Smoke-free college campuses: no ifs, ands or toxic butts

Objective

To better estimate the burden of toxic cigarette butt waste and create awareness of the hazardous nature of cigarette butts on two large university campuses in San Diego by organizing and conducting student cigarette butt clean-up activities.

Methods

Two separate campus-wide clean-ups were conducted by student volunteers at San Diego State University (SDSU) and at University of California San Diego (UCSD) between April and July 2010.

Results

In 1 h, 63 volunteers at SDSU collected 23 885 butts; 6525 cigarette butts were collected in 1 h by 17 volunteers at UCSD. The average number of cigarette butts picked up per individual was 379.1 at SDSU and 383.8 at UCSD (range 25–1030 per volunteer).

Conclusions

The amount of cigarette waste on college campuses nationally may be quite substantial given the many thousands of cigarette butts gathered at each of the San Diego institutions. In just 10 s on average a volunteer could locate, walk to, pick up and put a cigarette butt in the collection bag and then begin looking for another discarded butt, indicating the saturation of cigarette butts on campus. Smoke-free policies on campus could have far-reaching effects not only in reducing smoking behaviour on campus and ground clean-up costs, but also on the environment. Campus cigarette waste clean-ups can be utilized to call attention to the issue of cigarette butt waste in the environment.

Whose butt is it? tobacco industry research about smokers and cigarette butt waste

Background

Cigarette filters are made of non-biodegradable cellulose acetate. As much as 766 571 metric tons of butts wind up as litter worldwide per year. Numerous proposals have been made to prevent or mitigate cigarette butt pollution, but none has been effective; cigarette butts are consistently found to be the single most collected item in beach clean-ups and litter surveys.

Methods

We searched the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) and http://tobaccodocuments.org using a snowball strategy beginning with keywords (eg, ‘filter’, ‘biodegradable’, ‘butts’). Data from approximately 680 documents, dated 1959–2006, were analysed using an interpretive approach.

Results

The tobacco industry has feared being held responsible for cigarette litter for more than 20 years. Their efforts to avoid this responsibility included developing biodegradable filters, creating anti-litter campaigns, and distributing portable and permanent ashtrays. They concluded that biodegradable filters would probably encourage littering and would not be marketable, and that smokers were defensive about discarding their tobacco butts and not amenable to anti-litter efforts.

Conclusions

Tobacco control and environmental advocates should develop partnerships to compel the industry to take financial and practical responsibility for cigarette butt waste.

Tobacco and cigarette butt consumption in humans and animals

Discarded cigarette butts may present health risks to human infants and animals because of indiscriminate eating behaviours. Nicotine found in cigarette butts may cause vomiting and neurological toxicity; leachates of cigarette butts in aquatic environments may cause exposure to additional toxic chemicals including heavy metals, ethyl phenol and pesticide residues. This report reviews published and grey literature regarding cigarette butt waste consumption by children, pets and wildlife. Although reports of human and animal exposures number in the tens of thousands, severe toxic outcomes due to butt consumption are rare. Nonetheless, the ubiquity of cigarette butt waste and its potential for adverse effects on human and animal health warrants additional research and policy interventions to reduce the stream of these pollutants in the environment.

Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish

BACKGROUND

Cigarette butts are the most common form of litter, as an estimated 4.5 trillion cigarette butts are thrown away every year worldwide. Many chemical products are used during the course of growing tobacco and manufacturing cigarettes, the residues of which may be found in cigarettes prepared for consumption. Additionally, over 4000 chemicals may also be introduced to the environment via cigarette particulate matter (tar) and mainstream smoke.

METHODS

Using US Environmental Protection Agency standard acute fish bioassays, cigarette butt-derived leachate was analysed for aquatic toxicity. Survival was the single endpoint and data were analysed using Comprehensive Environmental Toxicity Information System to identify the LC50 of cigarette butt leachate to fish.

RESULTS

The LC50 for leachate from smoked cigarette butts (smoked filter + tobacco) was approximately one cigarette butt/l for both the marine topsmelt (Atherinops affinis) and the freshwater fathead minnow (Pimephales promelas). Leachate from smoked cigarette filters (no tobacco), was less toxic, with LC50 values of 1.8 and 4.3 cigarette butts/l, respectively for both fish species. Unsmoked cigarette filters (no tobacco) were also found to be toxic, with LC50 values of 5.1 and 13.5 cigarette butts/l, respectively, for both fish species.

