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Abstract
Tobacco-free (TF) college campus policies have potential to be a high-impact tobacco control strategy. The purposes of the study presented here were to (a) determine the demographic and personal characteristics associated with students' beliefs about and perceived effectiveness of a TF campus policy and (b) assess whether tobacco use status and exposure to secondhand smoke (SHS) predicted beliefs and perceived effectiveness. Five thousand randomly selected students from a large southeastern university were invited by e-mail to participate in an online survey in April 2013, three and a half years after policy implementation. Students held positive beliefs about the policy (average rating 84% of the maximum possible score). Sixty-one percent believed that the policy was successful at reducing SHS exposure; and 40% thought the policy encouraged quitting. Males were less likely than females to believe the policy was effective in reducing SHS exposure and encouraging quitting. Lower undergraduates were more likely to perceive the policy as less effective in reducing SHS exposure; international students were more likely than domestic students to perceive the policy as more effective at encouraging quitting. Students most exposed to SHS were less likely to perceive the policy was effective. Compared with nonusers, those who smoked cigarettes were less likely to perceive the policy as effective in encouraging quitting. Tailored messaging regarding policy benefits are necessary. Perceived effectiveness of TF policies may be related to compliance with the policy and should be further investigated. Objective measures of effectiveness and tobacco use behaviors are needed to fully measure the success of TF campus policies.
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Affiliation(s)
- Melinda J Ickes
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA.,2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,3 College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,4 College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,3 College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
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Hahn EJ, Hooper M, Riker C, Butler KM, Rademacher K, Wiggins A, Rayens MK. Lung Cancer Worry and Home Screening for Radon and Secondhand Smoke in Renters. J Environ Health 2017; 79:8-13. [PMID: 29135198 PMCID: PMC5754926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lung cancer is largely preventable by eliminating tobacco smoke and radon exposure. This exploratory study assessed the relationships of demographic factors, including having one or more smokers living in the household, and a) lung cancer worry and b) completion of home screening for radon and secondhand smoke (SHS) among renters. A convenience sample of renters (N = 47) received free test kits for radon and SHS as part of a larger study. Demographic factors, lung cancer worry, and completion of home testing were assessed at baseline. The sample was mostly Caucasian (68%), female (62%), and educated beyond high school (70%). The average age was 43 years (SD = 15), and roughly half lived with at least one smoker (49%). Gender, race/ethnicity, education, and whether they had smokers in the home accounted for 35% of the variability in lung cancer worry, F(4, 42) = 5.6, p = .001. Lung cancer worry was associated with lower level of education, b = 0.77; SE(b) = 0.32, and having at least one smoker living in the home, b = 0.71; SE(b) = 0.31. Renters tested their homes for radon and SHS whether they had smokers in the home or not. Constructing and delivering educational messages that target low-educated populations may promote radon testing and smoke-free homes.
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Hahn EJ, Kolpek JK, Lee E, Record R, Wiggins AT, Butler KM, Rayens MK. Rural Print Media and a Tailored Advocacy Intervention for Smoke-Free Policy. Am J Health Promot 2016; 31:52-58. [DOI: 10.4278/ajhp.140725-quan-364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine frequency, prominence, and content of local print media after a 4-year policy advocacy intervention. Design. This was a controlled community-based trial. Setting. The study took place in 39 rural counties (22 intervention, 17 comparison). Subjects. Subjects consisted of 2525 newspaper articles monitored over 18 quarters (July 2007 to December 2011). Intervention. One key element of the tailored policy advocacy intervention delivered by community advisors was building demand for smoke-free policy via media advocacy strategies. Measures. Media clips were coded to assess number of articles; percent of tobacco-related articles on the front page or bold heading section; percent of pro-health articles; and percent of articles with secondhand smoke (SHS)–relevant topics or themes. Analysis. Coded data were entered into Atlas.ti software. Article frequencies and attributes were compared between groups and over time using negative binomial regression for longitudinal data, with county-level demographics as covariates. Results. In the last 3 years, there were approximately twice as many articles in intervention than in comparison counties. Media clips from newspapers in intervention counties were between 1.4 and 2 times more likely to have front page placement and percent of relevant topic or theme than were those in comparison counties. There was no difference in rate of pro-health articles by group. Conclusion. The policy advocacy intervention to promote smoke-free policy increased media attention to SHS and may have increased public awareness of issues related to smoke-free policy.
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Affiliation(s)
- Ellen J. Hahn
- College of Nursing and the College of Public Health, University of Kentucky, Lexington, Kentucky
| | | | - Erin Lee
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Rachael Record
- College of Nursing and the College of Communication and Information Studies, University of Kentucky, Lexington, Kentucky
| | | | - Karen M. Butler
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Mary Kay Rayens
- College of Nursing and the College of Public Health, University of Kentucky, Lexington, Kentucky
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Hahn EJ, Rayens MK, Okoli CT, Love K, Kim S. Tobacco Use Prevention and Cessation Policies in Manufacturing Facilities in the Tobacco-Growing State of Kentucky. Am J Health Promot 2016; 18:225-31. [PMID: 14748312 DOI: 10.4278/0890-1171-18.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To assess workplace tobacco use prevention and cessation policies in manufacturing facilities and explore factors associated with tobacco policies and practices in the tobacco-growing state of Kentucky. Design. Cross-sectional, descriptive, correlational design. Setting. Telephone survey of Kentucky manufacturing facilities. Subjects. A total of 437 human resource managers (77% participation rate). Measures. Telephone interviews by trained local health department staff to assess indoor and outdoor smoking policies, sale of cigarettes on company property, and provision of cessation and prevention programs. Results. Nearly seven in 10 manufacturing facilities had a written smoking policy, but only 43% banned indoor smoking. About one-fourth of companies reimbursed for cessation treatment and/or provided cessation resources. Companies with unions were more likely than those without unions to provide cessation resources but were also more likely to allow indoor smoking. Although large companies had more than two and a half times the odds as small companies to have a written smoking policy, they were more likely to allow cigarette sales on company property. Conclusion. Despite the importance of smoke-free policies in the workplace, most manufacturing facilities surveyed allowed indoor smoking and few helped smokers quit. Companies with unions were more likely to cater to their smoking employees. Manufacturing facilities provide an opportunity to protect large numbers of adult workers from the hazards of secondhand smoke and to provide quit assistance for smokers.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky College of Nursing and College of Medicine, School of Public Health, 760 Rose Street, Lexington, KY 40536-0232, USA
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Abstract
Purpose. To evaluate the impact of a state-of-the-art Quit and Win contest on tobacco quit rates at 3, 6, and 12 months after the 30-day quit period. Design. Quasi-experimental with a volunteer sample of 494 Quit and Win contest registrants (treatment group) and 512 randomly selected tobacco users not exposed to the promotional media campaign (control group). Intervention included a 30-day quit period to be eligible for large cash prizes; provider advice via weekly mailings; online and telephone quit assistance; media campaign; and community support. Setting. Community-based intervention in Kentucky. Subjects. A total of 1006 adult tobacco users. Measures. Quit rates were measured using 7-day point prevalence for tobacco use. Urine cotinine measurements confirmed self-reported quitting. Results. Treatment group participants were significantly more likely than controls to experience quitting during the 1-year follow-up, as determined by both self-report and urine confirmation. After adjusting for baseline differences in demographics, tobacco use, and stage of change, those in the treatment group had 2.6 times the odds of reporting quitting in the postintervention period and 5.3 times the odds of experiencing quitting confirmed by urine cotinine, relative to controls. Women, minorities, and low-income tobacco users had equal odds of quitting as men, whites, and those with higher incomes. Conclusions. That the contest was minimally intensive and yielded a relatively high quit rate demonstrates the potential effectiveness of the intervention.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky College of Nursing and College of Public Health, Tobacco Policy Research Program, Lexington, Kentucky 40536-0232, USA.
