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Gravely S, Chung-Hall J, Craig LV, Fong GT, Cummings KM, Borland R, Yong HH, Loewen R, Martin N, Quah ACK, Hammond D, Ouimet J, Boudreau C, Thompson ME, Driezen P. Evaluating the impact of plain packaging among Canadian smokers: findings from the 2018 and 2020 ITC Smoking and Vaping Surveys. Tob Control 2023; 32:153-162. [PMID: 34548384 PMCID: PMC9330177 DOI: 10.1136/tobaccocontrol-2021-056635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In February 2020, Canada implemented plain packaging without any changes to the size and content of health warning labels (HWLs), which were last updated in 2012 (pictorial HWLs on 75% of the pack front and back). This pre-post evaluation study assessed the impact of plain packaging in Canada on: (1) pack appeal; (2) HWL effectiveness; and (3) support for plain packaging. Additionally, a quasi-experimental design was used to assess the Canadian results relative to two comparator countries: Australia, where plain packaging (with new larger HWLs) was implemented in 2012, and the United States (USA), where plain packaging has not been implemented and the same text warnings have appeared on cigarette packs since 1985. METHODS Data are from adult smokers who participated in the 2018 and/or 2020 International Tobacco Control Smoking and Vaping Surveys in Canada (n=4600), Australia (n=1834) and the USA (n=3046). Online surveys were conducted before (February to July 2018) and after (February to June 2020) the implementation of plain packaging in Canada. Adjusted regression analyses were conducted on weighted data. RESULTS Plain packaging was associated with a significant increase in the percentage of Canadian smokers who did not like the look of their cigarette pack (2018: 28.6% vs 2020: 44.7%, p<0.001), whereas no change in pack appeal was observed among smokers in Australia and the USA over the same period. Plain packaging was not associated with changes in HWL effectiveness in Canada. Support for plain packaging increased significantly among Canadian smokers (2018: 25.6% vs 2020: 33.7%, p<0.001). CONCLUSIONS Plain packaging in Canada substantially reduced pack appeal and increased support for the policy among adult smokers; however, there was no increase in the effectiveness of Canada's 8-year-old HWLs. The impact of plain packaging on health warning effectiveness may depend on the design of the warnings and length of time since implementation.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Hua-Hie Yong
- Department of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Studenmund C, Williams J, Hernandez A, Young E, Hui YY, Cruz E, Gribben V. Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening. Hosp Pediatr 2022; 12:45-53. [PMID: 34866157 DOI: 10.1542/hpeds.2021-005941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering "Quit Kits" with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.
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Affiliation(s)
- Christine Studenmund
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Jazzmin Williams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Elda Young
- San Francisco Department of Public Health, San Francisco, California
| | - Ying Ying Hui
- San Francisco Department of Public Health, San Francisco, California
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Dickinson BJ, Thompson ED, Gracely EJ, Wilson KM. Smoking Cessation Counseling in the Inpatient Unit: A Survey of Pediatric Hospitalists. Hosp Pediatr 2020; 11:30-35. [PMID: 33386295 DOI: 10.1542/hpeds.2020-000414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine practices and beliefs of pediatric hospitalists regarding smoking cessation counseling for caregivers of hospitalized children. METHODS An electronic survey was distributed to 249 members of the Pediatric Research in Inpatient Settings Network over 6 weeks in 2017 (83 responses [33%]). Questions explored beliefs regarding the impact of tobacco smoke exposure (TSE) and practices in TSE screening, provision of counseling, resources, and pharmacotherapy. Nonparametric tests were used to compare groups on numeric variables, χ2 tests were used to compare groups on nominal variables, and McNemar's test was used to compare dichotomous responses within subjects. RESULTS All respondents were familiar with the term "secondhand smoke," and >75% were familiar with "thirdhand smoke" (THS). Familiarity with THS was associated with more recent completion of training (P = .04). Former smokers (7%) were less likely to agree that THS has a significant impact on a child's health (P = .04). Hospitalists ask about TSE more often than they provide counseling, resources, or pharmacotherapy to caregivers who want to quit smoking. Hospitalists are more likely to ask about TSE and provide cessation counseling when patients have asthma as opposed to other diseases. Time was identified by 41% of respondents as a barrier for providing counseling and by 26% of respondents as a barrier for providing resources. Most respondents never prescribe pharmacotherapy (72%), nor do they follow-up with caregivers after hospitalization regarding cessation (87%). CONCLUSIONS Although most respondents ask about TSE, opportunities are missed for counseling and providing support to caregivers who want to quit smoking. Providers should be educated about THS, and systems should be streamlined to facilitate brief counseling sessions.
