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Berg CJ, Dekanosidze A, Hayrumyan V, LoParco CR, Torosyan A, Grigoryan L, Bazarchyan A, Haardörfer R, Kegler MC. Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors. Eur J Public Health 2023; 33:864-871. [PMID: 37500602 PMCID: PMC10567255 DOI: 10.1093/eurpub/ckad129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. METHODS Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. RESULTS In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. CONCLUSIONS SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hernandez D, Khan F, Albert D, Giovenco D, Branas C, Valeri L, Navas-Acien A. A randomized control trial to support smoke-free policy compliance in public housing. Trials 2023; 24:551. [PMID: 37608390 PMCID: PMC10463922 DOI: 10.1186/s13063-023-07339-4] [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: 03/16/2023] [Accepted: 04/29/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions. METHODS We are using an experimental design to test two compliance support interventions: (A) a "compliance through reduction (via relocation and reduction in personal smoking) and cessation" intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a "compliance through resident endorsement" intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach. DISCUSSION This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. TRIAL REGISTRATION Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.
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Affiliation(s)
- Diana Hernandez
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA.
| | - Farzana Khan
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - David Albert
- Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Daniel Giovenco
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - Charles Branas
- Epidemiology, Columbia Mailman School of Public Health, New York, USA
| | - Linda Valeri
- Biostatistics, Columbia Mailman School of Public Health, New York, USA
| | - Ana Navas-Acien
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, USA
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Hayrumyan V, Harutyunyan A, Torosyan A, Grigoryan L, Sargsyan Z, Bazarchyan A, Petrosyan V, Dekanosidze A, Sturua L, Kegler MC, Berg CJ. Tobacco-related risk perceptions, social influences and public smoke-free policies in relation to smoke-free home restrictions: findings from a baseline cross-sectional survey of Armenian and Georgian adults in a community randomised trial. BMJ Open 2022; 12:e055396. [PMID: 35131832 PMCID: PMC8823221 DOI: 10.1136/bmjopen-2021-055396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Given high prevalence of smoking and secondhand smoke exposure in Armenia and Georgia and quicker implementation of tobacco legislation in Georgia versus Armenia, we examined correlates of having no/partial versus complete smoke-free home (SFH) restrictions across countries, particularly smoking characteristics, risk perceptions, social influences and public smoking restrictions. DESIGN Cross-sectional survey study design. SETTING 28 communities in Armenia and Georgia surveyed in 2018. PARTICIPANTS 1456 adults ages 18-64 in Armenia (n=705) and Georgia (n=751). MEASUREMENTS We used binary logistic regression to examine aforementioned correlates of no/partial versus complete SFH among non-smokers and smokers in Armenia and Georgia, respectively. RESULTS Participants were an average age of 43.35, 60.5% women and 27.3% smokers. In Armenia, among non-smokers, having no/partial SFHs correlated with being men (OR=2.63, p=0.001) and having more friend smokers (OR=1.23, p=0.002); among smokers, having no/partial SFHs correlated with being unmarried (OR=10.00, p=0.001), lower quitting importance (OR=0.82, p=0.010) and less favourable smoking attitudes among friends/family/public (OR=0.48, p=0.034). In Georgia, among non-smokers, having no/partial SFHs correlated with older age (OR=1.04, p=0.002), being men (OR=5.56, p<0.001), lower SHS risk perception (OR=0.43, p<0.001), more friend smokers (OR=1.49, p=0.002) and fewer workplace (indoor) restrictions (OR=0.51, p=0.026); among smokers, having no/partial SFHs correlated with being men (OR=50.00, p<0.001), without children (OR=5.88, p<0.001), daily smoking (OR=4.30, p=0.050), lower quitting confidence (OR=0.81, p=0.004), more friend smokers (OR=1.62, p=0.038) and fewer community restrictions (OR=0.68, p=0.026). CONCLUSIONS Private settings continue to lack smoking restrictions in Armenia and Georgia. Findings highlight the importance of social influences and comprehensive tobacco legislation, particularly smoke-free policies, in changing household smoking restrictions and behaviours. TRIAL REGISTRATION NUMBER NCT03447912.
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Affiliation(s)
- Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Arevik Torosyan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Lilit Grigoryan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Alexander Bazarchyan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Ana Dekanosidze
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University, Washington, District of Columbia, USA
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Gagné T, Lapalme J, Ghenadenik AE, OLoughlin JL, Frohlich K. Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec's 2015 'An Act to Bolster Tobacco Control'. Tob Control 2021; 30:e128-e137. [PMID: 33115962 DOI: 10.1136/tobaccocontrol-2020-056010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec's 2015 An Act to Bolster Tobacco Control. METHODS Using data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex. RESULTS We detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period. CONCLUSIONS The persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.
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Affiliation(s)
- Thierry Gagné
- Epidemiology and Public Health, University College London, London, UK
| | - Josée Lapalme
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Adrian E Ghenadenik
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer L OLoughlin
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montré, Montreal, Quebec, Canada
| | - Katherine Frohlich
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technol Assess 2021; 25:1-132. [PMID: 34590577 PMCID: PMC7614019 DOI: 10.3310/hta25570] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. METHODS There were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert review was obtained. The process was overseen by a Scientific Advisory Group representing the range of relevant National Institute for Health Research and Medical Research Council research investments. RESULTS Key changes to the previous framework include (1) an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context; (2) an emphasis on the use of diverse research perspectives: efficacy, effectiveness, theory-based and systems perspectives; (3) a focus on the usefulness of evidence as the basis for determining research perspective and questions; (4) an increased focus on interventions developed outside research teams, for example changes in policy or health services delivery; and (5) the identification of six 'core elements' that should guide all phases of complex intervention research: consider context; develop, refine and test programme theory; engage stakeholders; identify key uncertainties; refine the intervention; and economic considerations. We divide the research process into four phases: development, feasibility, evaluation and implementation. For each phase we provide a concise summary of recent developments, key points to address and signposts to further reading. We also present case studies to illustrate the points being made throughout. LIMITATIONS The framework aims to help research teams prioritise research questions and design and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. In many of the areas of innovation that we highlight, such as the use of systems approaches, there are still only a few practical examples. We refer to more specific and detailed guidance where available and note where promising approaches require further development. CONCLUSIONS This new framework incorporates developments in complex intervention research published since the previous edition was written in 2006. As well as taking account of established practice and recent refinements, we draw attention to new approaches and place greater emphasis on economic considerations in complex intervention research. We have introduced a new emphasis on the importance of context and the value of understanding interventions as 'events in systems' that produce effects through interactions with features of the contexts in which they are implemented. The framework adopts a pluralist approach, encouraging researchers and research funders to adopt diverse research perspectives and to select research questions and methods pragmatically, with the aim of providing evidence that is useful to decision-makers. FUTURE WORK We call for further work to develop relevant methods and provide examples in practice. The use of this framework should be monitored and the move should be made to a more fluid resource in the future, for example a web-based format that can be frequently updated to incorporate new material and links to emerging resources. FUNDING This project was jointly funded by the Medical Research Council (MRC) and the National Institute for Health Research (Department of Health and Social Care 73514).
