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Montes de Oca D, Paraje G, Cuadrado C. Impact of Total Indoor Smoking Ban on Cardiovascular Disease Hospitalizations and Mortality: The Case of Chile. Nicotine Tob Res 2024; 26:1166-1174. [PMID: 38457437 PMCID: PMC11339173 DOI: 10.1093/ntr/ntae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (p < .01). In comparison, such a reduction was 4% (p < .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (p < .01) for the 20-44 age group, while for stroke, it was a 1.2% (p < .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.
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Affiliation(s)
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibáñez, Peñalolén, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
| | - Cristóbal Cuadrado
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
- School of Public Health, Universidad de Chile, Santiago de Chile, Chile
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Ashford KB, Blair LM, McCubbin AK, Wiggins AT, Rayens MK, Hahn EJ. Municipal smoke-free laws and preterm birth. Am J Obstet Gynecol 2022; 227:767.e1-767.e10. [PMID: 35932874 DOI: 10.1016/j.ajog.2022.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.
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Affiliation(s)
- Kristin B Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY.
| | - Lisa M Blair
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | - Andrea K McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | | | | | - Ellen J Hahn
- University of Kentucky College of Nursing, Lexington, KY
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Mantey DS, Omega-Njemnobi O, Barroso CS. Secondhand Smoke Exposure at Home and/or in a Vehicle: Differences Between Urban and Non-Urban Adolescents in the United States, From 2015 to 2018. Nicotine Tob Res 2021; 23:1327-1333. [PMID: 33155051 PMCID: PMC8496497 DOI: 10.1093/ntr/ntaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Secondhand smoke exposure during adolescence is linked to increased risk for cigarette smoking susceptibility and initiation. Non-urban youth may encounter a disproportionate number social and environmental risk factors for secondhand smoke exposure. Research is needed to explore geographic disparities in secondhand smoke exposure. AIMS AND METHODS Four years of National Youth Tobacco Survey (2015-2018) data were pooled. Participants were 69 249 middle and high school students. Multivariable logistic regression examined the relationship between geographic region and secondhand smoke exposure (1) at home and (2) in a vehicle. A multivariable, multinomial logistic regression examined the relationship between geographic region and number of sources of secondhand smoke exposure (ie, 0, 1 source, 2 sources). Covariates included sex, race/ethnicity, grade level, past 30-day tobacco use, and living with a tobacco user. RESULTS From 2015 to 2018, ~28.4% of middle and high school students reported secondhand smoke exposure either at home, in a vehicle, or both. Non-urban youth had greater odds of reporting secondhand smoke exposure at home (Adj OR: 1.26; 95% CI: 1.15 to 1.38) and in a vehicle (Adj OR: 1.50; 95% CI: 1.35 to 1.65), compared with urban youth. Similarly, non-urban youth had greater odds of reporting secondhand smoke exposure via one source (RRR: 1.21; 95% CI: 1.11 to 1.31) and two sources (RRR: 1.61; 95% CI: 1.42 to 1.82), relative to no exposure, than urban youth. CONCLUSION Secondhand smoke exposure at home and/or in a vehicle varies across geographic region. Targeted interventions should be developed and implemented to reduce secondhand smoke exposure among at-risk youth. IMPLICATIONS Findings showcase the need to address secondhand smoke exposure in non-urban areas and how it impacts adolescents. Public health interventions and regulatory policies aimed at improving social norms and expanding health infrastructure in rural communities should be designed and implemented in order to prevent and reduce secondhand smoke exposure among non-urban youth.
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Affiliation(s)
- Dale S Mantey
- University of Texas School of Public Health,
Austin, TX, USA
| | | | - Cristina S Barroso
- University of Tennessee, College of Education, Health, and
Human Sciences, Knoxville, TN, USA
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Garritsen HH, da Costa Senior YY, Rozema AD, Kunst AE, Kuipers MAG. Association between smoke-free legislation in hospitality venues and smoking behavior of young people: a systematic review. Nicotine Tob Res 2021; 24:807-812. [PMID: 34132801 DOI: 10.1093/ntr/ntab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people. METHODS A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (e.g. bar, restaurant) with a smoking behavior outcome (e.g. initiation, current smoking) among young people (aged 10-24 years). RESULTS Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decrease progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, while two other studies did not. CONCLUSION Most studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions. IMPLICATIONS This is the first systematic review to provide insight in the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).
