impact

  • [Show abstract] [Hide abstract]
    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). · 1.31 Impact Factor
  • Emily Anne McDonald, Pamela M Ling
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    ABSTRACT: This qualitative research explores the use of electronic cigarettes and other similar 'vapor' delivery devices among young adults in New York City. We employed 17 focus groups followed by 12 semistructured interviews to understand the beliefs, opinions and practices related to the use of electronic cigarettes among young adult smokers (N=87). Participants were mainly daily (52%) and non-daily (41%) smokers. While experimentation with electronic cigarette devices was frequently reported, participants related an overall lack of information about the devices and what they did know often reflected messages in e-cigarette marketing campaigns. Participants also used their own bodily sensations as a way to gauge potential risks and benefits of the products. Finally, young adults, steeped in a culture of personal technologies, perceived e-cigarettes as one more 'toy' among other technologies integrated into their everyday lives. E-cigarettes were also frequently used with other tobacco products, including conventional cigarettes. Our research indicates that public health campaigns may be needed to counter current industry marketing and inform the public that electronic cigarettes are currently unregulated, understudied and contain toxicants and carcinogens. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Tobacco control. 01/2015;
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    ABSTRACT: More than 25% of young adult Oklahomans smoked cigarettes in 2012. Tobacco marketing campaigns target young adults in social environments like bars/nightclubs. Social Branding interventions are designed to compete directly with this marketing. To evaluate an intervention to reduce smoking among young adult "Partiers" in Oklahoma. The Partier peer crowd was described as follows: attendance at large nightclubs, fashion consciousness, valuing physical attractiveness, and achieving social status by exuding an image of confidence and financial success. Repeated cross-sectional study with three time points. Randomized time location survey samples of young adult Partier bar and club patrons in Oklahoma City (Time 1 [2010], n=1,383; Time 2 [2011], n=1,292; and Time 3 [2012], n=1,198). Data were analyzed in 2013. The "HAVOC" Social Branding intervention was designed to associate a smoke-free lifestyle with Partiers' values, and included events at popular clubs, brand ambassador peer leaders who transmit the anti-tobacco message, social media, and tailored anti-tobacco messaging. Daily and nondaily smoking rates, and binge drinking rates (secondary). Overall, smoking rates did not change (44.1% at Time 1, 45.0% at Time 2, and 47.4% at Time 3; p=0.17), but there was a significant interaction between intervention duration and brand recall. Partiers reporting intervention recall had lower odds of daily smoking (OR=0.30 [0.10, 0.95]) and no difference in nondaily smoking, whereas Partiers who did not recall the intervention had increased odds of smoking (daily AOR=1.74 [1.04, 2.89]; nondaily AOR=1.97 [1.35, 2.87]). Among non-Partiers, those who recalled HAVOC reported no difference in smoking, and those who did not recall HAVOC reported significantly increased odds of smoking (daily AOR=1.53 [1.02, 2.31]; nondaily AOR=1.72 [1.26, 2.36]). Binge drinking rates were significantly lower (AOR=0.73 [0.59, 0.89]) overall. HAVOC has the potential to affect smoking behavior among Oklahoma Partiers without increasing binge drinking. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
    American journal of preventive medicine. 01/2015; 48(1 Suppl 1):S78-85.