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Affiliation(s)
- Kathryn Skivington
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Kvaavik E, Tverdal A, Batty GD. Biomarker-assessed passive smoking in relation to cause-specific mortality: pooled data from 12 prospective cohort studies comprising 36 584 individuals. J Epidemiol Community Health 2021; 75:794-799. [PMID: 33542031 PMCID: PMC8292572 DOI: 10.1136/jech-2020-215398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 11/04/2022]
Abstract
AIMS While investigators have typically quantified the health risk of passive (secondhand) smoking by using self-reported data, these are liable to measurement error. By pooling data across studies, we examined the prospective relation of a biochemical assessment of passive smoking, salivary cotinine, with mortality from a range of causes. METHODS We combined data from 12 cohort studies from England and Scotland initiated between 1998 and 2008. A total of 36 584 men and women aged 16-85 years of age reported that they were non-smoking at baseline, provided baseline salivary cotinine and consented to mortality record linkage. RESULTS A mean of 8.1 years of mortality follow-up of 36 584 non-smokers (16 792 men and 19 792 women) gave rise to 2367 deaths (775 from cardiovascular disease, 779 from all cancers and 289 from smoking-related cancers). After controlling for a range of covariates, a 10 ng/mL increase in salivary cotinine was related to an elevated risk of total (HRs; 95% CI) (1.46; 1.16 to 1.83), cardiovascular disease (1.41; 0.96 to 2.09), cancer (1.49; 1.00 to 2.22) and smoking-related cancer mortality (2.92; 1.77 to 4.83). CONCLUSIONS Assessed biomedically, passive smoking was a risk factor for a range of health outcomes known to be causally linked to active smoking.
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Affiliation(s)
- Elisabeth Kvaavik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Aage Tverdal
- Norwegian Institute of Public Health, Oslo, Norway
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
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Daley A, Rahman M, Watson B. Racial/Ethnic Differences in Light of 100% Smoke-free State Laws: Evidence from Adults in the United States. Popul Health Manag 2020; 24:353-359. [PMID: 32639185 DOI: 10.1089/pop.2020.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study estimates racial/ethnic differences in the association between 100% smoke-free state laws and smoking, as well as self-reported health, to facilitate policy aimed at reducing disparities. Data pertain to adults aged 18 years and older, obtained from the public-use Behavioral Risk Factor Surveillance System (2002-2014). The authors exploit variation in the timing of 100% smoke-free state laws using a difference-in-differences model. Examining heterogeneity across racial/ethnic minority groups, the authors consider the association between smoke-free laws and the probability of being: a daily smoker (versus occasional); an occasional smoker (versus former); and at the top of the self-reported health scale (versus the bottom). The authors find that 100% smoke-free state laws were not correlated with smoking among women. Moreover, racial/ethnic minority men who smoked occasionally were less likely to quit than white men, and results suggest that smoke-free laws did not reduce these disparities. However, there is evidence that smoke-free laws reduced the probability of being a daily smoker for Asian and Hispanic/Latinx men, but not the probability of quitting or being at the top of the self-reported health scale. More generally, smoke-free laws were not associated with self-reported health, except that there may have been an improvement among nonsmoking American Indian/Alaska Native women. These findings underscore the importance of looking beyond average effects to consider how 100% smoke-free state laws impact racial/ethnic minorities. There is evidence that they reduced smoking and improved self-reported health for some groups, but a suite of tobacco control policies is necessary to reduce racial/ethnic disparities more broadly.
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Affiliation(s)
- Angela Daley
- School of Economics, University of Maine, Orono, Maine, USA
| | | | - Barry Watson
- Faculty of Business, University of New Brunswick, Saint John, Canada
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St Claire AW, Friedrichsen S, Boyle RG, Kingsbury J, Parks MJ, Helgertz S. Location and duration of secondhand smoke exposure among Minnesota Nonsmokers, 2018. Prev Med Rep 2020; 19:101130. [PMID: 32528822 PMCID: PMC7280764 DOI: 10.1016/j.pmedr.2020.101130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
In 2007 Minnesota passed into law a comprehensive ban on indoor smoking of tobacco products in public places including bars, restaurants, and workplaces. Despite reductions in smoking prevalence in the past 12 years, people are still exposed to secondhand smoke (SHS). It remains important to understand where and how long nonsmokers face exposure to SHS. The 2018 Minnesota Adult Tobacco Survey was analyzed to examine self-reported SHS exposure among nonsmoking adults. We report prevalence and 95 percent confidence intervals of SHS exposure overall, by specific locations, and by demographics. Length of exposure to SHS was summarized in median minutes. Overall, 30 percent of nonsmokers reported exposure in the past seven days. A total of 1382 participants indicated a location of exposure. The most common locations other than one’s own home or car included building entrances (18.7 [16.2–21.1] percent), somewhere else outdoors (17.7 [15.1–20.3] percent), and restaurant/bar patios (12.8 [10.5–15.0] percent). Exposure was more likely to be reported by young adults (44.6 percent) and males (33.7 percent). The locations with the longest duration of SHS exposure in the prior seven days were a gambling venue (117.2 [72.2–162.2] minutes), another person’s home (26.1 [15.4–36.8] minutes), and a bus stop (10.8 [4.7–16.9] minutes). Monitoring nonsmokers’ self-reported exposure to SHS remains important as a way to measure the impact and compliance with smoke-free policies. Additional information on the location and duration of exposure can be used programmatically to address high levels of exposure and consider additional policies or strategies.
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Affiliation(s)
- Ann W St Claire
- ClearWay Minnesota 8011 34th Ave South, Suite 400, Minneapolis, MN 55425, United States
| | - Samantha Friedrichsen
- Professional Data Analysts 219 Main Street SE, Suite 302, Minneapolis, MN 55414, United States
| | - Raymond G Boyle
- University of California, Office of the President, 300 Lakeside Drive, 6th Floor, Oakland, CA 94612, United States
| | - John Kingsbury
- Minnesota Department of Health, PO Box 64975, St. Paul, MN 55164, United States
| | - Michael J Parks
- Minnesota Department of Health, PO Box 64975, St. Paul, MN 55164, United States.,University of Minnesota, 1100 Washington Ave S, Minneapolis, MN 55415, United States
| | - Sharrilyn Helgertz
- Minnesota Department of Health, PO Box 64975, St. Paul, MN 55164, United States
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Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103744. [PMID: 32466270 PMCID: PMC7277525 DOI: 10.3390/ijerph17103744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023]
Abstract
The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants' health.