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Affiliation(s)
- Heike H Garritsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Yoël Y da Costa Senior
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirte A G Kuipers
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Ickes MJ, Sampson S, Parsons J, Rayens MK, Xiao M, Fisher A, Mundy M, Hahn EJ. Tobacco-Free Ambassador Partnership: Empowering Youth Advocates in Appalachian Communities. Health Promot Pract 2020; 21:98S-109S. [PMID: 31908203 DOI: 10.1177/1524839919880563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kentucky youth (14.3%) smoke more cigarettes as compared to the U.S. average (8.8%), and Appalachian communities suffer disproportionately from tobacco-related diseases such as lung cancer. Training youth to become advocates is an effective strategy to improve health equity. This article describes the development and impact of a youth advocacy program to promote tobacco control policies in Appalachian Kentucky. Phase I (2017-2018): two ½-day trainings followed by monthly meetings with one high school (n = 20 youth). Trainings provided information on tobacco use, consequences, industry tactics, evidence-based tobacco control, and advocacy skills. Results provided support for expansion to Phase II (2018-20119): A 1-day training followed by monthly information sharing implemented in three counties (N = 80). Youth were surveyed before and 6-months posttraining during both phases. Phase I: At posttraining, 85% of youth believed they could reduce the amount of tobacco use in their community versus 66% at baseline. More students tried at least once to convince school or government officials to be more concerned about tobacco use (77% vs. 47%). Phase II: More students supported tobacco policies at posttraining survey and realized policies are an effective strategy to reduce tobacco use. At posttraining survey, students reported greater interpersonal confidence talking with others about tobacco-related issues, with a 24% increase in confidence talking with adults in their communities, as well as greater advocacy self-efficacy. Youth in Appalachia demonstrate desire to influence tobacco use and policy to improve health equity. Findings reinforce the need for collaborative public health interventions to promote ongoing training and support for youth living in high-risk communities.
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Affiliation(s)
| | | | | | | | - Min Xiao
- University of Kentucky, Lexington, KY, USA
| | - Amy Fisher
- University of Kentucky, Lexington, KY, USA
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Mojtabai R, Riehm KE, Cohen JE, Alexander GC, Vernick JS, Thrul J. Cigarette excise taxes, clean indoor air laws, and use of smoking cessation treatments: A mediation analysis. Prev Med 2020; 136:106098. [PMID: 32333928 PMCID: PMC7246130 DOI: 10.1016/j.ypmed.2020.106098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/12/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
The role of smoking cessation treatments in the link between clean indoor air laws and cigarette taxes with smoking cessation is not known. This study examined whether the use of smoking cessation treatments mediates the association between clean indoor air laws and cigarette excise taxes, on the one hand, and recent smoking cessation, on the other hand. Using data on 62,165 adult participants in the 2003 and 2010-2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we employed structural equation models to quantify the degree to which smoking cessation treatments (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet-based resources) mediate the association between clean indoor air laws, cigarette excise taxes and recent smoking cessation. Recent smoking cessation was associated with clean indoor air laws in 2003 and with both clean indoor air laws and excise taxes in 2010-2011. Smoking cessation treatments explained between 29% to 39% of the effect of clean indoor air laws and taxes on recent smoking cessation. While clean indoor air laws remained significantly associated with the recent smoking cessation over the first decade of the 2000s, excise taxes gained a more prominent role in later years of that decade. The influence of these policies was partly mediated through the use of smoking cessation treatments, underscoring the importance of policies that make these treatments more widely available.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
| | - Kira E Riehm
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Global Tobacco Control, 2213 McElderry Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, 1800 Orleans Street, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jon S Vernick
- Department of Health Policy and Management, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Hafez AY, Gonzalez M, Kulik MC, Vijayaraghavan M, Glantz SA. Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019. Am J Public Health 2019; 109:1568-1575. [PMID: 31536405 DOI: 10.2105/ajph.2019.305289] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.