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Huntington-Moskos L, Rayens MK, Wiggins A, Hahn EJ. Radon, Secondhand Smoke, and Children in the Home: Creating a Teachable Moment for Lung Cancer Prevention. Public Health Nurs 2016; 33:529-538. [PMID: 27443982 DOI: 10.1111/phn.12283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study determined whether having minor children in the home was associated with the teachable moment (TM) constructs of lung cancer worry, perceived risk, health-related self-concept, and the novel construct of synergistic risk. DESIGN AND SAMPLE Secondary data analysis of baseline data from a randomized controlled trial of an intervention to reduce home exposure to radon and secondhand smoke (SHS). Quota sample of adults recruited at a Central Kentucky academic medical center (N = 556). MEASURES Survey items assessed lung cancer worry, perceived risk, synergistic risk perception, and health-related self-concept. RESULTS The presence of children in the home was not a significant predictor of any construct needed to create a TM for lung cancer prevention. Individuals with children living in the home were more likely to be younger, a racial/ethnic minority, a current smoker, and live with a smoker compared to those without children in the home. CONCLUSIONS There is a critical need to raise parental awareness on child health inequities related to the home exposure to radon and SHS. Public health nurses can create TMs for lung cancer prevention through greater awareness of the risks posed by radon and SHS along with promoting home testing and low-cost resources to reduce risk.
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Affiliation(s)
| | - Mary Kay Rayens
- BREATHE, University of Kentucky (UK), College of Nursing, Lexington, Kentucky
| | - Amanda Wiggins
- BREATHE, University of Kentucky (UK), College of Nursing, Lexington, Kentucky
| | - Ellen J Hahn
- BREATHE, University of Kentucky (UK), College of Nursing, Lexington, Kentucky
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Abstract
Although federal law requires all public schools to be smoke free, lack of compliance with the smoke-free policy is commonly reported. The aims of this study were to describe the indoor fine-particle (PM2.5) air pollution in a rural high school and surrounding public venues. This cross-sectional, nonexperimental study was conducted in Monroe County, Kentucky (population of 11,756). Fine-particle concentrations were measured in the high school and 5 public venues using spectrometers. Because of illegal student smoking, PM2.5 concentrations were 19 times higher in the boys’ student restroom than the National Ambient Air Quality Standard for outdoor air (670 vs. 35 μg/m3). The staff restrooms adjacent to the student restroom where staff did not smoke also showed high PM2.5 levels. Average indoor air pollution in the public venues was 158 μg/m3. Strict enforcement of smoke-free school policy and cessation resources are needed to reduce secondhand smoke exposure. Collaborative school-community campaigns involving parents, students, mass media, and community organizations may be effective in reducing the harm caused by tobacco. Implications for school nurses are discussed.
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Affiliation(s)
- Kiyoung Lee
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
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Abstract
This article presents a policy analysis of proposed smoke-free legislation in Kentucky during the 2015 General Assembly. Kingdon's three streams model of agenda setting is used to analyze the failure to pass HB145. Secondhand smoke exposure and related deaths are a significant public health problem in Kentucky, a state with one of the highest smoking rates in the U.S. HB145, a comprehensive smoke-free bill, was designed to protect workers and the general public from secondhand smoke and e-cigarette aerosol in enclosed workplaces and public places, with few exemptions. The bill faced intense criticism from opponents who were concerned about violation of personal and business rights and the belief that the decision should be addressed on a local level. HB145 passed the House with amendments but failed to receive a hearing in the Senate. Failure of the smoke-free legislation was due to partisanship, fragmentation of advocacy groups, lack of political bargaining, and conflict of values. As in past years, the policy window did not open for state smoke-free legislation in 2015.
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Affiliation(s)
| | - Ellen J Hahn
- University of Kentucky, College of Nursing, Lexington, KY, USA
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Noland M, Ickes MJ, Rayens MK, Butler K, Wiggins AT, Hahn EJ. Social influences on use of cigarettes, e-cigarettes, and hookah by college students. J Am Coll Health 2016; 64:319-328. [PMID: 26822236 PMCID: PMC4913463 DOI: 10.1080/07448481.2016.1138478] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences. PARTICIPANTS Undergraduate students attending a large university in the Southeast United States (N = 511). METHODS An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics. RESULTS Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco. CONCLUSION To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies.
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Affiliation(s)
- Melody Noland
- a Department of Kinesiology and Health Promotion , College of Education, University of Kentucky , Lexington , Kentucky , USA
| | - Melinda J Ickes
- a Department of Kinesiology and Health Promotion , College of Education, University of Kentucky , Lexington , Kentucky , USA
| | - Mary Kay Rayens
- b Tobacco Policy Research Program, College of Nursing, University of Kentucky , Lexington , Kentucky , USA
| | - Karen Butler
- c College of Nursing, University of Kentucky , Lexington , Kentucky , USA
| | - Amanda T Wiggins
- b Tobacco Policy Research Program, College of Nursing, University of Kentucky , Lexington , Kentucky , USA
| | - Ellen J Hahn
- d Tobacco Policy Research Program, College of Nursing, University of Kentucky , Lexington , Kentucky , USA
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Huntington-Moskos L, Rayens MK, Hall LA, Hahn EJ. The Peer and Family Smoking Index: A Valid Measure of Secondhand Smoke Exposure in Adolescents. J Adolesc Health 2016; 58:446-450. [PMID: 26856961 DOI: 10.1016/j.jadohealth.2015.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Nearly half of all adolescents in the United States are exposed to secondhand smoke (SHS) daily, primarily at home, resulting in respiratory infections, asthma exacerbations, and reduced lung function. A concise self-report measure is needed to identity adolescents exposed to SHS. The purpose of this study was to test whether nonsmoking adolescents who reported exposure to peer and/or family smoking on the Peer and Family Smoking Index had higher salivary cotinine levels than those reporting no exposure to either peer or family smoking. METHODS A convenience sample of 135 English-speaking adolescents ages 15-18 years was recruited from two high schools. Those who reported use of nicotine replacement therapy, cigarette smoking (past 30 days), smokeless tobacco use (past 30 days), or who self-reported pregnancy were excluded. Salivary cotinine and self-report data from the Peer and Family Smoking Index were collected after obtaining parental consent and assent from the adolescent. RESULTS Mean salivary cotinine levels differed by exposure group (none, family, peer, or family and peer), F (3, 130) = 5.44, p = .001. The post hoc analysis identified a significantly higher mean cotinine level among those exposed to SHS from both family and peers than among those with no exposure (p = .001). CONCLUSIONS Known groups validity of the index was supported. Adolescents who reported family smoking or a combination of family and peer smoking had significantly higher salivary cotinine levels than unexposed adolescents. The Peer and Family Smoking Index is a concise and valid self-report measure for SHS exposure in adolescents.