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Ngo CQ, Phan PT, Vu GV, Chu HT, Nguyen TT, Nguyen MH, Phan HT, Ong BMY, Vu GT, Pham KTH, Tran BX, Latkin CA, Ho CSH, Ho RCM. Prevalence and Sources of Second-Hand Smoking Exposure among Non-Smoking Pregnant Women in an Urban Setting of Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245022. [PMID: 31835519 PMCID: PMC6950206 DOI: 10.3390/ijerph16245022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022]
Abstract
Exposure to second-hand smoke (SHS) among non-smoking pregnant women can lead to adverse maternal and fetal outcomes. A cross-sectional study was performed from July to August 2016 among 432 pregnant women at Bach Mai Hospital, Hanoi, Vietnam, to assess the prevalence and sources of SHS exposure among non-smoking pregnant women. Socio-economic characteristics and information regarding SHS exposure of participants were collected. Multivariable logistic regression was employed to identify associated factors. Overall, 92.6% and 64.5% of pregnant women were exposed to SHS in their lifetime and in the last 30 days, respectively. Cafeterias and restaurants had the highest proportion of pregnant women exposed to SHS. Those who reported that “smoking is allowed at home” (OR = 3.18; 95%CI = 1.97–5.13); going to working place (OR = 1.86; 95%CI = 1.08–3.19), going to state authority offices (OR = 1.98; 95%CI = 1.15–3.41), and cafeterias (OR = 1.96; 95%CI = 1.22–3.16) had the highest risk of SHS exposure in the last 30 days. We have found a high proportion of SHS exposure among non-smoking pregnant women in Vietnam. This comes from a multitude of sources, including homes, workplaces, cafeterias, and restaurants. The data emphasises the need for further intervention to address this health issue.
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Affiliation(s)
- Chau Quy Ngo
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam; (C.Q.N.); (P.T.P.); (G.V.V.); (T.T.N.); (M.H.N.)
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam;
| | - Phuong Thu Phan
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam; (C.Q.N.); (P.T.P.); (G.V.V.); (T.T.N.); (M.H.N.)
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam;
| | - Giap Van Vu
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam; (C.Q.N.); (P.T.P.); (G.V.V.); (T.T.N.); (M.H.N.)
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam;
| | - Hanh Thi Chu
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam;
| | - Toan Thi Nguyen
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam; (C.Q.N.); (P.T.P.); (G.V.V.); (T.T.N.); (M.H.N.)
| | - Mai Hong Nguyen
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam; (C.Q.N.); (P.T.P.); (G.V.V.); (T.T.N.); (M.H.N.)
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence: ; Tel.: +84-333998764
| | - Benjamin M. Y. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
| | - Kiet Tuan Huy Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.P.); (B.X.T.)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.P.); (B.X.T.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Roger C. M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
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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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12
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'If I pay rent, I'm gonna smoke': Insights on the social contract of smokefree housing policy in affordable housing settings. Health Place 2019; 56:106-117. [PMID: 30716667 DOI: 10.1016/j.healthplace.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these "social contracts" strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.
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13
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Fu M, Castellano Y, Tigova O, Kyriakos CN, Fong GT, Mons U, Zatoński WA, Agar TK, Quah ACK, Trofor AC, Demjén T, Przewoźniak K, Tountas Y, Vardavas CI, Fernández E. Prevalence and correlates of different smoking bans in homes and cars among smokers in six countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A8. [PMID: 31516462 PMCID: PMC6661853 DOI: 10.18332/tid/94827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/18/2018] [Accepted: 09/03/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Second-hand smoke exposure has decreased in a number of countries due to widespread smoke-free legislation in public places, but exposure is still present in private settings like homes and cars. Our objective was to describe to what extent smokers implement smoking rules in these settings in six European Union (EU) Member States (MS). METHODS A cross-sectional survey was conducted with a nationally representative sample of adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (ITC six European countries survey, part of the EUREST-PLUS Project). We analysed data from 6011 smokers regarding smoking rules in their homes and in cars with children (no rules, partial ban, total ban). We described the prevalence of smoking rules by EU MS and several sociodemographic and smoking characteristics using prevalence ratios (PR) and 95% confidence intervals (CI) derived from Poisson regression models. \. RESULTS In homes, 26.5% had a total smoking ban (from 13.1% in Spain to 35.5% in Hungary), 44.7% had a partial ban (from 41.3% in Spain to 49.9% in Greece), and 28.8% had no-smoking rules (from 20.2% in Romania to 45.6% in Spain). Prevalence of no-smoking rules in cars with children was 16.2% (from 11.2% in Germany to 20.4% in Spain). The correlates of not restricting smoking in homes and cars included: low education (PR=1.51; 95%CI: 1.20-1.90 and PR=1.55; 95%CI: 1.09-2.20), smoking >30 cigarettes daily (PR=1.53; 95%CI: 1.10-2.14 and PR=2.66; 95%CI: 1.40-5.05) and no attempts to quit ever (PR=1.18; 95%CI: 1.06-1.31 and PR=1.28; 95%CI: 1.06-1.54). CONCLUSIONS Among smokers in six EU MS, no-smoking rules were more prevalent in homes than in cars with children. Whilst awareness about the health effects of exposure to tobacco smoke on children seemed to be high, more research is needed to better understand the factors that promote private smoke-free environments.
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Affiliation(s)
- Marcela Fu
- Catalan Institute of Oncology, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- University of Barcelona, Catalonia, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
| | - Olena Tigova
- Catalan Institute of Oncology, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
| | - Christina N. Kyriakos
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Geoffrey T. Fong
- University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Witold A. Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland
- European Observatory of Health Inequalities, The President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | | | - Anne C. K. Quah
- University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Constantine I. Vardavas
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Esteve Fernández
- Catalan Institute of Oncology, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- University of Barcelona, Catalonia, Spain
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Abstract
Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest global public health challenges. Additionally, secondhand smoke, which was declared carcinogenic by the International Agency for Research on Cancer in 2004, is a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as smoking bans, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030, as 80% of the projected tobacco-related deaths will occur in low and middle-income countries.