CONCLUSION

Toxicity of cigarette butt leachate was found to increase from unsmoked cigarette filters (no tobacco) to smoked cigarette filters (no tobacco) to smoked cigarette butts (smoked filter + tobacco). This study represents the first in the literature to investigate and affirm the toxicity of cigarette butts to fish, and will assist in assessing the potential ecological risks of cigarette butts to the aquatic environment.

Brazil and the framework convention on tobacco control: global health diplomacy as soft power

As part of the PLoS Medicine series on Global Health Diplomacy, Kelley Lee and colleagues provide a case study of Brazil's growing influence in international relations and global health, using as an example that country's role and use of “soft power” in the negotiation of the Framework Convention on Tobacco Control.

Smoking among rural and urban young women in China

Methods

A survey of 11 095 urban and rural women attending high school or college, aged 14–24 years, in 6 Chinese provinces was conducted. Ever-smoking (ES), current smoking, established smoking and intention to smoke frequencies were calculated. Bivariate analyses were conducted to identify possible correlates of smoking, and those found to be significant at the p=0.1 level were included in a multivariate logistical regression model to obtain adjusted OR for correlates of ES.

Results

ES prevalence was 20.1%, with urban female students (UFS) at 22.0% and rural female students (RFS) at 19.0% (p<0.01). Established smoking prevalence was higher among UFS than RFS (2.4% vs 0.9%, p<0.01). Similarly, current smoking prevalence was higher among UFS than RFS (4.2% vs 1.9%, p<0.01). The intention to smoke prevalence was higher among UFS than RFS (3.5% vs 1.7%, p<0.01). The majority were aware that smoking was harmful to health, but were less aware of specific diseases associated with smoking. ES was associated with awareness of cigarettes made for women (OR, 1.66, 95% CI 1.49 to 1.86) and thinking that they were less harmful than other cigarettes (OR 1.54, 95% CI 1.33 to 1.79). The strongest correlate of ES was low refusal self-efficacy (OR 6.35, 95% CI 5.32 to 7.57).

Conclusions

This is the first report that having heard of women's cigarettes is a correlate of smoking among young Chinese women. ES among young Chinese women has increased in the last decade, and thus, specific prevention strategies need to be developed to prevent the tobacco epidemic from spreading among this vulnerable population.

Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy

We investigated the association of adherence to the Mediterranean diet and other risk factors for dyslipidemia in HIV-infected Croatian patients during the first year of highly active antiretroviral therapy (HAART). Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (> or = 4 points). We interviewed 117 participants between May 2004 and June 2005 and abstracted their serum lipid measurements taken during the first year of HAART The values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides increased most prominently in the first 3 to 6 months after initiation of HAART (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). A Mediterranean diet and physical activity had no effect on serum lipids. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor compared to participants receiving a combination of nucleoside analogs with a non-nucleoside analog or a combination of nucleoside analogs and a protease inhibitor Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. We conclude that adherence to a Mediterranean diet does not influence serum lipid profiles during the first year of HAART.

Policy coherence in US tobacco control: beyond FDA regulation

Joshua Yang and Thomas Novotny explore whether the US government can develop and implement a coherent policy agenda to reduce tobacco-related morbidity and mortality.

Smoking knowledge, attitudes, and behaviors among rural-to-urban migrant women in Beijing, China

BACKGROUND

China has the largest population of cigarette smokers worldwide; surveys suggest rising prevalence among young women. Migratory lifestyles may confer increased susceptibility.

OBJECTIVES

we aimed to understand how migration relates to smoking among young women.

METHODS

we implemented a cross-sectional behavioral survey of rural-to-urban Chinese women (n = 206) working in restaurants and commercial sex venues, assessing smoking attitudes, behaviors, and health-risk knowledge.

RESULTS

rates of ever smoking and current smoking among restaurant workers were high compared with the rates in general population surveys (16.1% and 6.5%, respectively); rates were much higher among sex workers (54.9% and 33.3%, respectively). Multivariate analysis revealed education to be protective, whereas exposure to female-branded cigarettes was a risk for ever smoking.

CONCLUSIONS

Chinese migrant women appear to be smoking at higher rates than nonmigrant women. Priorities for future research include representative studies in multiple cities examining reasons for uptake and stimuli to quit.