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Affiliation(s)
- Amy Y Hafez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Mariaelena Gonzalez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Margarete C Kulik
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Maya Vijayaraghavan
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Stanton A Glantz
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
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Mojtabai R, Riehm KE, Cohen JE, Alexander GC, Rutkow L. Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003-2011. Prev Med 2019; 126:105744. [PMID: 31173803 PMCID: PMC6697615 DOI: 10.1016/j.ypmed.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
There was an increase in the number and coverage of state and local clean indoor air laws in the US during the past fifteen years. These laws coincided with increases in federal, state, and local cigarette excise taxes. In light of these changes, the objective of this study was to examine the association between clean indoor air laws, cigarette excise taxes and smoking patterns between 2003 and 2011. Using data on 62,165 adult participants in the 2003 and 2010/2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we examined the association of state and county workplace, bar, and restaurant clean indoor air laws and cigarette excise taxes with quitting and current every-day smoking. Between 2003 and 2011, quitting increased and daily smoking among those who continued to smoke decreased significantly. Participants living in states and counties with higher excise taxes and more comprehensive clean indoor air laws had a higher likelihood of quitting and lower likelihood of everyday smoking. Based on the assumption of no uncontrolled confounding, changes in taxes and laws accounted for 64.8% of the increase in smoking cessation and all of the reduction in everyday smoking. Implementation of state and county-level clean indoor air laws and cigarette taxes appears to have achieved the intended goal of encouraging smokers to either quit or reduce their frequency of smoking.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kira E Riehm
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Global Tobacco Control, 2213 McElderry Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, 1800 Orleans Street, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Lainie Rutkow
- Department of Health Policy and Management, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
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Rozema AD, Mathijssen JJP, van Kesteren JN, van Oers JAM, Jansen MWJ. Results of outdoor smoking bans at secondary schools on adolescents smoking behaviour: a quasi-experimental study. Eur J Public Health 2019; 29:765-771. [PMID: 30726888 DOI: 10.1093/eurpub/cky281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research on the effectiveness of school smoking policies on adolescents' smoking behaviour remain inconclusive. This study evaluates the results of an outdoor school ground smoking ban at secondary schools on adolescents smoking behaviour, taking individual characteristics into account. METHODS Data on 2684 adolescents from 18 Dutch secondary schools (nine with and nine without an outdoor smoking ban) were obtained at two moments. Associations between outdoor school ground smoking bans, individual characteristics, and smoking prevalence and frequency were measured. Multilevel logistic regression analyses were used. At schools with a ban implementation fidelity was checked. RESULTS Although smoking prevalence and frequency appeared to make a slower increase at schools with an outdoor smoking ban compared with schools without an outdoor smoking ban, the differences were not significant. Differences between schools in the prevalence of smoking behaviour of students could mainly be explained by individual characteristics. Smoking prevalence and frequency were higher among adolescents with a positive attitude towards smoking and when significant others were more positive about smoking. Smoking prevalence and frequency were significantly lower when adolescents perceived it as easy not to smoke. Implementation fidelity was good at schools with a ban. CONCLUSIONS No short-term effects were found of an outdoor smoking ban. A longer follow-up time than 6 months is needed. In addition, future research should investigate effectiveness in relation to the enforcement of the ban, comprehensiveness of the ban and when it is prohibited to leave school grounds, as smoking behavior might be transferred off school grounds.
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Affiliation(s)
- A D Rozema
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands
| | - J J P Mathijssen
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands
| | - J N van Kesteren
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands
| | - J A M van Oers
- Department Tranzo, Academic Collaborative Centre for Public Health Brabant, Tilburg University, Tilburg, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - M W J Jansen
- Public Health Service South Limburg (GGD ZL), Academic Collaborative Centre for Public Health Limburg, Geleen, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
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Hahn EJ, Rayens MK, Wiggins AT, Gan W, Brown HM, Mullett TW. Lung cancer incidence and the strength of municipal smoke-free ordinances. Cancer 2017; 124:374-380. [DOI: 10.1002/cncr.31142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ellen J. Hahn
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Mary Kay Rayens
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Amanda T. Wiggins
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
| | - Wenqi Gan
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Holly M. Brown
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
| | - Timothy W. Mullett
- Markey Cancer Center, College of Medicine; University of Kentucky; Lexington Kentucky
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Wintemberg J, McElroy JA, Ge B, Everett KD. Can Smoke-Free Policies Reduce Tobacco Use Disparities of Sexual and Gender Minorities in Missouri? Nicotine Tob Res 2017; 19:1308-1314. [DOI: 10.1093/ntr/ntx078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/03/2017] [Indexed: 11/14/2022]