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15
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Crosby S, Bell D, Savva G, Edlin B, Bewick BM. The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study. BMC Public Health 2018; 18:1365. [PMID: 30537952 PMCID: PMC6288883 DOI: 10.1186/s12889-018-6231-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is a cause of avoidable morbidity and mortality. In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. There is a perception it has led to smokers congregating around hospital entrances (Selbie D. 2016, It's time for a truly smokefree NHS. Public Health Matters Blog. Public Health England). Efforts to shift social norms and create positive smokefree environments might be strengthened by delivering social norms messages. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances. METHOD Repeated cross sectional study design. Staff, patients, and hospital visitors at Pinderfields National Health Service (NHS) Hospital (Wakefield, United Kingdom (UK)) completed a survey before and after implementation of a public health social norms campaign (n = 481 surveyed before; n = 459 surveyed after). The main outcome measure was difference between perceived and reported levels of support for smokefree hospital entrances. RESULTS There were high levels of support for smokefree hospital entrances. The majority of participants agreed that patients (n = 849, 90% agreed), staff (n = 863, 92% agreed), and visitors (n = 850, 90% agreed) should not smoke in the hospital entrance. Participants underestimated the proportion of others who self-reported keeping the entrance smokefree. Over 90% of respondents reported not smoking in the hospital entrance, but the perception was that between 50 to 75% of hospital staff, patients, and visitors did not smoke in the hospital entrance. The mean percentage of hospital staff, patients, and visitors who respondents thought did not smoke in entrances was higher for respondents responding after, compared to those responding before, the campaign. There was an overall significant effect of time on attitudes towards smoking in the entrances; in all instances the mean percentage of hospital staff, patients, and visitors the participants believed agreed that hospital entrances should be smokefree was higher for those responding after, compared with before, the campaign. CONCLUSIONS People hold misperceptions of the proportion of people who choose to smoke in the hospital entrance. The social norms approach campaign was associated with a strengthening of positive social norms. Such campaigns should be considered by Trusts as one evidence-based based tactic to denormalise smoking, increase support for smokefree policies.
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Affiliation(s)
| | - Diane Bell
- Public Health England, Leeds, LS1, 4PL UK
| | - Gerard Savva
- Magpie Creative Communications Ltd, Leeds, LS2 9NG UK
| | - Becky Edlin
- Magpie Creative Communications Ltd, Leeds, LS2 9NG UK
| | - Bridgette M. Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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16
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Lee PN, Fry JS, Thornton AJ. Updating the evidence relating smoking bans to incidence of heart disease. Regul Toxicol Pharmacol 2018; 101:172-186. [PMID: 30500390 DOI: 10.1016/j.yrtph.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Abstract
In our latest update of the evidence on smoking bans and heart disease we summarize 59 studies. We take account of the underlying trends in incidence rates as far as possible by using control data in eight studies, and by adjustment based on observed trends in cases pre- and post-ban in 40 studies, being unable to make an adjustment in the remaining 11 studies. Overall, based on 62 independent estimates from the 59 studies, we estimate that bans reduce incidence by 5.0% (95% CI 3.2-6.8%), though this estimate reduces to 2.9% (0.01-5.6%) when we exclude regional estimates where national estimates are available, and studies where trend adjustment is not possible. For 25 of the studies, quadratic rather than linear adjustment is possible, but this hardly affects the overall estimates. Ban effects are somewhat greater when the pre-ban period studied is relatively short, and in smaller studies. We compare our findings with those in other recent reviews, one of which totally ignored underlying trends and results from control populations. We discuss reasons why we believe there is likely to be a true small effect of smoking bans, and weaknesses in the data which preclude reaching any very confident conclusion.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
| | - John S Fry
- ROELEE Statistics Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK
| | - Alison J Thornton
- Independent Consultant, Oak Cottage, Beer Farm, Okehampton, Devon, EX20 1SG, UK
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17
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Chen CC, Huang YT, Yang CY. Effects of national smoke-free legislation on the rates of preterm births and low birthweights in Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2018; 81:1207-1213. [PMID: 30465629 DOI: 10.1080/15287394.2018.1547669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study evaluated the effects of partial and complete island-wide smoking bans on perinatal outcomes in Taiwan. Trends were determined in the yearly prevalence rates for preterm births and low birth weight (LBW) for a 1978 to 1997 pre-ban period, a 1998 to 2008 Phase 1 partial ban period, and a 2009 to 2016 Phase 2 complete ban period. Poisson regression with a yearly time-series model was employed to determine alterations in trends in prevalence rates for preterm births and LBW. Compared with pre-ban period, the rate ratio (RR) for Phase 1 preterm births was 0.969 (95% confidence interval [CI] = 0.968-0.971) and Phase 2 0.995 (95% CI = 0.992-0.998). The Phase 1 RR LBW fell 0.4% (95% CI = 0.2%-0.5%), but Phase 2 RR rose 1.7% (95% CI = 1.4%-2.1%). Data indicated that the risk of preterm births and LBW in Taiwan was reduced significantly after implementation of the smoking ban. These findings are in agreement with growing evidence suggesting that smoke-free legislation exerted a beneficial health effect on pregnant women and their newborn infants.
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Affiliation(s)
- Chih-Cheng Chen
- a Department of Pediatrics, College of Medicine , Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University , Kaohsiung , Taiwan
| | - Yu-Tung Huang
- b Master program in Aging and Long-term Care, College of Nursing , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chun-Yuh Yang
- c Faculty of Public Health, College of Health Sciences , Kaohsiung Medical University , Kaohsiung , Taiwan
- d National Institute of Environmental Health Sciences, National Health Research Institute , Miaoli , Taiwan
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18
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Perez-Warnisher MT, De Miguel MDPC, Seijo LM. Tobacco Use Worldwide: Legislative Efforts to Curb Consumption. Ann Glob Health 2018. [PMID: 30779502 PMCID: PMC6748295 DOI: 10.29024/aogh.2362] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.
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19
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Perez-Warnisher MT, De Miguel MDPC, Seijo LM. Tobacco Use Worldwide: Legislative Efforts to Curb Consumption. Ann Glob Health 2018; 84:571-579. [PMID: 30779502 DOI: 10.9204/aogh.2362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.
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20
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Kabir MA, Hossain MM, Duty FA. Patterns, prevalence and determinants of environmental tobacco smoke exposure among adults in Bangladesh. Addict Behav Rep 2018; 8:113-121. [PMID: 30225338 PMCID: PMC6139484 DOI: 10.1016/j.abrep.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022] Open
Abstract
Background Exposure to environmental tobacco smoke (ETS) has been suggested as a risk factor for various health problems. Thus, this study examines the patterns and predictors of ETS exposure among adults at home, workplace and public places. Methods The dataset covered a nationally representative sample of 9629 respondents extracted from the Global Adult Tobacco Survey. Diamond-shaped equiponderant graphs were used to exhibit the prevalence of ETS. In Logistic regressions, ETS exposure at home, workplace and public places were used as response variables. Demographic and socioeconomic variables, health knowledge about ETS, attitude towards ETS, perception of smoking restrictions were considered as predictors. Results Adults in higher age groups and females were less exposed to ETS. Better education, high wealth status, better health knowledge on ETS, practice of no smoking at home, and support smoking restrictions were significantly associated with lower ETS exposure at home. Those residing in rural areas and living with many people together were more likely to be exposed to ETS at home. In contrast with home and workplace exposure, adults with higher education, better wealth status, good knowledge on ETS, and support smoking restrictions experienced a high level of exposure at public places. Interestingly, results suggest that those with high levels of ETS exposure at home and workplace had lower exposure to ETS in public places. Conclusions ETS control should not be overlooked in public health policy. Protection from ETS at home is particularly important, given its impact on the attitude towards and awareness about ETS exposure at all places.