Cigarettes butts and the case for an environmental policy on hazardous cigarette waste

Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell 'safe' cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has correspondingly reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt waste, including developing biodegradable filters, increasing fines and penalties for littering butts, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be attractive in coastal regions where beaches accumulate butt waste and where smoking indoors is increasingly prohibited. Additional research is needed on the various policy options, including behavioral research on the impact of banning the sale of filtered cigarettes altogether.

Global health diplomacy

A variety of shifts emergent with globalization, which are reflected in part by nascent programs in "Global Public Health," "Global Health Sciences," and "Global Health," are redefining international public health. We explore three of these shifts as a critical discourse and intervention in global health diplomacy: the expansion in non-governmental organization participation in international health programs, the globalization of science and pharmaceutical research, and the use of militarized languages of biosecurity to recast public health programs. Using contemporary anthropological and international health literature, we offer a critical yet hopeful exploration of the implications of these shifts for critical inquiry, health, and the health professions.

Unsafe sexual behavior among HIV-infected patients in Croatia, 2006: prevalence and associated factors

Information about risky sexual behavior among people living with HIV/AIDS is important to prevent the spread of the disease. Using an anonymous, self-administrated questionnaire, we surveyed 185 HIV-infected patients about risk behaviors at the University Hospital for Infectious Diseases in Croatia. Unprotected anal or vaginal sex in the preceding 6 months with partners of uninfected/unknown HIV status was reported by 20% of men who have sex with men (MSM), about half of whom reported multiple casual partners of unknown HIV status; 6% of heterosexual men; and 3% of women. Heterosexual patients were potentially more likely to expose regular partners to HIV but reported no risk behaviors with casual, non-concordant partners. MSM reported more risk behaviors, which were strongly associated with having > or = 2 sexual partners in the last 6 months and both insertive and receptive anal sex. Educational interventions in Croatia should target MSM to prevent high rates of HIV transmission.

Think globally, act locally, and collaborate internationally: global health sciences at the University of California, San Francisco

The University of California, San Francisco (UCSF) established Global Health Sciences (GHS) as a campus-wide initiative in 2003. The mission of GHS is to facilitate UCSF's engagement in global health across its four schools by (1) creating a supportive environment that promotes UCSF's leadership role in global health, (2) providing education and training in global health, (3) convening and coordinating global health research activities, (4) establishing global health outreach programs locally in San Francisco and California, (5) partnering with academic centers, especially less-well-resourced institutions in low- and middle-income countries, and (6) developing and collaborating in international initiatives that address neglected global health issues.GHS education programs include a master of science (MS) program expected to start in September 2008, an introduction to global health for UCSF residents, and a year of training at UCSF for MS and PhD students from low- and middle-income countries that is "sandwiched" between years in their own education program and results in a UCSF Sandwich Certificate. GHS's work with partner institutions in California has a preliminary focus on migration and health, and its work with academic centers in low- and middle-income countries focuses primarily on academic partnerships to train human resources for health. Recognizing that the existing academic structure at UCSF may be inadequate to address the complexity of global health threats in the 21st century, GHS is working with the nine other campuses of the University of California to develop a university-wide transdisciplinary initiative in global health.

Global health diplomacy: training across disciplines

Global health diplomacy is an emerging discipline where health is incorporated into traditional diplomacy as a foreign policy tool. As, with any new area, there is a need for training. This article sets out what global health policy involves and the current academic response to providing training for it.

The "ultimate prize" for big tobacco: opening the Chinese cigarette market by cigarette smuggling

Novotny discusses a new study in PLoS Medicine that documents how British American Tobacco has exploited China's large cigarette smuggling problem.

Marked improvement in survival among adult Croatian AIDS patients after the introduction of highly active antiretroviral treatment

We compared the survival of patients following the first AIDS event in Croatia from the period 1986-1996 to the period 1997-2000. A total of 72 (81.8%) out of 88 patients from 1986-1996 and 18 (32.1%) out of 56 from 1997-2000 died. Survival following the first AIDS-defining illness markedly improved in the period 1997-2000 compared to the period 1986-1996 (adjusted Hazard Ratio (HR) for patients surviving more than 6 months: 0.11, 95% confidence interval (95% CI) = 0.04-0.29). A CD4+ cell count of < 100 x 10(6)/L was an independent risk factor for patients surviving up to 2 years (adjusted HR = 1.96, 95% CI = 1.1-3.43, p = 0.02). Patients with tuberculosis or fungal infections had a longer survival when compared to other diagnosis (adjusted HR = 0.53, 95% CI = 0.32-0.90, p = 0.01). However, despite dramatic survival benefit of combination antiretroviral therapy, mortality at six months following the first AIDS event was similar in the two study periods and the one-year probability of death was still substantial (27.2%) in the period 1997-2000.

