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Sassano M, Mariani M, Pastorino R, Ricciardi W, La Vecchia C, Boccia S. Association of national smoke-free policies with per-capita cigarette consumption and acute myocardial infarction mortality in Europe. J Epidemiol Community Health 2024; 78:388-394. [PMID: 38485217 PMCID: PMC11103332 DOI: 10.1136/jech-2023-220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Evidence on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe is limited. Hence, we aimed to assess this association and to evaluate which factors influence it. METHODS We performed an interrupted time series analysis, including 27 member states of the European Union and the UK, on per-capita cigarette consumption and AMI mortality.A multivariate meta-regression was used to assess the potential influence of other factors on the observed associations. RESULTS Around half of the smoke-free policies introduced were associated with a level or slope change, or both, of per-capita cigarette consumption and AMI mortality (17 of 35). As for cigarette consumption, the strongest level reduction was observed for the smoking ban issued in 2010 in Poland (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53). Instead, the largest level reduction of AMI mortality was observed for the intervention introduced in 2012 in Bulgaria (RR: 0.38; 95% CI: 0.34, 0.42).Policies issued more recently or by countries with a lower human development index were found to be associated with a larger decrease in per-capita cigarette consumption. In addition, smoking bans applying to bars had a stronger inverse association with both cigarette consumption and AMI mortality. CONCLUSIONS The results of our study suggest that smoke-free policies are effective at reducing per-capita cigarette consumption and AMI mortality. It is extremely important to monitor and register data on tobacco, its prevalence and consumption to be able to tackle its health effects with concerted efforts.
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Affiliation(s)
- Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Sumnall HR. Encouraging a 'generational shift' in the UKs relationship with drugs. A commentary on the new UK drug strategy. What can be achieved with drug prevention? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103841. [PMID: 36041288 DOI: 10.1016/j.drugpo.2022.103841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/06/2022] [Accepted: 08/21/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Harry R Sumnall
- Public Health Institute, Liverpool John Moores University, UK.
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Brillinger J, Marsh L, Hoek J. Bar Atmospherics and Smoking: A Qualitative Analysis of New Zealand Young Adult Smokers. Nicotine Tob Res 2021; 23:724-731. [PMID: 33165535 DOI: 10.1093/ntr/ntaa227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking among young adults is often associated with social contexts and alcohol use. Although many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalize young adult smoking and explored potential policy implications. METHODS We conducted in-depth interviews with 22 young adults who had recently smoked in a New Zealand bar or nightclub and investigated how physical design attributes (atmospherics) influenced experiences of smoking in outside bar settings. We used qualitative description to identify recurring accounts of the outdoor bar environment and thematic analysis to explore how participants experienced the bar in relation to smoking. RESULTS Participants valued outdoor smoking areas that were comfortable and relaxing, and saw attributes such as seating, tables, heating, protection from inclement weather, and minimal crowding, as important. We identified four themes; these explained how participants used smoking to gain respite and make social connections, showed how bar settings enabled them to manage smoking's stigma, and identified potential policy measures that would decouple smoking and alcohol co-use. CONCLUSIONS Evidence bar environments facilitate and normalize smoking among young adults questions whether smokefree policies should be expanded to include all bar areas. Introducing more comprehensive smokefree outdoor policies could reduce the influence of design attributes that foster smoking while also reframing smoking as outside normal social practice. IMPLICATIONS Bar environments contain many stimuli that cue and reinforce smoking and integrate smoking into social experiences. Expanding smokefree bar settings to include outdoor areas would reduce exposure to these stimuli, decrease opportunities for casual smoking, help maintain young people's smokefree status, and support longer-term goals of sustained reductions in smoking prevalence.
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Affiliation(s)
- Julia Brillinger
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Louise Marsh
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Hernandez EM, Vuolo M, Frizzell LC, Kelly BC. Moving Upstream: The Effect of Tobacco Clean Air Restrictions on Educational Inequalities in Smoking Among Young Adults. Demography 2019; 56:1693-1721. [PMID: 31388944 PMCID: PMC6800635 DOI: 10.1007/s13524-019-00805-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.
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Affiliation(s)
- Elaine M Hernandez
- Department of Sociology, Indiana University, Ballantine Hall 744, 1020 E. Kirkwood Avenue, Bloomington, IN, 47405-7103, USA.