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Affiliation(s)
| | - Md Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Farhana Afrin Duty
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
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21
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Doku DT. Prevalence and socioeconomic inequalities in indoor exposure to secondhand smoke at home among children 0-5years in Ghana. Addict Behav 2018; 79:68-73. [PMID: 29253659 DOI: 10.1016/j.addbeh.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Daily exposure to secondhand smoke (ESHS) among children can be fatal for their health. With increasing prevalence of smoking in low-income countries, particularly among low socioeconomic status (SES) groups amidst poor tobacco legislations, children in these countries can be at risk of ESHS at home. This study investigated the prevalence and socioeconomic inequalities in indoor daily of ESHS at home among children aged 0-5years in Ghana. METHODS Population-based data collected through interviews in 2014 in 4616 households, 98.5% response rate, were used. Logistic regression analyses were used to investigate socioeconomic inequalities in daily ESHS among children at home. RESULTS One out of every ten children was exposed to daily secondhand smoke at home. The proportion of children's ESHS by wealth quintile ranges from richest (6.5%) to poorest (46.3%). Children of male-headed households were at higher risk of daily ESHS (OR 1.71, CI 1.27-2.31). A child living in a household where the head had no formal education had four folds the risk of daily ESHS compared with another in a household headed by a person with higher educational attainment. In rural setting, a child living in a poorest household (measured by wealth index) had more than two folds the risk of daily ESHS compared with another in the richest household. Correspondingly, a child living in the poorest household in an urban area had 8 times (OR 8.05, CI 4.03-16.08) the risk of daily ESHS compared with the counterpart in the richest household. CONCLUSIONS Children from socioeconomically disadvantaged and male-headed households both in rural and urban areas were at higher risk of daily ESHS at homes. However, children in the poorest households in urban areas had the highest concentration of ESHS among socioeconomically disadvantaged children. Interventions to end smoking indoors at home is urgently needed to protect children from its harmful effects.
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State Clean Indoor Air Laws and smoking among adults with poor mental health. J Public Health Policy 2018; 37:453-466. [PMID: 27146608 DOI: 10.1057/jphp.2016.17] [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: 11/21/2022]
Abstract
Persons with mental illness smoke at twice the rate of the general United States (US) population and die an average of 25-years younger, often from preventable diseases. This study seeks to determine whether disparities in smoking have increased over the past decade and whether Clean Indoor Air Laws (CIALs) are associated with changes in smoking among those with poor mental health. We used a fixed-effects model for estimation. CIALs were associated with 15 per cent decreased odds of smoking among adults in the US. Among those with poor mental health, these same laws had no effect. Between 2000 and 2010, the disparity in smoking rates between these two populations has steadily increased from 1.8 to 2.2 times greater. Given the lack of association between tobacco laws and smoking among those with poor mental health, alternative and more targeted tobacco reduction efforts may be necessary.
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Lim KH, Teh CH, Nik Mohamed MH, Pan S, Ling MY, Mohd Yusoff MF, Hassan N, Baharom N, Dawam ND, Ismail N, Ghazali SM, Cheong KC, Chong KH, Lim HL. Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia. BMJ Open 2018; 8:e017203. [PMID: 29317411 PMCID: PMC5780697 DOI: 10.1136/bmjopen-2017-017203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables. DESIGN Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis. RESULTS The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas. CONCLUSIONS The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.
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Affiliation(s)
| | | | | | - Sayan Pan
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Miaw Yn Ling
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Noraryana Hassan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Nizam Baharom
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Norliana Ismail
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | - Kar Hon Chong
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
| | - Hui Li Lim
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
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Ho V, Ross JS, Steiner CA, Mandawat A, Short M, Ku-Goto MH, Krumholz HM. A Nationwide Assessment of the Association of Smoking Bans and Cigarette Taxes With Hospitalizations for Acute Myocardial Infarction, Heart Failure, and Pneumonia. Med Care Res Rev 2017; 74:687-704. [PMID: 27624634 PMCID: PMC5665160 DOI: 10.1177/1077558716668646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 11/17/2022]
Abstract
Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics. Smoking bans were not associated with acute myocardial infarction or heart failure hospitalizations, but lowered pneumonia hospitalization rates for persons ages 60 to 74 years. Higher cigarette taxes were associated with lower heart failure hospitalizations for all ages and fewer pneumonia hospitalizations for adults aged 60 to 74. Previous studies may have overestimated the relation between smoking bans and hospitalizations and underestimated the effects of cigarette taxes.
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Affiliation(s)
- Vivian Ho
- Rice University, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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Torok M, Winickoff J, McMillen R, Klein J, Wilson K. Prevalence and location of tobacco smoke exposure outside the home in adults and children in the United States. Public Health 2017; 151:149-159. [DOI: 10.1016/j.puhe.2017.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/06/2017] [Accepted: 07/09/2017] [Indexed: 12/01/2022]
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Milcarz K, Bak-Romaniszyn L, Kaleta D. Environmental Tobacco Smoke Exposure and Smoke-Free Rules in Homes among Socially-Disadvantaged Populations in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E447. [PMID: 28430128 PMCID: PMC5409647 DOI: 10.3390/ijerph14040447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022]
Abstract
This study aims to examine the prevalence of exposure to environmental tobacco smoke (ETS) in homes among socially-disadvantaged populations in Poland, along with the prevalence and correlates of voluntary implementation of smoke-free home rules. Data concerning 1617 respondents from a cross-sectional study completed in the Piotrkowski District were used, which was part of the "Reducing Social Inequalities in Health" program. Overall, 19.4% of the respondents declared exposure to ETS at home. In the non-smokers group, 15.5%, including 6.6% males and 18.3% females, were exposed to ETS in their place of residence (p < 0.0001). Complete smoke-free rules were adopted by 22.1% of the study participants. Two factors, smoker status and lack of ETS-associated health risk awareness, were found to be significantly associated with no adoption of total smoking bans at home. Socially-disadvantaged non-smokers, especially females from rural areas in Poland, still constitute a large population exposed to ETS in their homes-a challenge from the perspective of public health. Focused efforts are required to address social norms around exposing others to ETS.
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Affiliation(s)
- Katarzyna Milcarz
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752 Lodz, Poland.
| | - Leokadia Bak-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338 Lodz, Poland.
| | - Dorota Kaleta
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752 Lodz, Poland.