  • Lucy Popova, Pamela Ling
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    ABSTRACT: Background: Perceived risk is central to initiation and cessation of tobacco, and warning labels on cigarettes promote cessation and effectively communicate risk, but research on smokeless tobacco and electronic cigarette warning labels is nascent. Tobacco companies have proposed alternative smokeless tobacco warning labels that endorse smokeless tobacco as safer than cigarettes. Methods: Online experiment with a national sample of 455 adult non-users of tobacco randomized to view print advertisements for snus, e-cigarettes, and moist snuff with either warning labels (current warning label, graphic warning label), or endorsements (“FDA-approved” or the label proposed by one of the large tobacco companies “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes”), or control. Perceived harm of each product was measured at pretest and post-test. Results: Warning labels increased perceived harm of e-cigarettes. Endorsements decreased perceived harm of moist snuff and snus, and the large tobacco company proposed endorsement had an effect similar to the prohibited “FDA Approved” endorsement. Almost 16% of non-users were interested in a free sample of an alternative tobacco product, mostly e-cigarettes (the most requested brand was blu, even if blu was not the brand of e-cigarette ad shown in the experiment). Those interested in a free sample had significantly lower perceived harm of all tobacco products than those not interested in a free sample. Conclusions: Regulatory agencies should not allow endorsements of alternative tobacco products and should implement graphic warning labels for smokeless tobacco products and warning labels for e-cigarettes.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Tobacco industry marketing campaigns often target young adults in social environments such as bars/nightclubs, but tobacco control programs rarely visit these venues. Social Branding (a unique social marketing model) interventions are designed to compete with these marketing efforts. The purpose of this intervention was to reduce smoking among young adults in California, New Mexico and Nevada (LGBT). Methods: Focus groups (FG) were conducted in each state prior to campaign launch. Three different campaigns were developed to target three different young adult cultures—Commune (CA – For “Hipsters”), HAVOC (NM – For “Partiers”) and Crush (NV – For LGBT). Each campaign used the Social Branding model with materials and messages tailored to their local audiences. Components include social media, paid digital media, bar and club events, brand ambassadors and direct mail. A pre-post test time series cross-sectional study was designed for each campaign, with a baseline and multiple follow-ups including at least 2,000 young adults in each site. Results. Tobacco use reductions among young adults at bars and clubs were observed in all 3 sites: Relative tobacco use rate reductions of 16% in CA, 25.1% NM and 13.8% in NV. Reductions were concentrated in the targeted young adult subcultures and were present among both non-daily and daily tobacco users. Conclusions. Social Branding is a promising strategy to reduce young adult tobacco use that has demonstrated impact in three distinct sites with three distinct young adult cultures. Broader implementations of the Social Branding model should be considered to reduce young adult tobacco use rates.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Louisa Holmes, Pamela Ling
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    ABSTRACT: BACKGROUND: Smoking rates in the USA have declined in recent years, but this decline has not been geographically or demographically uniform, and the use of the alternative tobacco products has risen. We describe cigarette and alternative tobacco product (cigar, hookah, smokeless tobacco, snus, and electronic cigarettes) use among young adult bar patrons in six U.S. cities. METHODS: We employed time location sampling to randomly survey young adults, ages 18-26, (n=6,811) from six cities – Albuquerque, Nashville, New York City, San Diego, San Francisco and Tucson – to investigate prevalence rates and predictors of alternative tobacco product use and poly-tobacco use (use of more than 1 tobacco product for at least 3 of the past 30 days). RESULTS: The use of alternative tobacco products varied by city and race/ethnicity. The most commonly used products were cigarettes, which ranged from 30.2% (Tucson) to 50.2% (San Francisco), hookah ranged from 14% (Nashville) to 37% (New York), and e-cigarette use which ranged from 10% (Nashville) to 24% (Albuquerque). In all cities, men were significantly more likely to use a combination of tobacco products (p<.05) than women, while Latinos in New York (OR: 1.75, CI: [1.3, 2.5]) and Non-Hispanic blacks in San Diego (OR: 2.42, CI: [1.1, 5.6]) were more likely than Non-Hispanic whites to be poly-tobacco users. CONCLUSION: Bar-going young adults are at risk of alternative tobacco product use and poly-tobacco use, but the risk varies geographically and by race/ethnicity. High rates of hookah and e-cigarette use among non-white young adults warrant further investigation.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Ganna Kostygina, Pamela Ling