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Asfar T, Arheart KL, Dietz NA, Caban-Martinez AJ, Fleming LE, Lee DJ. Changes in Cigarette Smoking Behavior Among US Young Workers From 2005 to 2010: The Role of Occupation. Nicotine Tob Res 2016; 18:1414-23. [PMID: 26508398 DOI: 10.1093/ntr/ntv240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/18/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Young adult workers (18-24 years) in the United States have been identified as a high-risk group for smoking. This study compares changes in smoking behavior by occupational class among this group between 2005 and 2010. METHODS Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. All respondents 18-24 years who reported that they were employed during the two surveys were selected (n = 1880 in 2005; and n = 1531 in 2010). Weighted percentages and 95% confidence interval were reported. Logistic regression analyses were performed to compare smoking behavior between occupational groups (white-collar, blue-collar, and service) and between years (2005-2010), and to examine correlates of smoking, successful quit attempt, and heavy smoking. RESULTS Smoking prevalence and daily smoking declined in 2010 in white-collar. Smoking prevalence and intensity decreased while age of smoking initiation increased in blue-collar workers. Young workers were more likely to smoke in 2005 than 2010. Service and blue-collar workers were more likely to smoke than white-collar workers. Older young adults, whites, individuals with a high school/or less education, those without health insurance were more likely to smoke. White workers and individuals with a high school/or less education were more likely to be heavy smokers. CONCLUSIONS White-collar workers have benefited the most from tobacco control efforts. Although improvements were seen in smoking behavior among blue-collar workers, smoking prevalence remained the highest in this group. Smoking behavior among service workers did not change. Young service workers and blue-collar are priority populations for workplace tobacco control efforts. IMPLICATIONS The current study examines changes in smoking behavior among young adult workers (18-24 years) by occupational class (white-collar, blue-collar, and service workers) between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. Smoking prevalence and daily smoking declined significantly in white-collar workers. No change in smoking behavior was observed among service workers. Positive changes in smoking behavior were observed among blue-collar workers, but smoking prevalence remained the highest in this group. Blue-collar and service workers are priority groups for future workplace tobacco control efforts.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL;
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Noella A Dietz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Environmental and Occupational Medicine and Epidemiology (EOME) Division, Department of Environmental Health, Harvard School of Public Health, Boston, MA
| | - Lora E Fleming
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; European Centre for Environment and Human Health, University of Exeter Medical School; Knowledge Spa, Royal Cornwall Hospital, Cornwall, United Kingdom
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Hahn EJ, Rayens MK, Adkins S, Begley K, York N. A controlled community-based trial to promote smoke-free policy in rural communities. J Rural Health 2014; 31:76-88. [PMID: 25182714 DOI: 10.1111/jrh.12087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities. METHODS A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years. FINDINGS Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties. CONCLUSIONS The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky College of Nursing, Tobacco Policy Research Program, Kentucky Center for Smoke-Free Policy, Lexington, Kentucky
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Hahn EJ, Rayens MK, Adkins S, Simpson N, Frazier S, Mannino DM. Fewer hospitalizations for chronic obstructive pulmonary disease in communities with smoke-free public policies. Am J Public Health 2014; 104:1059-65. [PMID: 24825207 DOI: 10.2105/ajph.2014.301887] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). METHODS We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. RESULTS Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban-rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate-weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. CONCLUSIONS Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs.
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Affiliation(s)
- Ellen J Hahn
- Ellen J. Hahn, Mary Kay Rayens, and Nick Simpson are with the Tobacco Policy Research Program, University of Kentucky College of Nursing and College of Public Health, Lexington. Sarah Adkins and Susan Frazier are with the University of Kentucky College of Nursing. Susan Frazier is also with the RICH Heart Program, University of Kentucky College of Nursing. David M. Mannino is with the Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health
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Environmental determinants of smoking behaviors: The role of policy and environmental interventions in preventing smoking initiation and supporting cessation. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:446-452. [PMID: 24634706 DOI: 10.1007/s12170-013-0344-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tobacco control strategies have contributed to substantial declines in smoking in the United States. However, smoking still remains the single largest preventable cause of disease and premature deaths in the country. Despite the continuing challenges of implementing tobacco control strategies and the pervasive influence of the tobacco industry to undermine such strategies, there are now unprecedented opportunities to prevent smoking initiation, facilitate cessation, and protect nonsmokers from secondhand smoke. In this paper, we briefly review the most recent literature discussing key strategies that have proven effective in tobacco control including regulations on sales and marketing of tobacco products, taxation, and smoke-free legislation. We focused on these three tobacco control strategies because of their potential to positively influence the environment of both minors and adults regardless of their smoking status. Although research has identified significant individual and social predictors of tobacco use, environmental influences are also important risk factors for tobacco use.
