Students' Beliefs About and Perceived Effectiveness of a Tobacco-Free Campus Policy

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.

Lung Cancer Worry and Home Screening for Radon and Secondhand Smoke in Renters

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.

Rural Print Media and a Tailored Advocacy Intervention for Smoke-Free Policy

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.

Tobacco Use Prevention and Cessation Policies in Manufacturing Facilities in the Tobacco-Growing State of Kentucky

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.

A Controlled Trial of a Quit and Win Contest

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.

Radon, Secondhand Smoke, and Children in the Home: Creating a Teachable Moment for Lung Cancer Prevention

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.

Secondhand Smoke Exposure in a Rural High School

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.

A Policy Analysis of Smoke-Free Legislation in Kentucky

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.

Social influences on use of cigarettes, e-cigarettes, and hookah by college students

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.

The Peer and Family Smoking Index: A Valid Measure of Secondhand Smoke Exposure in Adolescents

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.

Recall and Believability of the Tips From Former Smokers Campaign Among University Students

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.

Secondhand tobacco smoke exposure and susceptibility to smoking, perceived addiction, and psychobehavioral symptoms among college students

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.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities

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.

Electronic Cigarette Retail Outlets and Proximity to Schools

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.

Radon potential, geologic formations, and lung cancer risk

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.

Secondhand smoke exposure is associated with smoke-free laws but not urban/rural status

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.

Polytobacco Use Among College Students

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.

Creating Effective Media Messaging for Rural Smoke-free Policy

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.

A tobacco-free campus ambassador program and policy compliance

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.

Smoke-free policy implementation: theoretical and practical considerations

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.

Smoke-free coalition cohesiveness in rural tobacco-growing communities

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.

Hardcore smokers: what do we know?

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.

Comparing Two Observational Measures to Evaluate Compliance With Tobacco-Free Campus Policy

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.

A controlled community-based trial to promote smoke-free policy in rural communities

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.

Outdoor tobacco smoke exposure at the perimeter of a tobacco-free university

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.