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    ABSTRACT: Objective: Flavored little cigar and cigarillo (LCC) use represents an underserved domain in tobacco control. The objective of this study was to describe the evolution of strategies used by tobacco companies to encourage uptake of LCCs and to describe industry research findings on consumer perceptions of flavored LCC products. Method: Qualitative analysis of internal tobacco industry documents triangulated with data from tobacco advertisement archives, national newspapers, trade press, and Internet. Results: Internally, flavored little cigar and cigarillo products have been associated with young and inexperienced tobacco users. Internal studies confirmed that menthol flavor and candy-like sweeter flavors (e.g., cherry) could increase appeal to starters by masking the heavy cigar taste and reducing throat irritation. Flavors made the product easier to inhale, which contributed to the initiation and maintenance of LCCs. Furthermore, to appeal to new users, little cigar manufacturers reduced the size of cigars to make them more cigarette-like, introduced filters and flavored filter tips, emphasized mildness and ease of draw in advertising, evoked associations with cigarettes, and featured actors inhaling the little cigar smoke in television commercials promoting the product. Discussion: Flavors in LCCs tend to make these products more attractive and palatable to new users. While fruit, candy, alcohol flavored cigarettes have been banned, flavored little cigars and cigarillos continue to be sold. Bans on flavored cigarettes should be expanded to include flavored LCCs due to their appeal to new users. Future tobacco use prevention initiatives should be adapted to ensure they are inclusive of LCC use.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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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 (, 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: Background: Light and intermittent smoking has become increasingly common. Smokefree laws and alcohol use affect smoking behavior. We examined whether 100% smokefree laws, especially bar laws, and alcohol use are associated with light/intermittent smoking and quit attempts. Methods: We linked 2009 National Health Interview Survey database with the American Nonsmokers' Rights Foundation US Tobacco Control Database. Dependent variables included current smoking, nondaily smoking, very light daily smoking (daily smokers who smoked 1-5 cigarettes per day [CPD]), very light nondaily smoking (nondaily smokers who smoked 1-3 CPD), infrequent smoking (smoked ≤8 days in past 30 days), and quit attempts. Multivariate logistic regression models were conducted among different smoking subgroups to determine if the outcomes were associated with smokefree law coverage and drinking status, controlling for demographics and cigarette pack price. Results: Greater smokefree law (or bar law) coverage scores were associated with decreased odds of current smoking, but were not associated with light/intermittent smoking. Drinking was associated with current smoking, but rarely showed a relationship with light/intermittent smoking. Young people aged 18-24 and Blacks and Hispanics were more likely to report light/intermittent smoking than 45-64-year-olds and Whites respectively. Smokefree law coverage and drinking were not associated with quit attempts, but very light daily smokers and infrequent smokers exhibited a positive association between drinking frequency and quit attempts. Conclusions: Stronger smokefree law coverage predicts less current smoking, but was not associated with smoking intensity or quit attempts. Novel interventions are needed to reach light and intermittent smokers, which is younger and minority.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objective: Non-daily smoking and purchasing illegal loose cigarettes (loosies) are common among young adults in New York. This may be due to high cigarette prices (median price ~$11.50 pack), cessation attempts, or social norms among daily and non-daily young adult smokers. Methods: Cross-sectional surveys (N= 1916) were collected in NYC bars and nightclubs. Multivariate logistic regressions examined associations between loose cigarette purchasing, loosie & pack prices, smoking norms and quitting behaviors among daily and non-daily smokers. Results: 45% of non-daily smokers and 59% of daily smokers had ever purchased a loose cigarette. 26% of non-daily smokers and 11% of daily smokers reported their last cigarette smoked was a loose cigarette. Controlling for social norms, quitting behaviors and demographics, non-daily smokers (OR= 4.47, 95%CI [1.57, 12.75]) were more likely than daily smokers to have recently smoked a loose cigarette. Using quit aids was associated with recently smoking a loose cigarette (OR= 2.01 [1.19, 3.40]) and ever purchasing a loose cigarette (OR= 2.13 [1.46, 3.10]). Agreement that New Yorkers approve of smoking was also associated with recent loose cigarette purchase (OR= 1.34 [1.05, 1.70]) and ever loose cigarette purchase (OR= 2.13, 1.46, 3.10]). Conclusions: Recently purchasing loose cigarettes is strongly associated with non-daily smoking. Smokers may also use loose cigarettes as a smoking cessation strategy. Those with stronger pro-smoking social norms may also view purchasing loose cigarettes as more socially acceptable. All of these issues should be considered to decrease frequency of loose cigarette purchasing among young adults in New York.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Lucy Popova, Youn Ok Lee, Pamela Ling