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Fernández E, Fu M, Pérez-Ríos M, Schiaffino A, Sureda X, López MJ. Changes in Secondhand Smoke Exposure After Smoke-Free Legislation (Spain, 2006–2011). Nicotine Tob Res 2017; 19:1390-1394. [DOI: 10.1093/ntr/ntx040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/06/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, WHO Collaborating Center for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, WHO Collaborating Center for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Mónica Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Xunta de Galicia, Santiago de Compostela, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Anna Schiaffino
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, WHO Collaborating Center for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Xisca Sureda
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain
| | - María J López
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
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Pandey S, Murugan V, Karki YB, Mathur A. In-home Smoking in Households with Women of Reproductive Age in Nepal: Does Women's Empowerment Matter? HEALTH & SOCIAL WORK 2017; 42:32-40. [PMID: 28395076 DOI: 10.1093/hsw/hlw057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/09/2016] [Indexed: 06/07/2023]
Abstract
Authors examined the prevalence and predictors of in-home smoking in households with women of reproductive age. They analyzed data from 9,837 ever married women from 2011 Nepal Demographic Health Survey. About 17 percent of women and 66 percent of their husbands smoked and 58 percent of the women lived in homes that permitted in-home smoking. About 6 percent of the women were pregnant and 42 percent had given birth within the past five years. In-home tobacco use was equally prevalent in homes with and without young children and irrespective of women's pregnancy status. Husband's use of tobacco doubled the odds of in-home smoking (odds ratio [OR] = 2.36; 95% confidence interval [CI] = 1.52-3.69) and wife's use of tobacco quadrupled the odds of in-home smoking controlling for other factors (OR = 3.94; 95% CI = 3.30-4.70). In addition, employed women were 39 percent more likely to allow in-home smoking than their unemployed counterparts (OR = 1.39; 95% CI = 1.19-1.63). Protective factors against in-home smoking were women's education, intrahousehold decision-making ability, household wealth, and urban residence. To reduce in-home smoking, social workers should increase awareness about the adverse consequences of secondhand smoke by providing counseling services to male and female tobacco users.
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Affiliation(s)
- Shanta Pandey
- Professor, Boston College School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Vithya Murugan
- Doctoral student, George Warren Brown School of Social Work, Washington University in St. Louis, USA
| | - Yagya B Karki
- Executive director, Population, Health and Development Group, Kathmandu, Nepal
| | - Amit Mathur
- Professor of pediatrics and codirector, Neurodevelopmental Research Group, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, USA
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Campbell M, Ballas D. SimAlba: A Spatial Microsimulation Approach to the Analysis of Health Inequalities. Front Public Health 2016; 4:230. [PMID: 27818989 PMCID: PMC5073091 DOI: 10.3389/fpubh.2016.00230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/03/2016] [Indexed: 11/13/2022] Open
Abstract
This paper presents applied geographical research based on a spatial microsimulation model, SimAlba, aimed at estimating geographically sensitive health variables in Scotland. SimAlba has been developed in order to answer a variety of "what-if" policy questions pertaining to health policy in Scotland. Using the SimAlba model, it is possible to simulate the distributions of previously unknown variables at the small area level such as smoking, alcohol consumption, mental well-being, and obesity. The SimAlba microdataset has been created by combining Scottish Health Survey and Census data using a deterministic reweighting spatial microsimulation algorithm developed for this purpose. The paper presents SimAlba outputs for Scotland's largest city, Glasgow, and examines the spatial distribution of the simulated variables for small geographical areas in Glasgow as well as the effects on individuals of different policy scenario outcomes. In simulating previously unknown spatial data, a wealth of new perspectives can be examined and explored. This paper explores a small set of those potential avenues of research and shows the power of spatial microsimulation modeling in an urban context.
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Affiliation(s)
- Malcolm Campbell
- GeoHealth Laboratory, Department of Geography, University of Canterbury , Christchurch , New Zealand
| | - Dimitris Ballas
- Department of Geography, University of Sheffield, Sheffield, UK; Department of Geography, University of the Aegean, Mytilene, Greece
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Wimbush E, Young I, Robertson G. Developing effective policy and practice for health promotion in Scotland. ACTA ACUST UNITED AC 2016; 14:228-32. [DOI: 10.1177/10253823070140040901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scotland has recently embarked on a new phase of policy and infrastructure development for improving population health and reducing health inequalities that broadly conforms to the Ottawa Charter and WHO's strategic framework for the prevention and control of non-communicable diseases. The new phase is characterised by an integrated, cross-government approach to improving health with strengthened political and Scottish Executive leadership and investment since devolution. A comprehensive policy framework for improving young people's health and reducing inequalities has been developed across education, health, environment and social justice. It builds on an earlier phase of relative stability and continuity in the health promotion infrastructure with policy focused on CVD and cancer prevention and tackling the behavioural risk factors (smoking, alcohol, diet, physical activity) as well as sexual health and mental health and wellbeing. These national strategies are currently being implemented across Scotland. They combine promotion, prevention, treatment and protection goals and target both population-level and high-risk groups. Crosscutting government objectives and headline targets for addressing poverty, disadvantage and health inequalities now supplement the NHS health improvement targets on smoking, alcohol, physical activity, teenage pregnancy and child immunization. Within the health service, prevention efforts are largely concerned with primary care development (anticipatory care) and health system reform to maximize their impact on reducing health inequalities. Efforts to tackle the social determinants of health and reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government with Community Planning Partnerships as the main vehicle. National level mechanisms for integrated funding, planning and performance reporting to deliver shared priority outcomes have yet to be developed. The development of health improvement strategies has been founded upon a rich source of population health data to monitor changes and improvements, epidemiological studies and evaluation work. The key issues have been to find ways of intervening to accelerate the rate of improvement and to stem the growing health inequalities. A further challenge is to ensure that the lessons from reviews and evaluations of past programmes and strategies are not lost, but help to guide improvements in the complex delivery system and to inform future policy direction. Within the health service, prevention efforts are largely concerned with primary care development and health system reform. Efforts to reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government. ( Promotion & Education, 2007, XIV (4): pp 228-232)
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Kingsbury JH, Reckinger D. Clearing the Air: Smoke-Free Housing Policies, Smoking, and Secondhand Smoke Exposure Among Affordable Housing Residents in Minnesota, 2014-2015. Prev Chronic Dis 2016; 13:E111. [PMID: 27536903 PMCID: PMC4993114 DOI: 10.5888/pcd13.160195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During the past 30 years, local and state tobacco use control laws in the United States have helped reduce smoking prevalence and exposure to secondhand smoke, but progress among low socioeconomic populations has been slow. Implementing smoke-free housing policies in affordable housing may help address this issue. The purpose of our study was to assess how such policies affect smoking rates and exposure to secondhand smoke among residents of affordable housing. METHODS We conducted a pretest-posttest longitudinal study of 180 residents from 8 affordable housing properties in Minnesota. Participating properties agreed to adopt a smoke-free housing policy covering indoor grounds, and 3 of these properties also prohibited smoking on all outdoor grounds. Policies were implemented with assistance from local public health departments and the Statewide Health Improvement Program. Participants completed surveys one month before policy implementation and 6 months postimplementation. Surveys assessed smoking, quit attempts, and indoor and outdoor secondhand smoke exposure. RESULTS Results indicated a significant reduction in nonsmokers' indoor exposure to secondhand smoke (F1,144 = 22.69, P < .001) and no change in outdoor exposure to secondhand smoke from Time 1 (pretest) to Time 2 (posttest) (F1,140 = 2.17, P = .14). However, when examining sites that only prohibited smoking indoors, we observed an increase in outdoor secondhand smoke exposure that approached significance (F1,118 = 3.76, P = .055). Results showed no change in quit attempts over time, but 77% of residents who smoked at pretest reported reducing the amount that they smoked at posttest, and an additional 5% reported that they had quit. CONCLUSIONS Smoke-free housing policies may be an effective strategy to reduce exposure to indoor secondhand exposure and promote decreased cigarette smoking among residents of affordable housing.
