Engineering clinician leadership and success in tobacco control: recommendations for policy and practice in Hungary and Central Europe

The Behavioral Ecological Model as a Framework for School-Based Anti-Bullying Health Promotion Interventions

This article presents a conceptual strategy which uses the Behavioral Ecological Model (BEM) as a health promotion framework to guide school-based bullying awareness programs and subsequent anti-bullying strategies for school nursing practice. Anti-bullying frameworks and tools are scarce despite the extent of the problem of bullying. This article reviews existing literature centered on the BEM and illustrates how the model can be applied to the school-setting. This is the first time that a multilevel framework has been proposed for school-based anti-bullying in the form of a model. The BEM is a useful tool for assisting in the development of more comprehensive programs to influence anti-bullying intervention in school-based nursing practice.

Tobacco use and asking prices of used cars: prevalence, costs, and new opportunities for changing smoking behavior

Secondhand smoke (SHS) causes premature death and disease in children and adults, and the scientific evidence indicates that there is no risk-free level of exposure to SHS. Smoking tobacco in a car can pollute the microenvironment of the car with residual SHS, leaving telltale signs to potential buyers (e.g., odor, used ash tray). This study examined (a) the proportion of used cars sold in the private party market that may be polluted with tobacco smoke and (b) whether asking prices of smoker and nonsmoker cars differed for cars of otherwise equivalent value. A random sample of 1,642 private party sellers were interviewed by telephone, and content analyses of print advertisements were conducted. Findings indicate that 22% of used cars were advertised by smokers or had been smoked in during the previous year. Among nonsmokers, 94% did not allow smoking in their car during the past year. Only 33% of smokers had the same restrictions. The smoking status of the seller and tobacco use in the car were significantly (p < .01) associated with the asking price independent of a car's Kelley Blue Book value (KBB). Used nonsmoker cars were offered at a considerable premium above their KBB value (>11%) and above comparable smoker cars (7–9%). These findings suggest that community preferences are affecting the value of smoke-free cars. New directions for research, tobacco control policies, and health education are discussed to further reduce smoking behavior, to help consumers make informed purchasing decisions, and to protect nonsmokers from SHS exposure.

Crossing borders: the impact of the California Tobacco Control Program on both sides of the US-Mexico border

We examined the association between exposure to the California Tobacco Control Program and tobacco-related behaviors and perceptions among adults of Mexican descent. Three cross-sectional population-based surveys were conducted among adults in cities that represent full, partial, and no exposure to the program: San Diego, Calif, Tijuana, Mexico, and Guadalajara, Mexico, respectively. After we controlled for socioeconomic differences, we found significantly different rates of smoking, exposure to environmental tobacco smoke, and smoking bans in the 3 cities. We also observed a parallel gradient of cross-city differences in theoretical mediators of tobacco control. This suggests a significant association among the California Tobacco Control Program, tobacco-control outcomes, and theoretical mediators of these outcomes. Similar programs should be implemented in other regions; they have widespread effects on social norms and behaviors related to smoking and environmental tobacco smoke and can help achieve tobacco control across nations.

Smoking cessation treatment by primary care physicians: An update and call for training

BACKGROUND

Public health and government organizations have invested considerably to increase physician adherence to smoking-cessation practice guidelines.

METHODS

A random sample of 2000 U.S. primary care physicians was ascertained from the American Medical Association (AMA) in 2002. Respondents (n = 1120, 62.3%) provided self-reported data about individual and practice characteristics and smoking-cessation practices. Data were analyzed in 2005.

RESULTS

Most primary care physicians (75%) advised cessation, 64% recommended nicotine patches, 67% recommended bupropion, 32% recommended nicotine gum, 10% referred to cessation experts, and 26% referred to cessation programs "often or always." Advising cessation was related to being older, having a faculty appointment, having trained staff for smoking counseling, and having confidence to counsel patients about smoking. Physicians who were internists, younger, and those with greater confidence to counsel patients about smoking recommended nicotine replacement more often. Prescribing bupropion was less common among older physicians, in the Northeast, with trained staff available for counseling, and with a greater proportion of minority or Medicaid patients. Prescribing bupropion was more common among AMA-member physicians and physicians with greater confidence to counsel patients about smoking. Providing a referral to an outside expert or program was more common among female physicians, and physicians in the Northeast or West, with larger clinical practices, and with trained staff for cessation counseling.

CONCLUSIONS

Current physician self-reported practices for smoking cessation suggest opportunity for improvement. Targeted efforts to educate and support subsets of primary care physicians may improve physician adherence and smoking outcomes.

Smoking cessation counseling by Russian oncologists: opportunities for intervention in the Russian Federation

The goal of this study was to examine the degree to which Russian oncologists are trained in providing smoking cessation counseling to patients and to assess physician smoking cessation practices and attitudes about providing smoking cessation treatment. Sixty-three oncologists at a large cancer center in Moscow completed a brief survey. The results showed that Russian oncologists: (a) lack training in smoking interventions; (b) rarely offer cessation treatment; (c) exhibit beliefs about smoking that may serve as barriers to providing cessation counseling; and (d) desire training in cessation counseling. These results can be used to guide the development of smoking cessation training programs for Russian physicians.

Time trends in smoking habits among Italian young adults

BACKGROUND

In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy.

METHODS

In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953-58, 1959-63, 1964-68, 1969-73, 1974-78). Probability to quit smoking was also evaluated among ever-smokers.

RESULTS

Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4-44.0%) in men and 52.7% (50.4-54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8-59.1%) in men and 68.7% (66.6-70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974-78). Also the probability to quit smoking significantly increased from the 1953-58 birth cohort to the 1969-73 one.

CONCLUSIONS

Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke.

Smoking habits and attitudes towards smoking among Estonian physicians

OBJECTIVES

This study examined the smoking habits and attitudes towards smoking among Estonian physicians.

STUDY DESIGN AND METHODS

Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey.

RESULTS

The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models.

CONCLUSIONS

This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.