Bioethical Implications of Globalization: an international consortium project of the European Commission

The BIG project looks at some of the ethical concerns surrounding globalization and health.

Ethical and legal aspects of global tobacco control

On 28 February 2005, the Framework Convention on Tobacco Control came into force as a result of at least 40 countries becoming State Parties through ratification of this first ever health treaty sponsored by the World Health Organization. This article discusses the bioethical, trade, and legal aspects of global tobacco control. Special emphasis is given to globalisation of tobacco use and the challenges it poses to sovereign nations. It also advocates a bioethical basis in the pursuit of global solutions to expanding tobacco use.

Why we need to rethink the diseases of affluence

Novotny discusses the implications of a new study in PLoS Medicine examining the relationship between national income and risk factors for cardiovascular disease.

Trends in adult cigarette smoking in California compared with the rest of the United States, 1978-1994

OBJECTIVES

This study compared trends in adult cigarette smoking prevalence in California and the remainder of the United States between 1978 and 1994.

METHODS

We used data from National Health Interview Surveys and Behavioral Risk Factor Surveillance System surveys to compare trends in smoking prevalence among persons 18 years and older.

RESULTS

In both California and the remainder of the United States, the estimated annual rate of decline in adult smoking prevalence accelerated significantly from 1985 to 1990: to -1.22 percentage points per year (95% confidence interval [CI] = -1.51, -0.93) in California and to -0.93 percentage points per year (95% CI = -1.13, -0.73) in the remainder of the nation. The rate of decline slowed significantly from 1990 to 1994: to -0.39 percentage points per year (95% CI = -0.76, -0.03) in California and to -0.05 percentage points per year (95% CI = -0.34, 0.24) in the remainder of the United States.

CONCLUSIONS

The presence of an aggressive tobacco control intervention has supported a significant decline in adult smoking prevalence in California from 1985 to 1990 and a slower but still significant decline from 1990 to 1994, a period in which there was no significant decline in the remainder of the nation. To restore nationwide progress in reducing smoking prevalence, other states should consider similar interventions.

Extended degree and continuing education preferences of California public health professionals

The authors conducted a randomized mail survey of members of six public health organizations in California. The purpose of the survey was to assess public health practitioner interest and resources available to participate in public health extended degree programs and public health continuing education (CE). The response rate was 52 percent (N = 262). Three CE topics of greatest interest to public health professionals were health policy, computer applications, and community-based interventions. Respondents were interested in both distance-based and on-site learning formats.

Consumption and production waste: another externality of tobacco use

OBJECTIVE

To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing.

STUDY SELECTION

All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed.

DATA SOURCES

Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities. Data from the Center for Marine Conservation's International Coastal Cleanup Project were used to describe some environmental impacts of tobacco-related trash. Data from the United States Environmental Protection Agency's (EPA's) Toxics Release Inventory and reported global cigarette consumption totals were used to estimate waste production from cigarette manufacturing.

DATA EXTRACTION AND SYNTHESIS

In 1995, an estimated 5.535 trillion cigarettes (27,675 million cartons and 276,753 million packages) were sold by the tobacco industry globally. Some of the wastes from these products were properly deposited, but a large amount of tobacco consumption waste ends up in the environment. Some is recovered during environmental clean-up days. For the past eight years (1990-1997), cigarette butts have been the leading item found during the International Coastal Cleanup Project; they accounted for 19.1% of all items collected in 1997. The tobacco manufacturing process produces liquid, solid, and airborne waste. Among those wastes, some materials, including nicotine, are designated by the EPA as Toxics Release Inventory (TRI) chemicals. These are possible environmental health hazards. In 1995, the global tobacco industry produced an estimated 2262 million kilograms of manufacturing waste and 209 million kilograms of chemical waste. In addition, total nicotine waste produced in the manufacture of reduced nicotine cigarettes was estimated at 300 million kilograms.