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Laura C Frizzell
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, 700 W State Street, West Lafayette, IN, 47907, USA
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Park E, Cho SI, Seo HG, Kim Y, Jung HS, Driezen P, Ouimet J, Quah ACK, Fong GT. Attitudes of Korean smokers towards smoke-free public places: findings from the longitudinal ITC Korea Survey, 2005-2010. BMJ Open 2019; 9:e025298. [PMID: 31401589 PMCID: PMC6701818 DOI: 10.1136/bmjopen-2018-025298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Prior to December 2012, restaurants in South Korea were required to implement only partial smoking bans. This study documents the changes in Korean smokers' attitudes towards smoking bans between 2005 and 2010 and explores the effects of anti-smoking advertising as a correlate of support for total smoking bans in public places. DESIGN Longitudinal cohort study of Korean adult smokers. SETTING The data were derived from three waves (2005, 2008 and 2010) of the International Tobacco Control (ITC) Korea Survey. PARTICIPANTS The ITC Korea Survey respondents were a probability-based, nationally representative sample of Korean smokers aged 19 and older. The current analysis includes 995 smokers who participated in Wave 1 (2005), 1737 smokers who participated in Wave 2 (2008) and 1560 smokers who participated in Wave 3 (2010). PRIMARY AND SECONDARY OUTCOME MEASURES Changes in respondents' awareness of secondhand smoke (SHS) harm, attitudes towards smoking bans and personal rules for smoking in private homes and/or vehicles were analysed. Correlates of support for smoking bans in public places were examined using generalised estimating equation regression models. RESULTS More than 80% of Korean smokers are aware of the harms of SHS. The proportion of smokers who support smoke-free restaurants or smoke-free bars increased twofold between 2005 and 2010. Smokers who were aware of the dangers of SHS were more likely to support a total smoking ban in workplaces. Noticing anti-smoking advertising or information was not significantly associated with support for a total smoking ban in public places. CONCLUSIONS Korean smokers became more supportive of smoking bans in public places between 2005 and 2008. These results show that smokers' attitudes towards smoking bans can change with the implementation of smoke-free policies, even in a country that has a high prevalence of smokers.
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Affiliation(s)
- Eunja Park
- Center for Food and Drug Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea (the Republic of)
| | - Sung-il Cho
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea (the Republic of)
| | - Hong Gwan Seo
- Center for Cancer Prevention and Detection, National Cancer Center, Goyangsi, Korea (the Republic of)
| | - Yeol Kim
- Center for Cancer Prevention and Detection, National Cancer Center, Goyangsi, Korea (the Republic of)
| | - Hyun-Suk Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of)
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Kelly BC, Vuolo M, Frizzell LC, Hernandez EM. Denormalization, smoke-free air policy, and tobacco use among young adults. Soc Sci Med 2018; 211:70-77. [DOI: 10.1016/j.socscimed.2018.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
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Vuolo M, Kadowaki J, Kelly BC. A Multilevel Test of Constrained Choices Theory: The Case of Tobacco Clean Air Restrictions. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:351-372. [PMID: 27601410 DOI: 10.1177/0022146516653790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
According to Bird and Rieker's sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts-including policy, community, and work/family-in which they are formulated. While each level received attention in the original and subsequent research, we contend their constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a comprehensive database of tobacco policies with the National Longitudinal Survey of Youth 1997 from ages 19 to 31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking and dependence while controlling for other policy-, city-, and individual-level constraints. We also find unique between- and within-person effects, as well as gender effects, for the constraint levied by smoking bans. We argue for the theory's broad applicability beyond commonly cited findings regarding gender and biological influences.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Joy Kadowaki
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Nesoff ED, Milam AJ, Bone LR, Stillman FA, Smart MJ, Hoke KS, Furr-Holden CDM. Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007. J Ethn Subst Abuse 2016; 16:328-343. [PMID: 27403708 DOI: 10.1080/15332640.2016.1196631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
African American young adults ages 18-25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18-25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues-selected on the basis of youth reports of popular venues-were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.