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Affiliation(s)
| | - Mary Kay Rayens
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Ellen J Hahn
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, Kentucky
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Ickes MJ, Butler K, Rayens MK, Noland M, Wiggins AT, Hahn EJ. Recall and Believability of the Tips From Former Smokers Campaign Among University Students. Am J Health Educ 2016; 47:324-331. [PMID: 28396713 DOI: 10.1080/19325037.2016.1203841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tobacco media campaigns are effective, but less is known regarding the impact on college students. PURPOSE The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. METHODS A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students (N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling. RESULTS Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (p<.05). Believability was greater for those who recalled seeing the ads more often (p<.05). DISCUSSION Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. TRANSLATION TO HEALTH EDUCATION PRACTICE Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.
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Affiliation(s)
- Melinda J Ickes
- Assistant Professor in the Department of Kinesiology and Health Promotion at University of Kentucky in Lexington, Kentucky
| | - Karen Butler
- Associate Professor in the College of Nursing at University of Kentucky in Lexington, Kentucky
| | - Mary Kay Rayens
- Professor in the College of Nursing at University of Kentucky
| | - Melody Noland
- Professor in the Department of Kinesiology and Health Promotion at University of Kentucky
| | - Amanda T Wiggins
- Assistant Professor in the and College of Nursing at University of Kentucky
| | - Ellen J Hahn
- Professor in the College of Nursing at University of Kentucky
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Okoli CTC, Rayens MK, Wiggins AT, Ickes MJ, Butler KM, Hahn EJ. Secondhand tobacco smoke exposure and susceptibility to smoking, perceived addiction, and psychobehavioral symptoms among college students. J Am Coll Health 2016; 64:96-103. [PMID: 26503903 PMCID: PMC5523056 DOI: 10.1080/07448481.2015.1074240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine the association of secondhand smoke (SHS) exposure with susceptibility to smoking, perceived addiction, and psychobehavioral effects of exposure among never- and ever-smoking college students. PARTICIPANTS Participants were 665 college students at a large, southeastern university in the United States. METHODS This study is a secondary analysis of online cross-sectional survey data from randomly selected students in April 2013. RESULTS Thirty-eight percent of the sample had moderate to high SHS exposure. Among never-smokers, SHS exposure was associated with increased susceptibility to initiating smoking. Among ever-smokers, SHS exposure was not associated with their perceived addiction to tobacco. In the total sample, SHS exposure was associated with greater psychobehavioral symptoms of exposure. CONCLUSIONS SHS exposure may the increase risk of smoking, especially among never-smoking college students. This study strengthens the need for prevention strategies that limit SHS exposure in college environments.
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Affiliation(s)
| | - Mary Kay Rayens
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Amanda T Wiggins
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Melinda J Ickes
- b University of Kentucky College of Education Lexington , Kentucky
| | - Karen M Butler
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Ellen J Hahn
- a University of Kentucky College of Nursing Lexington , Kentucky
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Rayens MK, Butler KM, Wiggins AT, Kostygina G, Langley RE, Hahn EJ. Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities. Nicotine Tob Res 2015; 18:1340-7. [PMID: 26385925 DOI: 10.1093/ntr/ntv197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 09/01/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. METHODS Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. RESULTS Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. CONCLUSIONS Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. IMPLICATIONS Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level.
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Affiliation(s)
- Mary Kay Rayens
- Tobacco Policy Research Program, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY;
| | - Karen M Butler
- Tobacco Policy Research Program, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY
| | - Amanda T Wiggins
- Tobacco Policy Research Program, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY
| | - Ganna Kostygina
- Tobacco Policy Research Program, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY
| | | | - Ellen J Hahn
- Tobacco Policy Research Program, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY
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Abstract
Purpose. To compare the retail distribution and density per population of electronic and conventional cigarettes in smoke-free communities with and without e-cigarette restrictions. Design. A cross-sectional study with field observations of retail tobacco stores. Setting. Two Central Kentucky counties with 100% smoke-free workplace regulations; counties selected on the basis of whether e-cigarette use was restricted. Subjects. Fifty-seven tobacco retailers in two counties, including conventional retailers and stand-alone e-cigarette stores. Measures. Type and location of store and products sold; addresses of stores and schools geocoded with ArcGIS. Analysis. Bivariate comparisons between counties, rates and confidence intervals for frequency of tobacco retailers and e-cigarette stores per population. Results. Fifty-three percent of tobacco retailers sold e-cigarettes. E-cigarette availability did not differ by whether smoke-free regulation covered e-cigarettes. Rates of tobacco retailers and e-cigarette distributors per 10,000 were 8.29 and 4.40, respectively, in the two-county area. Of the 40 schools, 88% had a tobacco retailer and 68% had an e-cigarette distributor within 1 mile. Conclusion. In this exploratory study, e-cigarette use restriction was not related to store availability. For a relatively new product, e-cigarettes were readily available in retail outlets and close to schools.
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Abstract
Objective Exposure to radon is associated with approximately 10% of U.S. lung cancer cases. Geologic rock units have varying concentrations of uranium, producing fluctuating amounts of radon. This exploratory study examined the spatial and statistical associations between radon values and geological formations to illustrate potential population-level lung cancer risk from radon exposure. Method This was a secondary data analysis of observed radon values collected in 1987 from homes (N = 309) in Kentucky and geologic rock formation data from the Kentucky Geological Survey. Radon value locations were plotted on digital geologic maps using ArcGIS and linked to specific geologic map units. Each map unit represented a package of different types of rock (e.g., limestone and/or shale). Log-transformed radon values and geologic formation categories were compared using one-way analysis of variance. Results Observed radon levels varied significantly by geologic formation category. Of the 14 geologic formation categories in north central Kentucky, four were associated with median radon levels, ranging from 8.10 to 2.75 pCi/L. Conclusion Radon potential maps that account for geologic factors and observed radon values may be superior to using observed radon values only. Knowing radon-prone areas could help target population-based lung cancer prevention interventions given the inequities that exist related to radon. We examine spatial and statistical associations between radon and rock formations. Observed radon levels vary significantly by geologic formation category. Four rock types are associated with high radon levels. Mapping both rock formations and radon values may be better than radon alone.