CONCLUSIONS

Laws against littering relative to cigarette butts could be better enforced. Additional taxes might be levied on cigarette products that would then be directed to environmental clean-up efforts. The tobacco industry should improve the biodegradability of filters, reduce packaging waste, and educate its customers. Worksites and public buildings should be encouraged or required to supply appropriate disposal mechanisms at all building entrances. Public awareness campaigns about the magnitude and prevention of cigarette consumption waste could be developed through partnerships among environmental groups, health organisations, and environmental protection agencies. Tobacco production waste should be a source of concern and regulation by governments throughout the world; it contains numerous chemicals which may be considered health hazards, not the least of which is nicotine produced in the manufacture of low-nicotine cigarettes.

Black-white differences in cigarette smoking uptake: progression from adolescent experimentation to regular use

BACKGROUND

More U.S. adolescents and young adults have initiated cigarette smoking in recent years. Blacks have been less likely than whites to start smoking, and the gap has widened recently. Reasons accounting for this large black-white difference remain unclear.

METHODS

A multiple logistic regression analysis was performed using a cohort of 2,467 adolescent smoking experimenters ages 11-18, within the 1989-1993 Teenage Attitudes and Practices Survey, a nationally representative survey.

RESULTS

Among experimenters (1989), 25.7% of whites and 10.3% of blacks had progressed to current smoking (1993). The unadjusted odds ratio (OR) of progression for blacks (vs whites) was 0.33 [95% confidence interval (CI) 0.23, 0.48]. Adjustment for factors significantly predictive of progression (most parsimonious model) modified the black-white OR to 0.36 (CI 0.24, 0.55), while the full model yielded a black-white OR of 0.39 (CI 0.24, 0.66).

CONCLUSIONS

The observed black-white difference in smoking progression was only partly explained by the factors evaluated, and some additional factor(s) must be important. Understanding the black-white difference in the progression from experimentation to current smoking may help prevent uptake among all adolescents.

Rates and independent correlates of Pap smear testing among Korean-American women

OBJECTIVES

This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing.

METHODS

Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing

RESULTS

Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1).

CONCLUSIONS

Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.

Trends in black/white differences in current smoking among 18- to 24-year-olds in the United States, 1983-1993

OBJECTIVES

A study was undertaken to analyze the independent relationship between race (black/white) and cigarette smoking among 18- to 24-year-olds in the United States, 1983-1993.

METHODS

An 11-year analysis of cross-sectional national surveys was used in the study. Odds ratio for current smoking among black-surveyed subjects (vs. whites) was determined.

RESULTS

The multiple logistic regression-derived odds ratio (OR) for current smoking for blacks aged 18 to 24 years, vs. whites, decreased from 0.69 (95% CI 0.53, 0.89) in 1983 to 0.26 (95% CI 0.17, 0.42) in 1993. The combined-years model predicted a decrease in OR for blacks from 0.82 in 1983 to 0.30 in 1993, adjusted for sex, age, education, poverty status, and geographic region.

CONCLUSION

From 1983 to 1993, blacks aged 18 to 24 years became decreasingly at risk to be smokers, compared to whites, even after adjustment for confounding factors. Young blacks have been more resistant than young whites to begin smoking in recent years. Understanding reasons behind this widening black/white difference could lead to better prevention strategies.

Mammography and clinical breast examination among Korean American women in two California counties

BACKGROUND

Mammography and clinical breast examination (CBE) are underutilized, especially by women from some racial/ethnic minorities. Few published studies of screening practices or correlates for these subgroups exist.

METHODS

A population-based telephone survey of 1,090 Korean Americans living in two California counties was conducted. To produce population estimates of mammography and CBE testing, we adjusted frequencies to account for different selection probabilities. Multivariable logistic regression was performed to determine independent correlates of testing.

RESULTS

Only 34% [95% confidence intervals (CI) 30%, 39%] of Korean American women age 50 and older were estimated to have had a mammogram in the past 2 years. Only 32% (95% CI 28%, 37%) had had a CBE in the past 2 years. The strongest independent correlate of testing was having a regular medical checkup [odds ratio (OR) for mammogram = 9.21, 95% CI 3.98, 21.35; OR for CBE = 11.58, 95% CI 4.71, 28.46].

CONCLUSIONS

These estimates are lower than the Healthy People 2000 objectives as well as published estimates for other populations in the United States. Planning and implementing tailored programs to improve screening are best done using a community-sensitive approach, which, because racial/ethnic subgroups are growing, will assume increasing public health importance.

