Table 2.
Feedback Loops Impacting Smoking Among Racial/Ethnic Minority and Lower-Income Adults
| Loop number | Short loop story | Variables in loop |
|---|---|---|
| Reinforcing feedback loops (reinforce earlier changes) | ||
| R1 | Smoking increases stress/anxiety through financial strain | Stress/anxiety –>(+) smoking –>(+) financial strain –>(+) stress/anxiety |
| R2 | R1, with the added impact of housing instability | Stress/anxiety –>(+) smoking –>(+) financial strain –>(+) housing instability –>(+) stress/anxiety |
| R3 | Smoking fuels discrimination, which triggers stress (a trigger for smoking) | Stress/anxiety –>(+) smoking –>(+) discrimination –>(+) stress/anxiety |
| R4 | Smoking lowers sense of control through financial strain | Sense of control –>(−) smoking –>(+) financial strain –>(−) sense of control |
| R5 | Interconnected demand and supply for menthol cigarettes | Menthol preference –>(+) product & flavor availability –>(+) menthol preference |
| R6 | Cycle of smoking and cravings/addiction | Cravings/addiction –>(+) smoking –>(+) cravings/addiction |
| R7 | Social norms are more (less) accepting of smoking when we smoke (abstain) | Normalization of smoking –>(+) smoking –>(+) normalization of smoking |
| R8 | R7, but among our family and friends | Normalization of smoking –>(+) tobacco use among family & friends –>(+) normalization of smoking |
| R9 | R8, with the added impact of smoke-free homes/workplaces on smoking norms | Normalization of smoking –>(+) tobacco use among family & friends –>(−) smoke-free homes/workplaces –>(−) normalization of smoking |
| R10 | Integrating R7 and R8, and adding the impact of health-related perceptions of tobacco use | Perceptions of tobacco use as low risk –>(+) smoking –>(+) normalization of smoking –>(+) tobacco use among family & friends –>(+) perceptions of tobacco use as low risk |
| R11 | Menthol in cigarettes can make smoking feel safer, counteracting the link between perceived risk of smoking and non-smoking | Perceptions of tobacco use as low risk –>(+) smoking –>(+) normalization of smoking –>(+) tobacco use among family & friends –>(+) product & flavor availability –>(+) menthol preference –>(+) perceptions of tobacco use as low risk |
| R12 | Cycle of tobacco use (non-use) among family and friends and smoke-free homes/workplaces | Tobacco use among family & friends –>(−) smoke-free homes/workplaces –>(−) tobacco use among family & friends |
| R13 | Product and flavor availability reinforces family and friends’ smoking and our own smoking | Normalization of smoking –>(+) tobacco use among family & friends –>(+) product & flavor availability –>(+) smoking –>(+) normalization of smoking |
| R14 | Product and flavor availability increases preference for menthol cigarettes, which increases cravings/addiction, smoking, and smoking norms, resulting in increased tobacco use among family and friends and more product and flavor availability to meet demand | Product & flavor availability –>(+) menthol preference –>(+) cravings/addiction –> smoking –>(+) normalization of smoking –>(+) tobacco use among family & friends –>(+) product & flavor availability |
Notes. Where the loops start and stop, as described here, is an arbitrary choice since the ripple effects circle around over time. (+) indicates that variables move in the same direction. (−) indicates that variables move in the opposite direction.