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Affiliation(s)
- Ellen J. Hahn
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
- Corresponding author at: University of Kentucky College of Nursing, 751 Rose St.Lexington, KY 40536-0232, United States.
| | - Yevgeniya Gokun
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | | | | | - Heather Robertson
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | - Amanda Wiggins
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | - Mary Kay Rayens
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
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Lee K, Hwang Y, Hahn EJ, Bratset H, Robertson H, Rayens MK. Secondhand smoke exposure is associated with smoke-free laws but not urban/rural status. J Air Waste Manag Assoc 2015; 65:624-627. [PMID: 25947320 DOI: 10.1080/10962247.2015.1006376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED The objective was to determine secondhand smoke (SHS) exposure with and without smoke-free laws in urban and rural communities. The research hypothesis was that SHS exposure in public places could be improved by smoke-free law regardless of urban and rural status. Indoor air quality in hospitality venues was assessed in 53 communities (16 urban and 37 rural) before smoke-free laws; 12 communities passed smoke-free laws during the study period. Real-time measurements of particulate matter with 2.5 µm aerodynamic diameter or smaller (PM2.5) were taken 657 times from 586 distinct venues; about 71 venues had both pre- and post-law measurements. Predictors of log-transformed PM2.5 level were determined using multilevel modeling. With covariates of county-level percent minority population, percent with at least high school education, adult smoking rate, and venue-level smoker density, indoor air quality was associated with smoke-free policy status and venue type and their interaction. The geometric means for restaurants, bars, and other public places in communities without smoke-free policies were 22, 63, and 25 times higher than in those with smoke-free laws, respectively. Indoor air quality was not associated with urban status of venue, and none of the interactions involving urban status were significant. SHS exposure in public places did not differ by urban/rural status. Indoor air quality was associated with smoke-free law status and venue type. IMPLICATIONS This study analyzed 657 measurements of indoor PM2.5 level in 53 communities in Kentucky, USA. Although indoor air quality in public places was associated with smoke-free policy status and venue type, it did not differ by urban and rural status. The finding supports the idea that population in rural communities can be protected with smoke-free policy. Therefore, it is critical to implement smoke-free policy in rural communities as well as urban areas.
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Affiliation(s)
- Kiyoung Lee
- a Graduate School of Public Health and Institute of Health and Environment, Seoul National University , Seoul , Korea
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Butler KM, Ickes MJ, Rayens MK, Wiggins AT, Hahn EJ. Polytobacco Use Among College Students. Nicotine Tob Res 2015; 18:163-9. [PMID: 25770131 DOI: 10.1093/ntr/ntv056] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students. METHODS Of 10,000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users were included in this study (n = 662, or 41.6% of survey completers). RESULTS About 15% of ever users reported current polytobacco use, and more than 70% of polytobacco users smoked cigars, little cigars, or clove cigarettes in combination with one or more products. Cigarettes were the most commonly-used product among single users, followed by hookah. Males, underclassmen, and students with greater acceptance of cigarette use were more likely to be polytobacco users. Race/ethnicity was marginally related to polyuse status, with white/non-Hispanics 28% less likely to be polytobacco users versus single product users. CONCLUSIONS Polytobacco users were more likely than single users to consume emerging tobacco products, (ie, hookah and electronic cigarettes). Males, underclassmen, and racial/ethnic minorities were more at risk for polytobacco use. As young people are particularly prone to nicotine addiction, there is a need to further investigate polytobacco use among college students.
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Affiliation(s)
- Karen M Butler
- College of Nursing, University of Kentucky, Lexington, KY;
| | - Melinda J Ickes
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, KY
| | | | | | - Ellen J Hahn
- Colleges of Nursing and Public Health, University of Kentucky, Lexington, KY
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Riker CA, Butler KM, Ricks JM, Record RA, Begley K, Anderson DG, Hahn EJ. Creating Effective Media Messaging for Rural Smoke-free Policy. Public Health Nurs 2015; 32:613-24. [PMID: 25731895 DOI: 10.1111/phn.12188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents. DESIGN AND SAMPLE Qualitative methods design. Thirty-nine rural adults recruited by community partners. MEASURES Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy. RESULTS Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials. CONCLUSIONS Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS.
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Affiliation(s)
- Carol A Riker
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Karen M Butler
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - JaNelle M Ricks
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Kathy Begley
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Ellen J Hahn
- Colleges of Nursing and Public Health, University of Kentucky, Lexington, Kentucky
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Ickes MJ, Rayens MK, Wiggins AT, Hahn EJ. A tobacco-free campus ambassador program and policy compliance. J Am Coll Health 2015; 63:126-33. [PMID: 25612060 PMCID: PMC4334676 DOI: 10.1080/07448481.2014.990972] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Assess impact and feasibility of a Tobacco-Free Ambassador Program on campus policy compliance. PARTICIPANTS Trained Ambassadors made 253 visits to campus sites over 15 months to observe and/or approach violators. METHODS Policy violators were observed at 23 locations during Wave 1 (April-June 2012) and/or Wave 2 (April-June 2013). For locations with at least 5 visits, average violators per visit were compared between the 2 waves using a paired t test. Attributes of violators were summarized. Cigarette butts were collected over 3-day periods in 4 campus hotspots during each wave. Personnel time and cost to implement the program were determined. RESULTS There were declines in observed violators per Ambassador visit and number of cigarette butts over time. Rate of violators per visit declined from 5.47 to 1.93, a 65% decrease. Personnel time was equal to 1.5 full-time equivalents annually. CONCLUSIONS The Ambassador Program was a feasible and potentially effective strategy to increase policy compliance.
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Affiliation(s)
- Melinda J Ickes
- a Department of Kinesiology and Health Promotion, College of Education, University of Kentucky , Lexington , Kentucky
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Abstract
Secondhand smoke exposure is a major public health issue, increasing the risk of cardiovascular and respiratory diseases and cancer. Although best practices for adopting smoke-free policy are well understood, there is limited research on the effective implementation of smoke-free policy. This article presents theoretical and practical considerations for smoke-free policy implementation in three Kentucky communities guided by the Institutional Analysis and Development (IAD) Framework. Although both Danville and Lexington-Fayette County, Kentucky have comprehensive smoke-free policies, Danville had more effective implementation, as well as better outcomes. Further study is needed to understand the critical elements of smoke-free policy implementation and their association with population outcomes. The IAD is a promising model to guide the study of both policy adoption and implementation.
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Affiliation(s)
- Amanda Fallin
- Tobacco Policy Research Program, University of Kentucky, Lexington, KY, USA
| | - Amie Goodin
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- Tobacco Policy Research Program, University of Kentucky, Lexington, KY, USA
| | - Sarah Morris
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Butler KM, Begley K, Riker C, Gokun Y, Anderson D, Adkins S, Record R, Hahn EJ. Smoke-free coalition cohesiveness in rural tobacco-growing communities. J Community Health 2014; 39:592-8. [PMID: 24338076 DOI: 10.1007/s10900-013-9804-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.
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Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, 423 College of Nursing, University of Kentucky, Lexington, KY, 40536, USA,
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Abstract
AIMS The existence of smokers who are resistant to smoking cessation treatment has long been noted in the literature. There has been ongoing debate as to whether the proportion of these smokers is increasing as smoking prevalence rates stagnate. Studies define hardcore smokers inconsistently and within the context of specific illnesses, addiction, population, and/or theoretical paradigms. This review examines the existing literature related to hardcore smokers to develop a better understanding of what is known and not known about this group to guide smoking cessation treatment. METHODS PubMed MESH search and review of research publications from 1998 to 2012 (N=61). RESULTS Inconsistent definitions of hardcore smoking make it difficult to estimate prevalence rates and to identify specific characteristics of persistent smokers. Generally, persistent smokers have higher levels of nicotine dependence, are disproportionately from lower socioeconomic groups, start smoking at an earlier age, and are more likely to have a psychological co-morbidity. DISCUSSION Defining some smokers as hardcore is limiting. Targeted and tailored interventions for smoking cessation for persistent smoking have demonstrated effectiveness in a small number of studies. Treatment access barriers need to be addressed to improve the reach and effectiveness of cessation with persistent smokers. Efforts to limit early age initiation of tobacco use are a critical element in averting persistent smoking.