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    ABSTRACT: Background: We examined whether different groups of social smokers (based on self-identification and behavior as social smokers) differed in smoking cessation attempts and how these groups and cessation attempts predicted use of alternative tobacco products. Methods: Online cross-sectional survey of a nationally representative sample of 1,813 current or recently former (quit within last two years) smokers. Social smoking was measured as self-identified (SI) or behavioral (smoking mainly or only with others). Chi-square tests and regression were used to analyze associations between groups and tobacco use. Results: Participants were classified into four groups: consistent social smokers (SI and behavior, 13% of participants), deniers (SI but not behavior, 33%), established smokers (not SI and not behavior, 52%), and behavior only (behavior but not SI, 3%). Consistent social smokers were significantly younger, had the lowest cigarette consumption, highest intentions to quit, and were more likely to report a quit attempt in the past year. Deniers had lower education, lower income, similar cigarette consumption as established smokers, and were most open to using alternative tobacco products. Making a cessation attempt predicted ever and 30 day use of e-cigarettes. Social smoking identification predicted ever use of snus and hookah and 30 day use of smokeless tobacco and hookah. Conclusions: Social smokers who identify and behave as such were the most inclined to quit smoking. Use of e-cigarettes (which are promoted as cessation devices) was predicted by making a cessation attempt, while use of “social” alternative tobacco products (like hookah) was predicted by social smoker identification.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: While flavoured cigarettes were prohibited in the USA in 2009, flavoured little cigars and cigarillos (LCCs) remain on the market. We describe the evolving strategies used by tobacco companies to encourage uptake of flavoured LCCs and industry research findings on consumer perceptions of flavoured LCC products.
    Tobacco Control 10/2014; · 5.15 Impact Factor
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    ABSTRACT: 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.
    Tobacco Control 10/2014; · 5.15 Impact Factor
  • Nan Jiang, Youn O. Lee, Pamela M. Ling
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    ABSTRACT: Objective Young adults frequently report social smoking. This study examined the relationship between different social smoking definitions and the co-use of cigarettes and alcohol, tobacco-related attitudes, and quitting efforts. Method Cross-sectional data were collected at bars using randomized time location sampling among young adults aged 21–26 in San Diego, CA from 2010–2011 (73% response rate). Multivariable logistic regression examined if current smoking and quit attempts were associated with tobacco-related attitudes, and whether social smoking self-identification or behavior was associated with cigarette-and-alcohol co-use, tobacco-related attitudes, quit attempts, or quitline use. Results Among 537 current smokers, 80% self-identified and 49% behaved as social smokers. Social smoking self-identification was positively associated with cigarette-and-alcohol co-use, and quit attempts. Social smoking behavior was negatively associated with tobacco marketing receptivity, quit attempts, quitline use. Tobacco-related attitudes were associated with smoking but did not generally differ by social smoking status. Conclusion Identification and behavior as a social smoker have opposing associations with co-use of cigarettes and alcohol and quit attempts. Tobacco cessation programs for self-identified social smokers should address co-use. Interventions denormalizing the tobacco industry or emphasizing the health effects of temporary smoking/secondhand smoke may address smoking among young adult bar patrons regardless of social smoking status.
    Preventive Medicine 09/2014; · 2.93 Impact Factor
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    Lucy Popova, Pamela M Ling
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    ABSTRACT: Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. However, smokeless tobacco products are not required to carry graphic warning labels, and as of September 2014, electronic cigarettes in the US carry no warning labels and are aggressively marketed, including with "reduced harm" or "FDA Approved" messages.