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Affiliation(s)
- Blair J Dickinson
- Department of Pediatrics, Drexel University College of Medicine and St Christopher's Hospital for Children, Philadelphia, Pennsylvania;
| | - E Douglas Thompson
- Department of Pediatrics, Drexel University College of Medicine and St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Edward J Gracely
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; and
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Sznitman SR, Zlotnick C, Harel-Fisch Y. Normalisation theory: Does it accurately describe temporal changes in adolescent drunkenness and smoking? Drug Alcohol Rev 2015; 35:424-32. [DOI: 10.1111/dar.12351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 09/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
| | - Cheryl Zlotnick
- The Cheryl Spencer Department of Nursing; University of Haifa; Haifa Israel
| | - Yossi Harel-Fisch
- The International Research Program on Adolescent Well-Being and Health; School of Education Faculty of Social Sciences; Bar-Ilan University; Ramat Gan Israel
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Schraufnagel DE. Electronic Cigarettes: Vulnerability of Youth. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:2-6. [PMID: 25830075 DOI: 10.1089/ped.2015.0490] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 02/14/2015] [Indexed: 11/13/2022]
Abstract
Electronic cigarettes have become popular and are heavily promoted as a safer cigarette and an aid to quit smoking. Although they may have value in reducing cigarette use among smokers, they are of limited value in smoking cessation and pose many problems, particularly in children. Nicotine is highly addictive and affects virtually all cells in the body. It is particularly harmful to developing brains and other organs. The electronic nicotine delivery systems are largely uncontrolled and safety risks are manifold. Initiating nicotine use and increasing dependence in the population may be linked with increased tobacco and other addictive substance abuse even if the individual electronic cigarette delivers less harm than a combustible cigarette does.
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Affiliation(s)
- Dean E Schraufnagel
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine M/C 719, University of Illinois at Chicago , Chicago, Illinois
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Hood NE, Wewers ME, Ferketich AK, Klein EG, Pirie P. Predictors of Voluntary Home-Smoking Restrictions and Associations with an Objective Measure of In-Home Smoking among Subsidized Housing Tenants. Am J Health Promot 2013; 28:97-104. [DOI: 10.4278/ajhp.120816-quan-399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Examine predictors of voluntary home-smoking restrictions (HSRs) and associations with an objective measure of in-home smoking. Design. Cross-sectional. Setting. Publicly subsidized multiunit housing units managed by private company in Columbus, Ohio, without a smoke-free housing policy. Subjects. Probability sample of primary leaseholders (N = 301, 64% response rate). Measures. Self-reported knowledge, attitudes, and behaviors collected during face-to-face survey in fall 2011, including individual (e.g., knowledge of health effects), social (e.g., number of friends who smoke), and environmental (e.g., safety) factors hypothesized to be related to having HSRs. Surface nicotine concentration (μg/m2) based on samples collected from wood surface in respondents' living rooms (n = 279). Analysis. Multiple linear and logistic regression were used to identify factors associated with having HSRs and with indoor surface nicotine concentrations. Results. Fewer than one-third (29.2%) of tenants had complete HSRs, while more than half (55.8%) had partial restrictions. Several individual and social factors, but no environmental/community factors, were associated with having HSRs. Type of HSRs (p < .001) and smoking status (p < .001) were independently associated with mean surface nicotine concentrations. Conclusion. Few subsidized housing tenants voluntarily limit in-home smoking. Partial restrictions could be considered as a harm reduction strategy but may be less effective among smokers. Strategies to change social norms are also needed to modify in-home smoking behavior among subsidized housing tenants.
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