Pandemic stress & tobacco harm reduction

Pandemic stress & tobacco harm reduction

Outline of person surrounded by hazard symbols
We can’t make perfect choices all the time.
Base image: Risk, CC-BY Nithinan Tatah

Candy is a queer, nonbinary Iranian person living in Oakland and working remotely as a teacher. Their former use of cigarettes was strongly associated with situations where they felt heightened anxiety. In these instances, Candy utilized cigarette smoking as a tool to take some space away from the situation and calm down. Though this was not a regular occurrence in the past, it is necessary to contextualize the role of stress in Candy’s current use:

“Like, ’cause my rent is more than half my paycheck, and my partners had to move away because they can’t afford it here… and also that we’ve been in our homes for a year because we just couldn’t get it together to do things better… But if I didn’t need to grasp at whatever I could to cope with what’s happening around me, there would be no benefit to this for me, and I would have no desire to smoke or anything else.”

Candy’s narrative reflects resource scarcity — their rent is half their paycheck and their partners can no longer afford to live in the state. The pandemic has been stressful for Candy, and this resource-related stress and isolation spurred a desire to smoke cigarettes again.

However, cigarettes are expensive — the cost per pack has increased by about $3 since the last time they bought one over a year ago. A former coworker introduced Candy to oral nicotine pouches, which are $2 per tin of about 20 pouches. In the Bay Area, that means that one nicotine pouch is about 80% cheaper than one cigarette ($.10/pouch vs $.50-.60/cigarette).

When I asked Candy, “If you had to say one reason right now to tell someone else why you use your nicotine pouches, what would it be?” they replied:

“Harm reduction. Yeah, the pandemic is hard. I’m having a time. Of all of the things I could use to cope, this feels the least destructive. It’s less expensive, and it feels like it takes less of a toll on my body than other things that I could be using. It feels more responsible than like, drinking a bunch, ’cause you know, if I’m teaching, I can do this while I do that…”

The decision to switch from cigarettes to nicotine pouches is a choice with straightforward implications of harm reduction. Candy had family members experience terminal cancer and noted that Covid-19 is a virus affecting the lungs, so switching to a non-inhaled product with less hand-to-mouth contact was a good option for them. Furthermore, the pouches weren’t a financial burden for Candy, and fit into the new rhythms of their everyday life teaching remotely and sheltering in place.

Candy commented on the nicotine effects as being useful and grounding, and specifically remarked that nicotine and tobacco use are better (for their body and for their job) than excessive drinking — a perspective shared by several other participants too.

This indicates a complex process of considerations around harm and risk when it comes to nicotine and tobacco use for many of the people we’ve spoken to in this study, revealing the breadth of harm reduction and its implications. When I asked Candy what they meant by “harm reduction,” they put it this way:

“I feel like if I tried to set the expectation of myself that I’m just not going to use any kinds of substances or not do things that I know are not good for me, like, period, full stop, that’s not a realistic expectation. And in the past, I’ve tried to make decisions like that… What happens is that it becomes all that I think about. And I don’t do it for a while, and then I give in and go way overboard, and it’s worse… I want to take care of myself. I want to make good choices. I can’t make perfect choices all the time. So, I’m going to do my best to make better ones.”

App That Converts Air Pollution Into Cigarettes

App That Converts Air Pollution Into Cigarettes

This Lifehacker post is from 2018 so perhaps y’all are already aware, but my partner just alerted me to the existence of an app entitled “Sh**t! I Smoke.”

Thought it was especially relevant to share here in the Bay Area given the current climate (literally), and even moreso considering

  1. the number of participants in the Stigma study who framed the harmfulness of cigarette smoking within the context of larger, structural health threats re: environmental pollution (most often in a “so smoking doesn’t really matter in the scheme of things” sort of way, in terms of their own health and in response to concerns/accusations that smoking is a particularly harmful and/or major source of environmental pollution)

  2. compounded concerns about population-level and individual respiratory health amid fires + COVID

  3. will be very interesting to see how the theme mentioned in point 1 shows up in our current study on Tobacco Harm Reduction given point 2!

Everything about this app is rhetorically FASCINATING.

The app icon is the shape of a poop emoji made out of a cigarette.

Cigarette twisted into the shape of a poop emoji

Everyone is a smoker within the language of this app…

Screen capture from app, point location in Oakland, CA, says "OMG! You smoke 9.3 cigarettes daily"Screen capture from app, point location in Oakland, CA, says "Dang! You smoke 64.9 cigarettes weekly"

… and it’s obvious that that is BAD.