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Affiliation(s)
- Elizabeth D Nesoff
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Adam J Milam
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Lee R Bone
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Frances A Stillman
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Mieka J Smart
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Kathleen S Hoke
- b University of Maryland Carey School of Law , Baltimore , Maryland
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Katikireddi SV, Der G, Roberts C, Haw S. Has Childhood Smoking Reduced Following Smoke-Free Public Places Legislation? A Segmented Regression Analysis of Cross-Sectional UK School-Based Surveys. Nicotine Tob Res 2016; 18:1670-4. [PMID: 26911840 PMCID: PMC4902887 DOI: 10.1093/ntr/ntw018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/05/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoke-free legislation has been a great success for tobacco control but its impact on smoking uptake remains under-explored. We investigated if trends in smoking uptake amongst adolescents differed before and after the introduction of smoke-free legislation in the United Kingdom. METHODS Prevalence estimates for regular smoking were obtained from representative school-based surveys for the four countries of the United Kingdom. Post-intervention status was represented using a dummy variable and to allow for a change in trend, the number of years since implementation was included. To estimate the association between smoke-free legislation and adolescent smoking, the percentage of regular smokers was modeled using linear regression adjusted for trends over time and country. All models were stratified by age (13 and 15 years) and sex. RESULTS For 15-year-old girls, the implementation of smoke-free legislation in the United Kingdom was associated with a 4.3% reduction in the prevalence of regular smoking (P = .029). In addition, regular smoking fell by an additional 1.5% per annum post-legislation in this group (P = .005). Among 13-year-old girls, there was a reduction of 2.8% in regular smoking (P = .051), with no evidence of a change in trend post-legislation. Smaller and nonsignificant reductions in regular smoking were observed for 15- and 13-year-old boys (P = .175 and P = .113, respectively). CONCLUSIONS Smoke-free legislation may help reduce smoking uptake amongst teenagers, with stronger evidence for an association seen in females. Further research that analyses longitudinal data across more countries is required. IMPLICATIONS Previous research has established that smoke-free legislation has led to many improvements in population health, including reductions in heart attack, stroke, and asthma. However, the impacts of smoke-free legislation on the rates of smoking amongst children have been less investigated. Analysis of repeated cross-sectional surveys across the four countries of the United Kingdom shows smoke-free legislation may be associated with a reduction in regular smoking among school-aged children. If this association is causal, comprehensive smoke-free legislation could help prevent future generations from taking up smoking.
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Affiliation(s)
| | - Geoff Der
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Roberts
- Social Research and Information Division, Welsh Government, Cardiff, UK
| | - Sally Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Vuolo M, Kelly BC, Kadowaki J. Independent and Interactive Effects of Smoking Bans and Tobacco Taxes on a Cohort of US Young Adults. Am J Public Health 2016; 106:374-80. [PMID: 26691133 PMCID: PMC4758814 DOI: 10.2105/ajph.2015.302968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the mutual effects of smoking bans and taxes on smoking among a longitudinal cohort of young adults. METHODS We combined a repository of US tobacco policies at the state and local level with the nationally representative geocoded National Longitudinal Survey of Youth 1997 (2004-2011) from ages 19 to 31 years and Census data, to examine the impact of tobacco policies on any current and daily pack smoking. The analytic sample amounts to 19,668 observations among 4341 individuals within 487 cities. RESULTS For current smoking, we found significant effects for comprehensive smoking bans, but not excise taxes. We also found an interaction effect, with bans being most effective in locales with no or low taxes. For daily pack smoking, we found significant effects for taxes, but limited support for bans. CONCLUSIONS Social smoking among young adults is primarily inhibited by smoking bans, but excise taxes only deter such smoking in the absence of a ban. Heavy smokers are primarily deterred by taxes. Although both policies have an impact on young adult smoking behaviors, their dual presence does not intensify each policy's efficacy.
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Affiliation(s)
- Mike Vuolo
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Brian C Kelly
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Joy Kadowaki
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
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Kadowaki J, Vuolo M, Kelly BC. A review of the current geographic distribution of and debate surrounding electronic cigarette clean air regulations in the United States. Health Place 2014; 31:75-82. [PMID: 25463920 DOI: 10.1016/j.healthplace.2014.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 11/18/2022]
Abstract
In this article, we present the results of a systematic review of state, county, and municipal restrictions on the use of electronic cigarettes (e-cigarettes) in public spaces within the United States, alongside an overview of the current legal landscape. The lack of federal guidance leaves lower-level jurisdictions to debate the merits of restrictions on use in public spaces without sufficient scientific research. As we show through a geographic assessment of restrictions, this has resulted in an inconsistent patchwork of e-cigarette use bans across the United States of varying degrees of coverage. Bans have emerged over time in a manner that suggests a "bottom up" diffusion of e-cigarette clean air policies. Ultimately, the lack of clinical and scientific knowledge on the risks and potential harm reduction benefits has led to precautionary policymaking, which often lacks grounding in empirical evidence and results in spatially uneven diffusion of policy.
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Affiliation(s)
- Joy Kadowaki
- Department of Sociology, Purdue University, 700 W State St, West Lafayette, IN 47907, USA.
| | - Mike Vuolo
- Department of Sociology, Purdue University, 700 W State St, West Lafayette, IN 47907, USA.
| | - Brian C Kelly
- Department of Sociology, Purdue University, 700 W State St, West Lafayette, IN 47907, USA.