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Nguyen KH, Wright RJ, Sorensen G, Subramanian SV. Association between local indoor smoking ordinances in Massachusetts and cigarette smoking during pregnancy: a multilevel analysis. Tob Control 2013; 22:184-9. [PMID: 22166267 PMCID: PMC3401240 DOI: 10.1136/tobaccocontrol-2011-050157] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the association between local clean indoor air ordinances and prenatal maternal smoking across 351 municipalities in Massachusetts before the 2004 statewide ban and to test the effect of time since ordinance adoption on the association. METHODS The authors linked 2002 birth certificate data of women who gave birth in the state and reported a Massachusetts residence (n=67,584) to a database of indoor smoking ordinances in all municipalities. Multilevel regression models accounting for individual- and municipality-level variables estimate the associations between the presence of local smoking ordinances, strength of the ordinances, time since ordinance adoption and prenatal smoking. RESULTS Compared with those living in municipalities with no ordinances, women living in municipalities with a smoking ordinance had lower odds of prenatal smoking (OR=0.72, CI=0.53 to 0.98). No effect was found for 100% smoke-free ordinances. For the analyses testing the effect of time, pregnant women living in municipalities with ordinances enacted >2 years were less likely to smoke than those in municipalities with more recent (<1 year) ordinances. CONCLUSIONS Preventing smoking among women of reproductive age is a public health priority. This study suggests that indoor smoking ordinances were associated with lower prenatal smoking prevalence and the favourable effect increased over time. Findings highlight the public health benefit of tobacco control policies.
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Affiliation(s)
- K H Nguyen
- Helen Diller Family Comprehensive Cancer Center, University of California, 1450 3rd Street, San Francisco, CA 94111, USA.
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Balaraman B, Biesbroeck LK, Lickerman SH, Cornelius LA, Jeffe DB. Practices of unregulated tanning facilities in Missouri: implications for statewide legislation. Pediatrics 2013; 131:415-22. [PMID: 23439910 PMCID: PMC4074666 DOI: 10.1542/peds.2012-1781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The incidence of skin cancer has increased in the United States, concomitant with increased UV radiation (UVR) exposure among young adults. We examined whether tanning facilities in Missouri, a state without indoor-tanning regulations, acted in accordance with the Food and Drug Administration's recommendations and consistently imparted information to potential clients about the known risks of UVR. METHODS We conducted a statewide telephone survey of randomly selected tanning facilities in Missouri. Each tanning facility was surveyed twice, in the morning (7 am-3 pm) and evening (3-10 pm), on different days, to determine intrasalon consistency of information provided to potential clients at different times. RESULTS On average, 65% of 243 tanning-facility operators would allow children as young as 10 or 12 years old to use indoor-tanning devices, 80% claimed that indoor tanning would prevent future sunburns, and 43% claimed that there were no risks associated with indoor tanning. Intrasalon inconsistencies involved allowable age of use, and UVR exposure type and duration. Morning tanning-facility employees were more likely to allow consumers to start with maximum exposure times and UV-A-emitting devices (P < .001), whereas evening employees were more likely to allow 10- or 12-year-old children to use indoor-tanning devices (P = .008). CONCLUSIONS Despite increasing evidence that UVR exposure in indoor-tanning devices is associated with skin cancer, ocular damage, and premature photoaging, tanning facilities in Missouri often misinformed consumers regarding these risks and lack of health benefits and inconsistently provided information about the Food and Drug Administration's guidelines for tanning devices.