Screen capture from app, reads "Loading... Cough... Cough"

But at the same time the positioning of personal responsibility, victimhood, innocence, and contagion are structured totally differently.

Screen capture from app says "The app was inspired by Berkeley Earth's findings about the equivalence between air pollution and cigarette smoking. The rule of thumb is... one cigarette per day is the rough equivalent of a PM2.5 level of 22"

Neat, wow, yikes, enjoy!

(All images via the Sh**t! I Smoke app)

Women of Color Being Policed

Women of Color Being Policed

Between 2017 and 2018, we conducted 49 interviews with young Black and Latina women in the San Francisco Bay Area about their perceptions and experiences of the police. This study came on the heels of nationwide outrage about countless police killings of Black men, including Philando Castile and Alton Sterling in 2016, as well as one woman, Sandra Bland, whose life was also stricken by the same violence in 2015. Now, sparked by the killing of George Floyd only a few years later, this outrage is reignited. 

To continue our #POCbeingPoliced series and further highlight the long-standing issue of racist police violence directed at women, we present the following video: “Women of Color Being Policed,” which highlights Black women’s voices, specifically.  We humbly thank the women who participated in this study, many of whom courageously shared their experiences with the sole intention of making a difference by amplifying the attention paid to women of color’s experiences with police violence. 

Findings from this study can be found here.

For more research on police violence and police use of force, see our public access bibliography.

For more information about Black women and police violence, see work from the African American Policy Forum’s #SayHerName campaign.

Voices on Police Violence

Voices on Police Violence

In recognition of the fortitude of those on the front lines; in honor of Ahmaud Arbery, Breonna Taylor, George Floyd, Tony McDade, and so many others whose lives have been cut short by police violence: Over the next few days the Center for Critical Public Health will highlight direct quotes from participants in our studies.

Since 2007, we’ve conducted interviews with people of color whose stories have included countless experiences with racial profiling, unjust stop and search, and police brutality. Though the studies they come from are not all focused on policing nor directly on violence, these quotes highlight how pervasive racist violence is. These participants and their experiences are unique, but the connecting thread of police violence is not.

Neither this violence nor the outrage it justifies are new. Immense gratitude to all of the participants who have generously shared their experiences with us. These voices, past and present, must be heard.

To follow this series, please join us on our Twitter or Facebook feeds. Since this material can be traumatic, we will use the hashtag #POCbeingPoliced consistently throughout the series so you can choose to mute it any time.

Update: Threaded quotes below

Continue reading
The what is and why bother with a critical public health

The what is and why bother with a critical public health

Continue reading

Truth-telling, trust and e-cigarettes

Truth-telling, trust and e-cigarettes

Headshot of Dana Scully from The X-Files, with caption "MULDER, THE TRUTH IS OUT THERE, BUT SO ARE LIES."

Lange, M. (1994, February 11). The X-Files. Young at Heart. 20th Century Fox Television.

It should go without saying that public health institutions and researchers have an obligation to tell the truth. In principle, there aren’t many stakeholders in e-cigarette research who would argue otherwise. But questions about whose truth and how information about e-cigarettes should be communicated have been highly controversial.

Partly this is because e-cigarettes haven’t been around long (relatively speaking), and research takes time.

But while influential figures on all sides of the e-cigarette debate in the US have increasingly acknowledged a body of evidence that vaping is less harmful than combustible cigarettes, the US public has increasingly come to believe the opposite. It’s unlikely that this outcome results from even-handed cautions against jumping to conclusions. People have been inundated with a particular message about the current state of research on vaping, and that message is false. Continue reading

Who does research on the researcher?

Who does research on the researcher?

Photo of antique typewriter holding a sheet of paper that has "What's your story" typed on it

(Image in public domain)

Since February of last year, I have been talking to Black and Latina women from the Bay Area about their perceptions of and experiences with police. These women that I have had the pleasure of speaking with have all been between the ages of 18-25. As I have sat with stories of their interactions with police, as well as their views of police and policing today, I couldn’t help but think: How have I not have had the experiences that these women have had?