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Affiliation(s)
- Audrey Darville
- UK HealthCare, USA; University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA.
| | - Ellen J Hahn
- University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA; Tobacco Policy Research Program and Kentucky Center for Smoke-free Policy, USA; Center for Biobehavioral Research in Self-Management, Lexington, KY, USA
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Ickes M, Gokun Y, Rayens MK, Hahn EJ. Comparing Two Observational Measures to Evaluate Compliance With Tobacco-Free Campus Policy. Health Promot Pract 2014; 16:210-7. [DOI: 10.1177/1524839914561060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite potential benefits of tobacco-free campus policies, compliance remains a challenge. Observational measures hold the most promise in determining compliance with these policies. There is need for further study to determine validity of observational measures of compliance with tobacco-free campus policies. The purpose of this study was to determine the validity of two observational measures of compliance with a tobacco-free campus policy: direct observation of violators and cigarette butts. Data collection took place over a 1-year time period. Direct observation was operationally defined as the number of observed violators in hot spots. A cigarette butt protocol previously found to be reliable was used to count the number of butts in campus hot spots. Results indicated a positive relationship between number of violators observed per visit and number of cigarette butts collected. Although most of the hot spots exhibited two or fewer violators per visit and 100 butts or fewer per collection, the data points outside this range supported a positive association between observed violators per visit and cigarette butts. The findings support that direct observation of violators is a valid measure of compliance compared to cigarette butts. Given available resources, using one or the other as evaluation measures is warranted.
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Affiliation(s)
- Melinda Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Yevgeniya Gokun
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
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Abstract
PURPOSE Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities. METHODS A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years. FINDINGS Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties. CONCLUSIONS The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky College of Nursing, Tobacco Policy Research Program, Kentucky Center for Smoke-Free Policy, Lexington, Kentucky
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Cho H, Lee K, Hwang Y, Richardson P, Bratset H, Teeters E, Record R, Riker C, Hahn EJ. Outdoor tobacco smoke exposure at the perimeter of a tobacco-free university. J Air Waste Manag Assoc 2014; 64:863-866. [PMID: 25185388 DOI: 10.1080/10962247.2014.896295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There are few studies measuring exposure to outdoor tobacco smoke (OTS). Tobacco users often gather at the boundaries of tobacco-free campuses, resulting in unintended consequences. The objective of this study was to measure exposure levels from OTS on sidewalks bordering a tobacco-free university campus. Data were collected while walking along a sidewalk adjacent to a medium traffic road between May and August 2011. Monitoring occurred during "background," "stop," and "walk-through" conditions at and near hot spot area to measure fine particulate matter (< 2.5 microm; PM2.5) from OTS using a portable aerosol monitor The average PM2.5 levels during stop and walk-through conditions were significantly higher than during background conditions. PM2.5 peak occurrence rate and magnitude of peak concentration were significantly different depending on smoking occurrence. The peak occurrence rate during the stop condition was 10.4 times higher than during the background condition, and 3.1 times higher than during the walk-through condition. Average peak PM2.5 concentrations during the stop condition were 48.7% higher than during the background condition. In conclusion, individuals could be exposed to high levels of PM2.5 when stopping or even passing by smokers outdoors at the perimeter of tobacco-free campuses. The design and implementation of tobacco-free campus policies need to take into account the unintended consequences of OTS exposure at the boundaries. Implications: In this study, outdoor tobacco smoke (OTS) exposure was measured at the perimeter of tobacco-free campus. OTS exposure could be determined by peak analysis. Peak occurrence rate and peak concentration for OTS exposure were identified by using peak analysis. People could be exposed to high levels of PM2.5 when standing or even passing by smokers at the perimeter of tobacco-free campus. OTS exposure measurement in other outdoor locations with smokers is needed to support outdoor smoking regulation.
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Hahn EJ, Rayens MK, Adkins S, Simpson N, Frazier S, Mannino DM. Fewer hospitalizations for chronic obstructive pulmonary disease in communities with smoke-free public policies. Am J Public Health 2014; 104:1059-65. [PMID: 24825207 DOI: 10.2105/ajph.2014.301887] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). METHODS We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. RESULTS Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban-rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate-weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. CONCLUSIONS Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs.
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Affiliation(s)
- Ellen J Hahn
- Ellen J. Hahn, Mary Kay Rayens, and Nick Simpson are with the Tobacco Policy Research Program, University of Kentucky College of Nursing and College of Public Health, Lexington. Sarah Adkins and Susan Frazier are with the University of Kentucky College of Nursing. Susan Frazier is also with the RICH Heart Program, University of Kentucky College of Nursing. David M. Mannino is with the Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health
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Hahn EJ, Riker CA, Brown H. E-cigarettes: what nurses need to know. Ky Nurse 2014; 62:6. [PMID: 24791354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hahn EJ, Rayens MK, Kercsmar SE, Robertson H, Adkins SM. Results of a Test and Win Contest to Raise Radon Awareness in Urban and Rural Settings. American Journal of Health Education 2014. [DOI: 10.1080/19325037.2013.875960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kostygina G, Hahn EJ, Rayens MK. 'It's about the smoke, not the smoker': messages that motivate rural communities to support smoke-free policies. Health Educ Res 2014; 29:58-71. [PMID: 23969628 PMCID: PMC3894665 DOI: 10.1093/her/cyt087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Rural residents are exposed to sophisticated tobacco advertising and tobacco growing represents an economic mainstay in many rural communities. There is a need for effective health messages to counter the pro-tobacco culture in these communities. To determine relevant cultural themes and key message features that affect receptivity to pro-health advertisements among rural residents, 11 exploratory focus groups and surveys with community advocates (N = 82) in three rural Kentucky counties were conducted. Participants reviewed and rated a collection of print media advertisements and branding materials used by rural communities to promote smoke-free policies. Findings reveal that negative emotional tone, loss framing, appeals to religiosity, and shifting focus away from smokers are effective strategies with rural audiences. Potential pitfalls were identified. Attacks on smokers may not be a useful strategy. Health risk messages reinforced beliefs of secondhand smoke harm but some argued that the messages needed to appeal to smokers and emphasize health hazards to smokers, rather than to non-smokers only. Messages describing ineffectiveness of smoking sections were understood but participants felt they were only relevant for restaurants and not all public spaces. Emphasis on religiosity and social norms shows promise as a culturally sensitive approach to promoting smoke-free environments in rural communities.