Poverty status and cigarette smoking prevalence and cessation in the United States, 1983-1993: the independent risk of being poor

OBJECTIVE

To analyse the independent relations between poverty status and cigarette smoking prevalence and cessation in the United States, 1983-1993.

DESIGN

An analysis of eight cross-sectional national surveys.

SETTING

The United States, 1983-1993.

PARTICIPANTS

236,311 civilian, non-institutionalised adult residents of the United States, aged 18 years and older.

MAIN OUTCOME MEASURES

Probability of current cigarette smoking and proportion of former smokers among ever-smokers (quit ratio) in surveyed subjects below the poverty threshold, compared with those at or above the poverty threshold.

RESULTS

The odds ratio for current smoking among persons below the poverty threshold ranged from a low of 1.10 in 1985 to a high of 1.45 in 1990, and remained between 1.26 and 1.30 during 1991-1993. The odds ratio for smoking cessation (quit ratio) among persons below the poverty threshold ranged from 0.81 in 1985 to 0.64 in 1991, and remained between 0.73 and 0.66 during 1991-1993. These measures of the relations between poverty status and smoking were derived using multiple logistic regression models, which adjusted for the effects of sex, age, education, race, employment status, marital status, and geographic region.

CONCLUSIONS

Persons below the poverty threshold continue to be more likely than those at or above the threshold both to be current smokers and not to have quit. Poverty may be an indicator of underparticipation in the changing social norms regarding smoking behaviour in recent years. Individuals below the poverty threshold may need focused efforts to help achieve the Healthy People 2000 objectives for reducing adult smoking prevalence. Further understanding of the relation between poverty and smoking is essential to develop effective programmes for this vulnerable population subgroup.

Hospital smoking bans and employee smoking behavior: Results of a national survey

OBJECTIVE

To examine the impact of workplace smoking bans on smoking behavior of employees.

PARTICIPANTS

A total of 1469 current or former smokers (intervention group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior.

DESIGN

This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities.

MAIN OUTCOME MEASURES

Postban quit ratio and progression along the stages-of-change continuum.

METHODS

The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables.

RESULTS

Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P<.001). Despite preban differences in smoking intensity, the overall difference in postban quit ratios remained significant even after multivariate adjustment for socioeconomic, demographic, and smoking intensity variables. For those sites that were 5 years postban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted. In all but 1 category, the intervention group was further along the stages-of-change continuum toward quitting smoking than the comparison group (P<.001).

CONCLUSION

American hospitals' experiences with smoking bans, which directly affect more than 5 million workers, should be examined by other industries as a method of improving employee health. Workplace smoking bans could also be effective in saving lives, reducing health care costs, addressing safety concerns, and decreasing operating and maintenance expenses of employers.

Use of a 24-hour recall diary to assess exposure to environmental tobacco smoke

Methods to assess exposure to environmental tobacco smoke need to be valid and relatively easy to use. We therefore explored the use of a 24-h environmental tobacco smoke exposure-recall diary by comparing data from the 24-h diary with questionnaire responses and levels of salivary cotinine--a biochemical marker of environmental tobacco smoke exposure. A total of 875 nonsmokers at five Rhode Island worksites participated in the study. Twenty-five percent of the participants lived with smokers, and 96% had regular exposure to environmental tobacco smoke at work. Individuals who lived with smokers reported more exposures in the 24-h diary, both outside of work and during work hours, compared with those who had no smokers in their household. The correlation between saliva cotinine concentrations and the exposures recorded in the diary was weak (r = .10). Brief instruments for assessment of environmental tobacco smoke should be viewed cautiously, and use of this 24-h recall diary is not recommended.

California's tobacco control saga

The California tobacco control program known as Proposition 99 was established in 1989 using a portion of a twenty-five-cent increase in the cigarette tax. With an initial availability of more than $150 million, tobacco control was the state's single most important public health activity. Health and medical care programs also were supported by the tax. Despite sustained public support, the tobacco control component was weakened by political actions of the tobacco industry and also by the competing efforts of organized medicine and the lack of support from the executive and legislative branches of government. Nevertheless, Proposition 99 succeeded in reducing exposure to environmental tobacco smoke, cigarette consumption, and smoking prevalence among adults in California.