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Affiliation(s)
- John H Kingsbury
- Minnesota Department of Health, 85 7th Place E, St. Paul, MN 55101.
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Monson E, Arsenault N. Effects of Enactment of Legislative (Public) Smoking Bans on Voluntary Home Smoking Restrictions: A Review. Nicotine Tob Res 2016; 19:141-148. [PMID: 27613902 DOI: 10.1093/ntr/ntw171] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 06/30/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The positive effects of worldwide increases in enactment of legislative bans on smoking in public areas have been well documented. Relatively little is known about the effects of such bans on voluntary home smoking behavior. Meanwhile, private spaces, such as homes, have replaced public spaces as the primary milieu of secondhand smoke exposure. METHODS A systematic search of peer-reviewed articles was conducted using multiple databases including Cochrane Library, Cinahl, Embase, Global Health, Health Star, Joanna Briggs, MEDLINE, PsycINFO, PAIS International, PubMed, and Web of Science. We examined peer-reviewed studies that considered the impact of legislation-based public smoking bans on enactment of private home smoking restrictions. RESULTS Sixteen articles published between 2002 and 2014 were identified and included. Our results suggest overall positive effects post-legislative ban with the majority of studies demonstrating significant increases in home smoking restrictions. Studies focusing on smoking and nonsmoking samples as well as child populations are discussed in depth. CONCLUSIONS Existing evidence indicates an overall significant positive effect post-legislative ban on voluntary home smoking restrictions. While disentangling these effects over space and time remains a challenge, scientific research has converged in dispelling any notion of significant displacement of smoking into the home. Policy makers, especially those in countries without existing public smoking legislation, can rest assured that these types of bans contribute to the minimization of tobacco-related harm. IMPLICATIONS Findings converge in dispelling notions of displacement of smoking into the home as a consequence of legislative bans that prohibit smoking in public spaces. Evidence from the studies reviewed suggests that through their influence on social norms, legislative bans on smoking in public places may encourage citizens to establish voluntary home smoking restrictions, thus decreasing harm related to secondhand smoke.
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Affiliation(s)
- Eva Monson
- Department of Psychiatry, McGill University, Montreal, QC, Canada; .,Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Nicole Arsenault
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
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Hajizadeh M, Nandi A. The socioeconomic gradient of secondhand smoke exposure in children: evidence from 26 low-income and middle-income countries. Tob Control 2016; 25:e146-e155. [DOI: 10.1136/tobaccocontrol-2015-052828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/01/2016] [Accepted: 04/28/2016] [Indexed: 11/03/2022]
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Kilpatrick M, Blizzard L, Sanderson K, Teale B, Nelson M, Chappell K, Venn A. Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program. J Occup Environ Med 2016; 58:505-13. [DOI: 10.1097/jom.0000000000000713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2:CD005992. [PMID: 26842828 PMCID: PMC6486282 DOI: 10.1002/14651858.cd005992.pub3] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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 the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking. OBJECTIVES To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015. SELECTION CRITERIA We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: 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 Organisation of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence. AUTHORS' CONCLUSIONS Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.
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Affiliation(s)
- Kate Frazer
- University College DublinSchool of Nursing, Midwifery & Health SystemsHealth Sciences CentreBelfieldDublin 4Ireland
| | - Joanne E Callinan
- Milford Care CentreLibrary & Information Service, Education, Research & Quality DepartmentPlassey Park RoadCastletroyLimerickIreland000
| | - Jack McHugh
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | - Susan van Baarsel
- University College DublinSchool of Medicine and Medical ScienceDublinIreland
| | - Anna Clarke
- National Immunisation OfficeManor StreetDublin 7Ireland
| | - Kirsten Doherty
- Education and Research CentreDepartment of Preventive Medicine and Health PromotionSt Vincent's University HospitalElm ParkDublin 4Ireland
| | - Cecily Kelleher
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
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National and state prevalence of smoke-free rules in homes with and without children and smokers: Two decades of progress. Prev Med 2016; 82:51-8. [PMID: 26601642 PMCID: PMC4766981 DOI: 10.1016/j.ypmed.2015.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/28/2015] [Accepted: 11/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The home is the primary source of secondhand smoke (SHS) exposure for children. We assessed national and state progress in smoke-free home (SFH) rule adoption in homes with and without children and adult smokers. METHODS Data came from the 1992-1993 and 2010-2011 Tobacco Use Supplements to the Current Population Survey, a U.S. national probability household survey. Households were defined as having a SFH rule if all household respondents aged ≥18 indicated no one was allowed to smoke inside the home at any time. Households with children were those with occupants aged <18. Smokers were those who smoked ≥100 lifetime cigarettes and now smoked "everyday" or "some days". RESULTS From 1992-1993 to 2010-2011, SFH rule prevalence increased from 43.0% to 83.0% (p<.05). Among households with children, SFH rules increased overall (44.9% to 88.6%), in households without smokers (59.7% to 95.0%), and households with ≥1 smokers (9.7% to 61.0%) (p<.05). Among households without children, SFH rules increased overall (40.8% to 81.1%), in households without smokers (53.4% to 90.1%), and households with ≥1 smokers (6.3% to 40.9%) (p<.05). Prevalence increased in all states, irrespective of smoker or child occupancy (p<.05). In 2010-2011, among homes with smokers and children, SFH rule prevalence ranged from 36.5% (West Virginia) to 86.8% (California). CONCLUSIONS Considerable progress has been made adopting SFH rules, but many U.S. children continue to be exposed to SHS because their homes are not smoke-free. Further efforts to promote adoption of SFH rules are essential to protect all children from this health risk.