I am a part of the same demographic of women who have participated in these interviews: young, in her mid-ish 20s, Black and from Oakland. Questions of how I have not had experiences similar to the young women of Color I’ve interviewed, as well as acknowledging my role as a researcher, dawned upon me during two separate interviews when two Black women from Oakland asked me if I had ever been stopped by police. When I gave them an answer and inquired about why they had asked, they followed up with statements like: “You’ve only been in a traffic stop, huh?” or “You don’t look like you’ve been stopped by the police because you look like you went to college.”

These statements not only provided a fraction of these women’s perceptions of and experiences with policing, but also provided some insight into the role(s) of a participant and a researcher. I was glad that these women asked me questions as I had asked them many. I was elated that they knew they had the space to ask me questions. I have done many interviews where participants felt that I was looking for a particular answer or felt pressured to answer questions in a particular manner.

As a qualitative researcher, I am interested in the experiences and narratives that others share with me; but I realized that I often miss other narratives and experiences as well: How does a participant see me as a researcher? What do they think my stories are and how does this influence how we interact with one another? What does all of this mean in regard to “building rapport”?

As much as I can understand and acknowledge esoteric statements and experiences of those I relate to, I realized that barriers can still exist: I am still a researcher and I am still the one asking the questions.

Welcome to the Neighborhood!

Welcome to the Neighborhood!

“I think moving to the Bay Area, moving to Berkeley and Oakland and being in the East Bay where there is more exposure to just more self-love culture and what that looks like, and then also just witnessing my queer friends and kind of being an observer of the queer community and really admiring and wondering where all of these people got their strength from to be themselves in the world. I remember asking myself who told them that they were – I don’t remember what I thought. I think I thought, who told them that they were so fabulous?”                                                                                            –Kimmy, 30


As an interviewer for our LGBTQ Adults and Tobacco Stigma study, I heard countless stories like the one above. Stories of heartbreak and struggle and triumph and solidarity and love.  While each story was different, a distinct pattern emerged.  I was reminded over and over again just how important a sense of community is.  When I asked our participants what was most needed in the Bay Area LGBTQ+ communities, so very many of them expressed a desire for a central place to access medical, housing, job, and mental health resources.  A central place to meet people and socialize.  A central place to simply “be themselves in the world.”  On September 7, the Oakland LGBTQ Community Center opened its doors.  From all of us at the Center for Critical Public Health: Welcome to the neighborhood!!!

Anthro-less or anthro-lite at mid-career: Diagnosis and remedies

SfAA 2017 meeting logo
Ed. note: This is a version of Namino Glantz’s thought-provoking and inspiring talk at the 2017 meeting of the Society for Applied Anthropology (SfAA). You can find the program for the 2017 meeting here (pdf), and more information about SfAA here.

I am so grateful for this chance to confess to you active social scientists about my applied anthropology career crisis, and explore with you potential ways to weather and even prevent such a crisis for me, perhaps for you someday, and maybe even for the discipline.

Many people study anthropology and we embrace it as part of our identity. In fact, per the National Science Foundation and the National Center for Educational Sciences, an estimated 400,000 people in the United States have anthropology degrees, including about 20,000 PhDs and 50,000 masters, presumably many in applied anthropology. Further, the American Anthropological Association (AAA) boasts over 10,000 members and the Society for Applied Anthropology (SfAA) about 2,500.

These organizations often have a different set of values that compete with our applied anthropology tenets, and this culture clash sets us dyed-in-the-wool anthropologists up for conflict.

Of AAA members, 75% are employed in higher education or students of anthropology, and it’s safe to assume that these folks practice anthropology daily. What about those who aren’t in academia? What do they do? Just about anything and nearly everything, with more or less success at incorporating our anthropology learnings in a sustained way. Those of us not in academia work for governments, development agencies, NGOs, tribal and ethnic associations, advocacy groups, social-service, health, and educational agencies, and businesses. These organizations often have a different set of values, methods, and priorities that compete with our applied anthropology tenets. And this culture clash sets us dyed-in-the-wool anthropologists up for conflict.

Take, for example… me! I was an applied medical anthropologist before I even heard of the term. I came of age on the Navajo Reservation, hearing stories from my step-mom, an Indian Health Service doctor. As a high school student, I pondered ways to prevent kids from being bounced out of pick-up truck beds. I envisioned policy to enable my friends preparing for military deployment to both take peyote in their protection ceremony and pass their pre-deployment drug test. I devised a group prescription system that would allow my high school girlfriends to obtain and take birth control pills together as a community, a way that would prevent more pregnancy than each of us playing roulette by taking turns popping out pills from a single, shared pill pack. Continue reading