Environmental and policy interventions to control tobacco use and prevent cardiovascular disease

Despite its declining prevalence during the past few decades, tobacco use remains one of the most significant public health issues of the 1990s. Environmental and policy interventions are among the most cost-effective approaches to control tobacco use and prevent cardiovascular diseases. In this article, the authors review and offer to state and local health departments and other public health partners a summary of recommended policy and environmental interventions that have either reduced or show potential to reduce tobacco use. Priority recommendations include clean indoor air policies, restrictions on tobacco advertising and promotion, policies limiting youth access to tobacco, comprehensive school health programs, and excise taxes and other economic incentives. Many of these recommendations should be integrated with other health promotion interventions to also improve nutrition and physical activity. The authors also highlight several successful interventions and strategies used to establish policies at the state and local levels.

The efficacy of two comprehensive perinatal programs on reducing adverse perinatal outcomes

Through the collaboration among University of California at Berkeley School of Public Health, Samuel Merritt College, and a private nonprofit, community-based medical center, the adequacy of two perinatal programs was assessed based on the pregnancy outcomes of teenaged Medi-Cal clients. Historical data from June 1991 to June 1992 were compiled on the pregnancy outcomes of 312 Medi-Cal clients, 12-18 years of age, delivering at the study medical center in Oakland, California. The effect of enrollment in two special perinatal programs, Comprehensive Perinatal Services Program (CPSP) and a school-based program, the Comprehensive Teenage Pregnancy and Parenting Program (CTAPPP), on the occurrence of adverse perinatal outcomes was examined. Adverse perinatal outcomes were defined as the occurrence of one of the following: low birthweight (< 2,500 grams), gestational age less than 37 weeks, or admission to the neonatal intensive care unit (NICU), not related to congenital syphilis. The percentage of teens experiencing adverse perinatal outcomes was 10.9% at the study hospital. No significant association was observed between CTAPPP enrollment and reduced adverse perinatal outcomes, but CPSP enrollment was associated with reduced adverse perinatal outcomes. This association persisted after controlling for potential confounders, including substandard prenatal care, which were also found to be risk factors for adverse perinatal outcomes. Enrollment in both programs simultaneously was not associated with a reduction in adverse outcomes. The significant association between CPSP enrollment and reduced adverse perinatal outcomes indicates that a more comprehensive prenatal program may be beneficial in improving birth outcomes, specifically among high-risk teenage populations.(ABSTRACT TRUNCATED AT 250 WORDS)

A continuing education preference survey of public health graduates

Continuing education (CE) is a vital component in strengthening the public health work force, and its importance has been emphasized by the Institute of Medicine and the Council for Education in Public Health. A CE preference survey was undertaken of alumni of the University of California, Berkeley, School of Public Health (UCB-SPH). Questionnaires were mailed to a one-third random sample of 1,500 graduates from 1981-1992 who currently reside in U.S. Department of Health and Human Services (HHS) Region IX. A response rate of 57% was achieved. Results of the survey show that CE activities are highly desired among respondents. Overall, 58% of respondents prefer a half-day to one-day seminar format during regular business hours, as opposed to night classes. They prefer a traditional didactic classroom presentation that is within one hour's automobile travel. The optimal setting for CE courses would be at the University of California, Berkeley, or in-house at their institution. Subject areas of interest noted by respondents are health policy development, communication in public health, community involvement, and research. Schools of public health may respond to the CE needs of their alumni through a variety of channels, including the mainstreaming of CE as part of a school's teaching responsibility, special seminars or institutes, extension courses through the larger university system, distance-based learning, and through a separately funded for-profit CE activity.

An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure

To evaluate the relationship between self-reported exposure to environmental tobacco smoke and saliva cotinine concentrations, we studied 186 nonsmokers. Each participant completed an exposure questionnaire, kept a daily exposure diary for 7 days, and provided a saliva sample for cotinine analysis. Salivary cotinine concentrations were measured using gas chromatography/mass spectrometry. Of the volunteers, 30% lived with one or more smokers, and 84% were regularly exposed to smokers at work. Eighty-three percent of the volunteers had detectable saliva cotinine concentrations (> or = 0.5 ng/ml) (median = 1.1; range = 0.5-7.4 ng/ml). Cotinine concentrations were related to exposure in the household and at the workplace. Volunteers who lived with smokers had significantly higher cotinine levels (median = 1.0; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-4.7 ng/ml). Volunteers who reported regular exposure at work had higher cotinine levels (median = 0.8; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-3.0 ng/ml). Cotinine concentrations were predicted by a regression equation that included the number of smokers at home and work and the number of minutes of exposure recorded in the daily diary (r2 = 0.29).