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Affiliation(s)
- Brundha Balaraman
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
| | - Lauren K. Biesbroeck
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie H. Lickerman
- Department of Dermatology, Saint Louis University School of Medicine, St Louis, Missouri; and
| | - Lynn A. Cornelius
- Division of Dermatology, Department of Medicine, and,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri
| | - Donna B. Jeffe
- Division of Health Behavior Research, Washington University School of Medicine, St Louis, Missouri;,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri
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Bernat DH, Choi K, Erickson DJ, Lenk KM, Forster JL. Minnesota's comprehensive statewide smokefree law: short-term effects on young adults. Am J Prev Med 2012; 43:S156-62. [PMID: 23079212 PMCID: PMC3481548 DOI: 10.1016/j.amepre.2012.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/20/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Young adults have the highest rate of smoking among any age group. PURPOSE The purpose of this study is to assess the short-term effects of Minnesota's comprehensive statewide smokefree law on young adult smoking perceptions and behavior. METHODS Telephone surveys were conducted before and up to 18 months after Minnesota's statewide smokefree law went into effect on October 1, 2007 (data analyzed 2010-2011). Participants included young adults from a population-based cohort in Minnesota (n=1458) and from five other upper Midwest states that serve as a comparison (n=248). Differences in perceptions and smoking behavior were examined between Minnesota participants who lived with and without a local smokefree law prior to Minnesota's statewide law, and participants who lived in the comparison states. RESULTS The majority of youth in Minnesota were aware of the smoking restrictions in restaurants and bars following the law. After implementation of the law, Minnesota participants who previously lived without a local law (versus comparison) were more likely to perceive fewer adult and peer smokers and less likely to report leaving social events early because it was too smoky. No changes in smoking behaviors were observed before and after the law. Minnesota participants, however, who lived without a prior law (versus participants with a prior law) were more likely to attribute a quit attempt after the law to smoking restrictions in restaurant and bars. CONCLUSIONS Results suggest that Minnesota's law has changed perceptions of the tobacco environment. Longer-term follow-up may be needed to observe changes in smoking behavior.
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Affiliation(s)
- Debra H Bernat
- Medical Humanities and Social Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306-4300, USA.
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Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction 2012; 107:1677-86. [PMID: 22360495 DOI: 10.1111/j.1360-0443.2012.03853.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the immediate as well as the longer-term impact of the 2005 smoke-free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. DESIGN Interrupted time-series analyses of 11 cross-sectional nationally representative surveys. SETTING Italy, 1999-2010. PARTICIPANTS Adults aged 20-64 years. MEASUREMENTS For each year we computed the prevalence of current smoking, the quit ratio and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. FINDINGS Among males, smoking prevalence decreased by 2.6% (P = 0.002) and smoking cessation increased by 3.3% (P = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both highly and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (P = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (P < 0.001). However, these favourable trends reversed over the following years. Among highly educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long-term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. CONCLUSION The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long term, and they may have limited effects on inequalities in smoking.
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Affiliation(s)
- Bruno Federico
- Department of Health and Sport Sciences, University of Cassino, Cassino, Italy.
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Reshuffling and relocating: the gendered and income-related differential effects of restricting smoking locations. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:907832. [PMID: 22619688 PMCID: PMC3348646 DOI: 10.1155/2012/907832] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/10/2012] [Indexed: 11/18/2022]
Abstract
This study investigates secondhand smoke (SHS) exposure and management in the context of smoking location restrictions, for nonsmokers, former, and current smokers. A purposive sample of 47 low income and non-low-income men and women of varied smoking statuses was recruited to participate in a telephone interview or a focus group. Amidst general approval of increased restrictions there were gendered patterns of SHS exposure and management, and effects of SHS policies that reflect power, control, and social roles that need to be considered as policies are developed, implemented and monitored. The experience of smoking restrictions and the management of SHS is influenced by the social context (relationship with a partner, family member, or stranger), the space of exposure (public or private, worksite), the social location of individuals involved (gender, income), and differential tolerance to SHS. This confluence of factors creates differing unintended and unexpected consequences to the social and physical situations of male and female smokers, nonsmokers, and former smokers. These factors deserve further study, in the interests of informing the development of future interventions and policies restricting SHS.