    BMC Public Health 09/2014; 14(1):997. · 2.32 Impact Factor
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    Nan Jiang, Youn O Lee, Pamela M Ling
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    ABSTRACT: Bars and nightclubs are key public venues where young adults congregate and use both tobacco and alcohol, and young adult bar patrons are at high risk for substance use. This study examined the association between cigarette smoking and alcohol use among a random sample of young adult bar patrons from three different cities in the USA.
    BMC Public Health 05/2014; 14(1):500. · 2.32 Impact Factor
  • Circulation 05/2014; 129(19):e490-2. · 14.95 Impact Factor
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    ABSTRACT: Objectives: Public health professionals have debated the use of smokeless tobacco (SLT) over cigarettes for harm reduction. This article describes SLT and cigarette risk comparisons and other SLT “debate” messages potentially reaching the public through news stories. Methods: We conducted a content analysis of SLT-related 2006-10 articles from top newspapers and selected news wires. Results: About 16% of articles (N = 677) referred to SLT as less harmful than smoking, attributing these messages to public health professionals as frequently as to tobacco company representatives. About 29% of articles included an “anti” SLT message, including variously phrased warnings that SLT is not a safe smoking alternative, or other potential consequences such as youth uptake. Conclusion: Professionals should begin developing and using more consistent messages about SLT's risks.
    Health Behavior and Policy Review. 05/2014; 1(3).
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    ABSTRACT: To describe the characteristics associated with patterns of daily and dual tobacco use in U.S. Air Force (USAF) personnel transitioning from Basic Military Training to Technical Training. Cross-sectional survey of USAF personnel in Technical Training School at Lackland Air Force Base (N = 8,956, response rate: 73%). Logistic regression analyzed the association of predictor variables between daily smokers, daily smokeless tobacco (ST) users, daily smokers who used ST nondaily, daily ST users who smoked cigarettes nondaily, and daily users of both cigarettes and ST. Compared to daily smokers, participants who were daily smokers/nondaily ST users were more likely to be male, would use ST and multiple forms of tobacco in the future, reported more friends using ST and cigarettes, and were more susceptible to tobacco advertising. Compared to daily ST users, daily ST users/nondaily cigarette users were more likely to live in the Midwest, would use multiple forms of tobacco in the future, reported more friends smoked cigarettes and used ST, and were more likely to try a product that claimed to be safer than cigarettes. Daily users of both cigarettes and ST were significantly more likely to be nicotine dependent than daily smokers/nondaily ST users and daily ST users/nondaily smokers. Dual users are heterogeneous groups of tobacco users who are at high risk for continued tobacco use. Daily users of both cigarettes and ST have higher levels of nicotine dependence, even compared to other dual users. Specific interventions targeted at dual users are needed in this increasingly prevalent and high-risk population.
    Nicotine & Tobacco Research 04/2014; · 2.48 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. · 4.24 Impact Factor

Publication Stats

1k Citations
310.39 Total Impact Points


  • 2002–2014
    • University of California, San Francisco
      • • Division of General Internal Medicine
      • • Division of Hospital Medicine
      • • Center for AIDS Prevention Studies
      San Francisco, California, United States
    • American Lung Association of Florida
      Denver, Colorado, United States
  • 2013
    • Research Triangle Park Laboratories, Inc.
      Raleigh, North Carolina, United States
  • 2012
    • Rutgers New Jersey Medical School
      • Center for Tobacco Surveillance and Evaluation Research
      Newark, NJ, United States
  • 2011
    • University of California, Merced
      • School of Social Sciences, Humanities and Arts
      Merced, California, United States
  • 2009–2011
    • Governors State University
      • M.A. Program in Political and Justice Studies
      University Park, IL, United States
    • CSU Mentor
      • Department of Medicine
      Long Beach, California, United States
  • 2008
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2005
    • Dartmouth College
      Hanover, New Hampshire, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States