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Affiliation(s)
- Ganna Kostygina
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA and Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Ellen J. Hahn
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA and Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, KY, USA
- *Correspondence to: E. J. Hahn. E-mail:
| | - Mary Kay Rayens
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA and Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, KY, USA
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Abstract
PURPOSE The study investigated the relationships among local smoke-free public policies, county-level quitline call rate, and adult smoking status. DESIGN A retrospective cross-sectional examination of demographic characteristics, smoking status of Kentuckians, and data from the Kentucky Tobacco Quitline were used to investigate the relationship of local smoke-free ordinances or Board of Health regulations together with county-level quitline use rates and population-level adult smoking status. SETTING One hundred and four Kentucky counties. SUBJECTS The sample was comprised of 14,184 Kentucky participants with complete demographic information collected from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS). MEASURES Individual-level demographics and smoking status from the BRFSS; county-level urban/rural status; quitline rates; and smoke-free policy status. ANALYSIS Given the hierarchical structure of the dataset, with BRFSS respondents nested within county, multilevel modeling was used to determine the predictors of smoking status. RESULTS For every 1-unit increase in the county-level call rate the likelihood of current smoking status decreased by 9%. Compared to those living in communities without a policy, those in communities with a smoke-free public policy were 18% less likely to be current smokers. Limitations include quitline call rate as the sole indicator of cessation demand, as well as the cross-sectional design. CONCLUSION Communities with smoke-free policies and higher rates of quitline use have lower rates of adult smoking.
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Butler KM, Rayens MK, Adkins S, Record R, Langley R, Derifield S, McGinn C, Murray D, Hahn EJ. Culturally-specific smoking cessation outreach in a rural community. Public Health Nurs 2014; 31:44-54. [PMID: 24387774 DOI: 10.1111/phn.12066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Tobacco use is the leading preventable cause of death, resulting in 443,000 US deaths per year. Rural adults have higher smoking prevalence and less access to tobacco dependence treatment than their urban counterparts. This study examined exposure to a culturally specific smoking cessation outreach intervention, assessing whether exposure was associated with cessation behaviors. DESIGN AND SAMPLE Post-test only quasi-experimental study. Targeted adult smokers (N = 251) living in a rural, economically distressed southeastern US county for at least 6 months. MEASUREMENTS Five outreach elements (brochures/pushcards, posters, print and radio advertisements, quilt made by local artisans) based on themes from focus groups with current and former smokers and paired with brief tobacco cessation counseling, and were delivered over 6 months in 2009-2010. Exposure and cessation behavior indicators were collected via cross-sectional random-digit dial survey. The total intervention exposure score was 4.8 (SD = 4.3, range 0-19). RESULTS Intervention exposure was associated with having talked to a health care provider about quitting smoking in the past 6 months and planning to quit smoking in the next 6 months. CONCLUSIONS Culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation.
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Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, Kentucky
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Rinker GH, Hahn EJ, Rayens MK. Residential radon testing intentions, perceived radon severity, and tobacco use. J Environ Health 2014; 76:42-47. [PMID: 24645412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Kentucky homeowners requesting radon test kits through the Kentucky Radon Program and randomly selected homeowners (N = 129) completed a survey assessing factors related to their radon testing intentions and perceived severity of radon exposure, including social influence, perceived susceptibility, synergistic risk perception, and tobacco use. Perceived severity, social influence, and current smoking were the strongest predictors of radon testing intentions. Those with higher perceived severity were nearly eight times more likely to plan to test. Perceived severity was highest among females and those rating combined radon and tobacco smoke exposure as much riskier than tobacco smoke alone. Knowing someone who had tested for radon was associated with seven times greater likelihood of planning to test for radon. Current smokers were over six times more likely to plan to test than nonsmokers. The findings have implications for targeting interventions to improve residential radon testing and decrease lung cancer risk.
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Hahn EJ, Rayens MK, Kercsmar SE, Adkins SM, Wright AP, Robertson HE, Rinker G. Dual home screening and tailored environmental feedback to reduce radon and secondhand smoke: an exploratory study. J Environ Health 2014; 76:156-161. [PMID: 24645427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Combined exposure to secondhand smoke (SHS) and radon increases lung cancer risk 10-fold. The authors assessed the feasibility and impact of a brief home screening and environmental feedback intervention to reduce radon and SHS (Freedom from Radon and Smoking in the Home [FRESH]) and measured perceived risk of lung cancer and synergistic risk perception (SHS x radon). Participants (N = 50) received home radon and SHS kits and completed baseline surveys. Test results were shared using an intervention guided by the Teachable Moment Model. Half of the participants completed online surveys two months later. Most (76%) returned the radon test kits; 48% returned SHS kits. Of the returned radon test kits, 26% were >4.0 pCi/L. Of the returned SHS kits, 38% had nicotine > .1 microg/m3. Of those with high radon, more than half had contacted a mitigation specialist or planned contact. Of those with positive air nicotine, 75% had adopted smoke-free homes. A significant increase occurred in perceived risk for lung cancer and synergistic risk perception after FRESH.
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Fallin A, Johnson AO, Riker C, Cohen E, Rayens MK, Hahn EJ. An intervention to increase compliance with a tobacco-free university policy. Am J Health Promot 2013; 27:162-9. [PMID: 23286592 DOI: 10.4278/ajhp.110707-quan-275] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To test the effects of a population-based self-efficacy message card campaign on compliance with a tobacco-free campus policy. SETTING This study was conducted at a large public university in the South. SUBJECTS Three hundred twelve observational periods at 39 campus sites. INTERVENTION The message card campaign, based on the Theory of Planned Behavior, consisted of distributing approximately 6000 efficacy-enhancing cards over 3 days. The intent of the cards was to increase awareness of the policy and resources available to help individuals stop smoking or remain comfortable while on campus. MEASURES Policy compliance was measured using the Tobacco-Free Compliance Assessment Tool. Field notes were used to assess campaign reaction. ANALYSIS Mann-Whitney U-test was conducted to compare number of cigarette butts in hot spot areas before and after the intervention. A rate ratio was also calculated using Geographic Information System (GIS) mapping software to compare cigarette butts collected per day before and after the intervention at each of the study sites. RESULTS The median number of cigarette butts per day after the intervention was significantly lower than before the intervention (1.9 vs. 4.7, χ(2): 8.1, p = .004). Eighteen sites (66.6%) had a post-pre ratio of .11 to .75, indicating a decrease in cigarette butts per day. CONCLUSION An efficacy-enhancing message card campaign shows promise in improving compliance with tobacco-free campus policies.
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Affiliation(s)
- Amanda Fallin
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA.
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Butler KM, Rayens MK, Ashford K, Adkins S, Gombeski B, Britt J, Hahn EJ. Smoke-free homes, strength of smoke-free law, and children in the home. Nicotine Tob Res 2013; 16:485-90. [PMID: 24302637 DOI: 10.1093/ntr/ntt191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics. METHODS An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law. RESULTS Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers. CONCLUSIONS Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.
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Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY
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Abstract
INTRODUCTION One in five college students report tobacco use, thus universities are making strides to reduce tobacco use by adopting smoke- or tobacco-free policies. PURPOSE Describe an innovative ambassador program to increase adherence with a tobacco-free campus policy. METHODS The Tobacco-Free Take Action! (TFTA!) Ambassador program was created to form an environment of compliance. Hot spots were targeted by Ambassadors, who were trained to use scripted messages. Ambassadors completed an online documentation form to assess the number of violators observed and approached. The Tobacco-Free Compliance Assessment Tool (TF-CAT) was used to collect pre- and post-cigarette butt data at each hot spot. RESULTS During the 4-week intervention period, Ambassadors approached 332 violators (529 observed), of which 68% responded positively and complied with the policy. The number of cigarette butts declined by 25%. DISCUSSION Adherence with campus tobacco-free policies remains a challenge. Lessons learned from this innovative approach will benefit those currently implementing and planning tobacco-free campus policies.