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Rooke C, Amos A, Highet G, Hargreaves K. Smoking spaces and practices in pubs, bars and clubs: young adults and the English smokefree legislation. Health Place 2012; 19:108-15. [PMID: 23220373 DOI: 10.1016/j.healthplace.2012.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 10/09/2012] [Accepted: 10/18/2012] [Indexed: 11/16/2022]
Abstract
Young adulthood is an important but overlooked period in the development of smoking behaviour. We know little about the impact of smokefree policies on this group. In a secondary analysis of longitudinal, qualitative interview data we explore smoking practices in young adulthood, the role of smoking in the spaces of the night-time economy, and the impact of smokefree legislation. Participants carefully managed their smoking in different spaces in relation to the self they wished to present. This was shaped by the transitional nature of young adulthood. Smoking played a role in constructing time-out periods from the demands of everyday life in a similar way to alcohol use. The restrictions imposed by the smokefree legislation quickly became normal for most; however, the experience of smoking was influenced by the nature and quality of smoking spaces. The re-spatialisation of smoking necessitated by the smokefree legislation may reaffirm processes of social denormalisation and stigmatisation of smoking, whilst simultaneously allowing young adult smokers to produce, in some contexts, a positive, fun, sociable smoker identity.
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Affiliation(s)
- Catriona Rooke
- UK Centre for Tobacco Studies, Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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Bell K, McCullough L, Salmon A, Bell J. 'Every space is claimed': smokers' experiences of tobacco denormalisation. SOCIOLOGY OF HEALTH & ILLNESS 2010; 32:914-29. [PMID: 20525013 DOI: 10.1111/j.1467-9566.2010.01251.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Over the past decade, the strategy of 'denormalising' tobacco use has become one of the cornerstones of the global tobacco control movement. Although tobacco denormalisation policies primarily affect people on the lowest rungs of the social ladder, few qualitative studies have explicitly set out to explore how smokers have experienced and responded to these legislative and social changes in attitudes towards tobacco use. Drawing on a qualitative study of interviews with 25 current and ex-smokers living in Vancouver, Canada, this paper examines the ways they interpret and respond to the new socio-political environment in which they must manage the increasingly problematised practice of tobacco smoking. Overall, while not opposed to smoking restrictions per se, study participants felt that recent legislation, particularly efforts to prohibit smoking in a variety of outdoor settings, was overly restrictive and that all public space had increasingly been 'claimed' by non-smokers. Also apparent from participants' accounts was the high degree of stigma attached to smoking. However, although the 'denormalisation' environment had encouraged several participants to quit smoking, the majority continued to smoke, raising ethical and practical questions about the value of denormalisation strategies as a way of reducing smoking-related mortality and morbidity.
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Affiliation(s)
- Kirsten Bell
- Department of Anthropology, University of British Columbia, Canada.
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Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010:CD005992. [PMID: 20393945 DOI: 10.1002/14651858.cd005992.pub2] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and smoking behaviour of those populations they affect. OBJECTIVES To assess the extent to which legislation-based smoking bans or restrictions reduce exposure to SHS, help people who smoke to reduce tobacco consumption or lower smoking prevalence and affect the health of those in areas which have a ban or restriction in place. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Conference Paper Index, and reference lists and bibliographies of included studies. We also checked websites of various organisations. Date of most recent search; July 1st 2009. SELECTION CRITERIA We considered studies that reported legislative smoking bans and restrictions affecting populations. The minimum standard was having a ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. We included randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before and after studies, interrupted-time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because of heterogeneity in the design and content of the studies, we did not attempt a meta-analysis. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There were 50 studies included in this review. Thirty-one studies reported exposure to secondhand smoke (SHS) with 19 studies measuring it using biomarkers. There was consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. There was a greater reduction in exposure to SHS in hospitality workers compared to the general population. We failed to detect any difference in self-reported exposure to SHS in cars. There was no change in either the prevalence or duration of reported exposure to SHS in the home as a result of implementing legislative bans. Twenty-three studies reported measures of active smoking, often as a co-variable rather than an end-point in itself, with no consistent evidence of a reduction in smoking prevalence attributable to the ban. Total tobacco consumption was reduced in studies where prevalence declined. Twenty-five studies reported health indicators as an outcome. Self-reported respiratory and sensory symptoms were measured in 12 studies, with lung function measured in five of them. There was consistent evidence of a reduction in hospital admissions for cardiac events as well as an improvement in some health indicators after the ban. AUTHORS' CONCLUSIONS Introduction of a legislative smoking ban does lead to a reduction in exposure to passive smoking. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban compared to the general population. There is limited evidence about the impact on active smoking but the trend is downwards. There is some evidence of an improvement in health outcomes. The strongest evidence is the reduction seen in admissions for acute coronary syndrome. There is an increase in support for and compliance with smoking bans after the legislation.
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Affiliation(s)
- Joanne E Callinan
- Milford Care Centre, Plassey Park Road, Castletroy, Limerick, Ireland
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