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Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. Am J Prev Med 2010; 39:S66-76. [PMID: 21074680 DOI: 10.1016/j.amepre.2010.08.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/13/2010] [Accepted: 08/24/2010] [Indexed: 12/12/2022]
Abstract
CONTEXT Smokefree legislation is a powerful public health intervention. Despite progress in smokefree legislation, over half of U.S. adults remain unprotected by comprehensive smokefree legislation. EVIDENCE ACQUISITION This paper reviews the scientific literature on health and economic outcome studies of smokefree legislation from the past decade, 2000 to early 2010, using MEDLINE and key search terms: smoking, smoking cessation, smoking/legislation and jurisprudence, smoking cessation/legislation and jurisprudence, and health policy. EVIDENCE SYNTHESIS There is a wealth of research showing the health benefits to entire populations when communities implement comprehensive smokefree laws and/or regulations. These laws improve the health of hospitality workers and the general population by improving indoor air quality, reducing acute myocardial infarctions and asthma exacerbations, and improving infant and birth outcomes. Some studies report reduced smoking prevalence and cigarette consumption and improved cessation outcomes after smokefree legislation. In addition to the health benefits, economic studies confirm that smokefree laws do not adversely affect business revenues or operating costs. CONCLUSIONS While there is an abundance of smokefree policy outcomes research showing both the health and economic impacts of smokefree legislation, these outcomes may have more to do with implementation effectiveness than adoption, especially among subpopulations. An emerging body of literature documents not only that disparities in health protections remain among subpopulations, but that health outcomes of smokefree legislation may vary by gender, race/ethnicity, SES, and age. Further research is needed on implementation effectiveness of smokefree legislation and differential effects on subpopulations.
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Affiliation(s)
- Ellen J Hahn
- Kentucky Center for Smoke-Free Policy, College of Nursing and College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
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Fernander A, Rayens MK, Hahn E, Zhang M, Adkins SM. Menthol smoking, smoke-free policies and cessation services. Addiction 2010; 105 Suppl 1:105-14. [PMID: 21059141 DOI: 10.1111/j.1360-0443.2010.03189.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study examined whether menthol cigarette smoking is related to exposure to smoke-free home and work-place policies, availability of cessation services at work and knowledge of cessation resources among current smokers. DESIGN Secondary analysis was conducted using logistic regression of cross-sectional data. SETTING The 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey, administered by the National Cancer Institute, the Centers for Disease Control and Prevention (CDC) and the Census Bureau, formed the basis for this investigation. PARTICIPANTS A total of 66,145 current smokers who participated in the TUS CPS administrations in 2003 and 2006/07. MEASUREMENTS Demographic characteristics (gender, race/ethnicity, age, education, income), smoking frequency, menthol cigarette use, status of smoking bans in the work-place and at home, availability of cessation services at work and knowledge of quitting resources were assessed. FINDINGS Among all current smokers with an indoor job, with no smoke-free restrictions at either work or home as the reference, those who smoked menthol cigarettes were about one-third as likely to have a smoke-free policy at both work and home [odds ratio (OR) = 0.32; 95% confidence interval (CI): 0.27-0.38]. In the comparison of those with an indoor smoke-free policy at work only versus those with no restrictions, menthol status was a risk factor for not having a work-place restriction (OR = 0.79; 95% CI: 0.67-0.93); similarly, within this sample, menthol use was a risk factor for not having a home restriction (OR = 0.38; 95% CI: 0.31-0.46). Among all current smokers, the use of menthol cigarettes was a risk factor for not having a smoking restriction at home (OR = 0.93; 95% CI: 0.88-0.98). Menthol smoking was not related to availability of cessation services offered at work or knowledge of cessation services. CONCLUSIONS This study suggests that menthol smoking is associated with lack of policy protection from second-hand smoke exposure. Policymakers and tobacco control professionals should monitor tobacco control efforts to ensure that policies and interventions reach all menthol smokers.
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Affiliation(s)
- Anita Fernander
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536-0086, USA.
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Hahn EJ, Rayens MK, Langley RE, Adkins SM, Dignan M. Do smoke-free laws in rural, distressed counties encourage cessation? Policy Polit Nurs Pract 2010; 11:302-308. [PMID: 21531965 DOI: 10.1177/1527154410397707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The authors examined the association between smoke-free laws and smoking/cessation behaviors and secondhand smoke exposure among current and former smokers in rural, distressed counties. A quasi-experimental, two-group design compared outcomes between participants from a county with a longstanding smoke-free law (n = 252) and those living in four demographically similar counties without smoke-free laws ( n = 250). Participants were recruited using random digit dialing. Controlling for demographic factors, those in the treatment group reported greater nicotine dependence, were more likely to have smoke-free workplaces, and less likely to have smoke-free homes. There were no differences in smoking status, past-year quit attempts, intent to quit in 5 years, cigarettes per day, or time since last cigarette. Smokers in the treatment group were just as likely to attempt to quit, despite greater nicotine dependence. Findings showed that making nonsmoking the social norm through policy change may be more difficult in rural, distressed areas.
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Affiliation(s)
- Ellen J Hahn
- Tobacco Policy Research Program, University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536, USA.
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