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Affiliation(s)
- Melinda J Ickes
- Assistant Professor in the Department of Kinesiology and Health Promotion at the University of Kentucky. She is Director of University of Kentucky's Tobacco-free Take Action!
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87
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Abstract
The purpose was to determine factors associated with rural communities' political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials' perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.
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Affiliation(s)
- Mary Kay Rayens
- University of Kentucky College of Nursing, Lexington, KY 40526, USA.
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88
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Abstract
Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak policies. The study determined whether overall strength of Resources, Capacity, and Efforts in tobacco control predicts readiness for smoke-free policy in rural communities, controlling for county population size and pounds of tobacco produced. This was a correlational, cross-sectional analysis of data from key informants (n = 148) and elected officials (n = 83) from 30 rural counties who participated in telephone interviews examining smoke-free policy. Six dimensions of community readiness (knowledge, leadership, resources, community climate, existing smoke-free policies, and political climate) were identified and summed to assess overall readiness for smoke-free policy. General strength of overall Resources, Capacity and Efforts in tobacco control at the county level was measured. Readiness for smoke-free policy was lower in communities with higher smoking rates, higher tobacco production, and smaller population. Efforts related to general tobacco control (i.e., media advocacy, training, and technical assistance) predicted readiness for local smoke-free policy development (standardized β = .35, p = .05), controlling for county population size and pounds of tobacco produced. Given that small, rural tobacco-growing communities are least ready for smoke-free policy change, tailoring and testing culturally sensitive approaches that account for this tobacco-growing heritage are warranted.
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Affiliation(s)
- Ellen J. Hahn
- University of Kentucky College of Nursing, Tobacco Policy Research Program, Lexington, KY
| | - Mary Kay Rayens
- University of Kentucky College of Nursing, Tobacco Policy Research Program, Lexington, KY
| | - Nancy York
- Bellarmine University, Lansing School of Nursing & Health Sciences, Louisville, KY
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Affiliation(s)
- Amanda Fallin
- University of California, Center for Tobacco Control Research and Education, San Francisco, California 94158, USA.
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Abstract
INTRODUCTION Rural residents in the United States are more likely to use tobacco, have less access to tobacco control resources and efforts, and are more highly exposed to secondhand smoke than their urban counterparts. The purpose was to design and pilot test a shortened, self-administered online survey (Community Readiness Survey-Short form [CRS-S]) to assess community readiness for smoke-free policy in rural communities. The Community Readiness Survey-Long form (CRS-L) is a 30- to 90-min telephone-administered survey. The Community Readiness Model can guide the design of programs and policy interventions to reduce health risks. METHODS 160 key informants from Wave 3 of a 5-year community-based randomized controlled trial set in Kentucky completed the CRS-L; 61 of approximately 140-284 items were significantly related to the relevant readiness dimension subscores and selected for inclusion. The online CRS-S was created with these items using Qualtrics software; 43 smoke-free advocates who had completed the CRS-L during Wave 4 were invited to participate. Correlations between the CRS-S and the CRS-L on overall readiness and the dimension scores were calculated. Readiness scores were correlated with existence of public policy and voluntary smoke-free policies to assess convergent validity. RESULTS The correlation between the overall CRS-S and CRS-L scores was relatively strong (.82), and there is evidence to support convergent validity. Most respondents completed the CRS-S in less than 15 min and preferred this format. CONCLUSIONS The CRS-S is a valid and less time- and resource-intensive method to assess readiness for smoke-free policy in rural communities.
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Affiliation(s)
- Amanda Fallin
- Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, KY, USA.
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92
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Abstract
This article describes a 3-pronged compliance strategy to implement a tobacco-free campus policy at 1 large, land grant public university in the South, and evaluates its impact on outcomes and costs. Although there has been a recent wave of tobacco-free colleges, policy restrictiveness and implementation vary, and compliance remains a challenge. The 3 Ts strategy (Tell-Treat-Train) involves regular, consistent communications, access to tobacco treatment medications and counseling, and ongoing training of supervisors and student leaders. Administrative support, access to tobacco treatment, campus buy-in, sustained communications, and careful implementation planning are critical to instituting a tobacco-free university policy.
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Affiliation(s)
- Ellen J Hahn
- Kentucky Center for Smoke-free Policy, Tobacco Policy Research Program, University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA.
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Hahn EJ, Rayens MK, Burkhart PV, Moser DK. Smoke-free laws, gender, and reduction in hospitalizations for acute myocardial infarction. Public Health Rep 2012; 126:826-33. [PMID: 22043098 DOI: 10.1177/003335491112600608] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI. METHODS We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if (1) the patient was $35 years of age; (2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and (3) the date of service was between January 1, 2001, and December 31, 2006. RESULTS Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law. CONCLUSIONS We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky, College of Nursing, Lexington, KY, USA.
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Abstract
OBJECTIVE The purpose is to describe psychometric testing and feasibility of the Tobacco-Free Compliance Assessment Tool (TF-CAT) to measure tobacco-free policy compliance at a public university and medical center. The aims are to (1) investigate concurrent validity by comparing the number of cigarette butts in areas covered by the policy with those on adjacent sidewalks; (2) evaluate the interrater reliability of the TF-CAT; and (3) describe the feasibility of using the TF-CAT. METHODS Phase I was a pilot study on the health care campus. Phase II was baseline of an intervention study on the main campus. Cigarette butts and smokers were counted in hot spots. Validity was assessed using Mann-Whitney U and Geographical Information System Analysis methods. RESULTS There was some support for the validity and high interrater reliability. Data collectors spent 1 hour per week for 8 weeks during Phase I, and 31 hours in 1 week during Phase II. CONCLUSION TF-CAT is a feasible, time-intensive method to measure tobacco-free policy compliance.
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Affiliation(s)
- Amanda Fallin
- Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, Kentucky, USA.
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Abstract
OBJECTIVES The purpose of this study was to assess attitudes and behaviors related to smoke-free policy among undergraduate student alcohol drinkers on a campus in a community with smoke-free bars. DESIGN AND SAMPLE This was a secondary data analysis of a study in which participants completed mailed surveys assessing demographic characteristics, attitudes and behaviors related to alcohol and tobacco use and smoke-free policy (n = 337). Opinion and behavior items were summarized descriptively; associations were examined using Kruskal Wallis tests and chi-square tests of association. Logistic regression tested for predictors of importance of smoke-free policy. RESULTS Respondents were predominantly female and Caucasian; mean age 20.3 years. One fourth were current smokers. Seventy-nine percent said the community smoke-free law had no effect on frequency of visiting bars. Eighty-seven percent said smoke-free policy in campus buildings was "somewhat" or "very important." Predictors of perceived importance of smoke-free policy included gender and smoking status. CONCLUSIONS Most smokers in this sample did not experience a change in their motivation to quit smoking or in number of cigarettes smoked daily. Implementation of a community smoke-free law did not reduce the likelihood of visiting bars. Women and nonsmokers were more likely to rate smoke-free campus policy as very important.
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Affiliation(s)
- Karen M Butler
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
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Fallin A, Parker L, Lindgreen J, Riker C, Kercsmar S, Hahn EJ. Secular trends and smoke-free policy development in rural Kentucky. Health Educ Res 2011; 26:711-21. [PMID: 21558440 PMCID: PMC3202908 DOI: 10.1093/her/cyr032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 03/15/2011] [Indexed: 05/30/2023]
Abstract
Secondhand smoke (SHS) exposure causes cardiovascular disease, lung cancer and pulmonary disorders. Smoke-free policies are the most effective way to prevent exposure to SHS. A 5-year community-based randomized control trial (RCT) is in progress to assess factors associated with smoke-free policy development in rural communities. Considering secular trends is critical when conducting community-based RCTs as they may threaten the internal validity of the study. For the purposes of this paper, secular trends are defined as patterns or recurring events that are not directly related to smoke-free policy but have the potential to influence policy development. There are no established protocols to monitor secular trends in the study of smoke-free policy in rural communities. The purpose of this paper is to (i) describe the development of a protocol to identify and monitor secular trends that may threaten the internal validity of a community-based RCT to promote smoke-free policy development and (ii) describe secular trends identified in the first 2 years of the RCT. The sample includes 854 secular events captured from media outlets covering the 40 study counties over the first 2 years of the RCT. Of these 854 events, there were 281 secular events in Year 1 and 573 in Year 2. This paper focuses on five specific categories: 'tobacco use and cessation activities', 'farming', 'economics', 'city/county infrastructure' and 'wellness'. This protocol is a feasible yet time-intensive method of identifying events that may threaten the internal validity of a community-based RCT.
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Affiliation(s)
- Amanda Fallin
- Department of Health Behavior, University of Kentucky College of Nursing, Tobacco Policy Research Program, 509 College of Nursing Building, University of Kentucky, 760 Rose Street, Lexington, KY 40536, USA.
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97
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Abstract
INTRODUCTION Numerous empirical studies have examined the influence of smoke-free legislation on economic activity, with most finding a null effect. The influence could possibly differ in rural areas relative to urban areas due to differing rates of smoking prevalence and access to prevention and treatment programs. Furthermore, the discussion of the effectiveness of smoke-free laws has been extended to consider local ordinances relative to statewide laws. This study examines these issues using 21 local laws in Kentucky and the Ohio statewide smoke-free law. METHODS The number of employees, total wages paid, and number of reporting establishments in all hospitality and accommodation services in Kentucky and Ohio counties were documented, beginning the first quarter 2001 and ending the last quarter of 2009. A generalized estimating equation time-series design is used to estimate the impact of local and state smoke-free laws in Kentucky and Ohio rural and urban counties. RESULTS There is no evidence that the economies in Kentucky counties were affected in any way from the implementation of local smoke-free laws. There was also no evidence that total employment or the number of establishments was influenced by the statewide law in Ohio, but wages increased following the implementation of the law. Furthermore, there is no evidence that either rural or urban counties experienced a loss of economic activity following smoke-free legislation. CONCLUSIONS The study finds no evidence that local or state smoke-free legislation negatively influences local economies in either rural or urban communities.
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Affiliation(s)
- Mark K Pyles
- School of Business, College of Charleston, 5 Liberty Street, Suite 400, Charleston, SC 29401, USA.
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Helme DW, Rayens MK, Kercsmar SE, Adkins SM, Amundsen SJ, Lee E, Riker CA, Hahn EJ. Rural print media portrayal of secondhand smoke and smoke-free policy. Health Promot Pract 2011; 13:848-56. [PMID: 21460255 DOI: 10.1177/1524839911399429] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this article is to describe how the print media portrays secondhand smoke and smoke-free policy in rural communities. Baseline print media clips from an ongoing 5-year study of smoke-free policy development in 40 rural communities were analyzed. The authors hypothesized that community population size would be positively associated with media favorability toward smoke-free policy. Conversely, pounds of tobacco produced and adult smoking prevalence would be negatively associated with media favorability. There was a positive correlation between population size and percentage of articles favorable toward smoke-free policy. The authors did not find a correlation between adult smoking or tobacco produced and media favorability toward smoke-free policy, but we did find a positive relationship between tobacco produced and percentage of pro-tobacco articles and a negative relationship between adult smoking prevalence and percentage of articles about health/comfort. Implications for targeting pro-health media in rural communities as well as policy-based initiatives for tobacco control are discussed.
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Abstract
OBJECTIVE The purpose of this study was to determine the factors related to motivation to quit among smoking family members of lung cancer patients. DESIGN AND SAMPLE Relatives of multidisciplinary lung cancer clinic patients were recruited during family members' treatment. Participants (N=29) were primarily female and Caucasian. MEASURES The items assessed included the effect of their relative's disease on motivation to quit, intent to quit in the next 6 months, stage of change, perceived risk from smoking, and attitudes about being approached about cessation. RESULTS Most indicated that their relative's disease had increased motivation to quit smoking (71%); 72% planned to quit within 6 months. One fourth (28%) were in precontemplation stage of change; 65% in contemplation; and 7% in preparation. The average perceived risk of developing lung cancer was 6.3. Two thirds were glad or very glad that someone had talked with them about quitting; 91% thought it was somewhat or very appropriate to talk about cessation with family members of lung cancer patients. Motivation to quit smoking was positively correlated with stage of change and perceived lung cancer risk. CONCLUSIONS Public health nurses who interact with families of lung cancer patients may be able to promote cessation in an at-risk group that is motivated to quit smoking.
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Affiliation(s)
- Karen M Butler
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
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100
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Abstract
CONTEXT Smokefree legislation is a powerful public health intervention. Despite progress in smokefree legislation, over half of U.S. adults remain unprotected by comprehensive smokefree legislation. EVIDENCE ACQUISITION This paper reviews the scientific literature on health and economic outcome studies of smokefree legislation from the past decade, 2000 to early 2010, using MEDLINE and key search terms: smoking, smoking cessation, smoking/legislation and jurisprudence, smoking cessation/legislation and jurisprudence, and health policy. EVIDENCE SYNTHESIS There is a wealth of research showing the health benefits to entire populations when communities implement comprehensive smokefree laws and/or regulations. These laws improve the health of hospitality workers and the general population by improving indoor air quality, reducing acute myocardial infarctions and asthma exacerbations, and improving infant and birth outcomes. Some studies report reduced smoking prevalence and cigarette consumption and improved cessation outcomes after smokefree legislation. In addition to the health benefits, economic studies confirm that smokefree laws do not adversely affect business revenues or operating costs. CONCLUSIONS While there is an abundance of smokefree policy outcomes research showing both the health and economic impacts of smokefree legislation, these outcomes may have more to do with implementation effectiveness than adoption, especially among subpopulations. An emerging body of literature documents not only that disparities in health protections remain among subpopulations, but that health outcomes of smokefree legislation may vary by gender, race/ethnicity, SES, and age. Further research is needed on implementation effectiveness of smokefree legislation and differential effects on subpopulations.
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Affiliation(s)
- Ellen J Hahn
- Kentucky Center for Smoke-Free Policy, College of Nursing and College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
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