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Park JH, Lee CK, Kim KH, Son BC, Kim JH, Suh CH, Kim SY, Yu SD, Kim SJ, Choi WH, Kim DH, Park YB, Park SH, Lee SW. Decrease in the urine cotinine concentrations of Korean non-smokers between 2009 and 2011 following implementation of stricter smoking regulations. Int J Hyg Environ Health 2016; 219:123-8. [DOI: 10.1016/j.ijheh.2015.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
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Patterson C, Semple S, Wood K, Duffy S, Hilton S. A quantitative content analysis of UK newsprint coverage of proposed legislation to prohibit smoking in private vehicles carrying children. BMC Public Health 2015; 15:760. [PMID: 26253515 PMCID: PMC4529703 DOI: 10.1186/s12889-015-2110-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022] Open
Abstract
Background Mass media representations of health issues influence public perceptions of those issues. Despite legislation prohibiting smoking in public spaces, second-hand smoke (SHS) remains a health risk in the United Kingdom (UK). Further legislation might further limit children’s exposure to SHS by prohibiting smoking in private vehicles carrying children. This research was designed to determine how UK national newspapers represented the debate around proposed legislation to prohibit smoking in private vehicles carrying children. Methods Quantitative analysis of the manifest content of 422 articles about children and SHS published in UK and Scottish newspapers between 1st January 2003 and 16th February 2014. Researchers developed a coding frame incorporating emergent themes from the data. Each article was double-coded. Results The frequency of relevant articles rose and fell in line with policy debate events. Children were frequently characterised as victims of SHS, and SHS was associated with various health risks. Articles discussing legislation targeting SHS in private vehicles carrying children presented supportive arguments significantly more frequently than unsupportive arguments. Conclusions The relatively positive representation of legislation prohibiting smoking in vehicles carrying children is favourable to policy advocates, and potentially indicative of likely public acceptance of legislation. Our findings support two lessons that public health advocates may consider: the utility of presenting children as a vulnerable target population, and the possibility of late surges in critical arguments preceding policy events.
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Affiliation(s)
- Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Sean Semple
- Division of Applied Health Sciences, Scottish Centre for Indoor Air, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Karen Wood
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Sheila Duffy
- Action on Smoking & Health (Scotland), 8 Frederick Street, Edinburgh, EH2 2HB, UK.
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
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Lupsa IR, Nunes B, Ligocka D, Gurzau AE, Jakubowski M, Casteleyn L, Aerts D, Biot P, Den Hond E, Castaño A, Esteban M, Kolossa-Gehring M, Fiddicke U, Knudsen LE, Schoeters G, Reis MF. Urinary cotinine levels and environmental tobacco smoke in mothers and children of Romania, Portugal and Poland within the European human biomonitoring pilot study. ENVIRONMENTAL RESEARCH 2015; 141:106-117. [PMID: 25841796 DOI: 10.1016/j.envres.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to explore data from the DEMOCOPHES study population for Romania, Portugal and Poland, in order to assess smoking patterns and the extent of ETS exposure and compare the national study samples with reference to the respective anti-smoking laws. The subset of the DEMOCOPHES study sample consisted of 360 children and their mothers (120 in each of the three countries - Romania (RO), Portugal (PT) and Poland (PL). Smoking was assessed using a detailed questionnaire for the participants, which addresses both active and passive smoking. This assessment uses exposure-relevant questionnaire data, in particular on the home environment and residence, socio-demographic characteristics, lifestyle such as nutrition, smoking behavior, other exposure-relevant behavior and occupational history, as well as urinary cotinine and creatinine measurements. We performed general statistical analysis and innovative receiver operating characteristic (ROC) curve analyses. Smoking prevalence as evaluated by the questionnaire was generally high, and higher than official statistics, which suggests some under-reporting in the countries, particularly in Romania. Urinary cotinine levels provided biochemical confirmation of the high and similar smoking prevalence for the three countries. Concerning ETS exposure, Romania presented significantly higher levels, for children as well as for non-smoking mothers, with Portugal showing significantly lower levels. Compared to non-smoking mothers, the children showed relatively higher ETS exposure levels in all three countries. The established country-specific optimal cut-off values in urinary cotinine to distinguish smokers from non-smokers vary more than those to discriminate ETS exposure extent in non-smoking mothers and children. Although different between countries, these values are a valuable output to monitor effectiveness of both national antismoking laws and educational programs in the three countries. The findings of this study point to the urgent need for stronger, more effective and well enforced smoke-free legislation in the three countries.
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Affiliation(s)
- Ioana-Rodica Lupsa
- Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania.
| | - Baltazar Nunes
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | | | - Anca Elena Gurzau
- Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania
| | | | - Ludwine Casteleyn
- University of Leuven, Centrum Menselijke Erfelijkheid, Herestraat 49 bus 602, 3000 Leuven, Belgium
| | - Dominique Aerts
- Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium
| | - Pierre Biot
- Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium
| | - Elly Den Hond
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium
| | - Argelia Castaño
- Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain
| | - Marta Esteban
- Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain
| | - Marike Kolossa-Gehring
- Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany
| | - Ulrike Fiddicke
- Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany
| | - Lisbeth E Knudsen
- University of Copenhagen, Department of Public Health, Øster Farimagsgade 5, DK 1353 Copenhagen K, Denmark
| | - Greet Schoeters
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium; University of Southern Denmark, Odense, Denmark
| | - M Fátima Reis
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal
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Jones AM, Laporte A, Rice N, Zucchelli E. Do public smoking bans have an impact on active smoking? Evidence from the UK. HEALTH ECONOMICS 2015; 24:175-192. [PMID: 24677756 DOI: 10.1002/hec.3009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/16/2013] [Accepted: 09/25/2013] [Indexed: 06/03/2023]
Abstract
The literature on the effects of public smoking bans on smoking behaviour presents conflicting results and there is limited evidence on their impact on active smoking. This paper evaluates the impact of smoking bans on active smoking using data from the British Household Panel Survey and exploiting the policy experiment provided by the differential timing of the introduction of the bans in Scotland and England. We assess the short-term impact of the smoking bans by employing a series of flexible difference-in-differences fixed effects panel data models. We find that the introduction of the public smoking bans in England and Scotland had limited short-run effects on both smoking prevalence and the total level of smoking. Although we identify significant differences in trends in smoking consumption across the survey period by population sub-groups, we find insufficient evidence to conclude that these were affected by the introduction of the smoking bans. These results challenge those found in the public health literature but are in line with the most recent strand of economic literature indicating that there is no firm evidence on the effects of smoking bans on smoking.
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Affiliation(s)
- Andrew M Jones
- Department of Economics and Related Studies (DERS), University of York, UK
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Huque R, Dogar O, Cameron I, Thomson H, Amos A, Siddiqi K. Children Learning About Second-Hand Smoking: A Feasibility Cluster Randomized Controlled Trial. Nicotine Tob Res 2015; 17:1465-72. [PMID: 25634936 DOI: 10.1093/ntr/ntv015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to second-hand smoke is a threat to children's health. We developed a school-based smoke-free intervention (SFI) to support families in implementing smoke-free homes in Bangladesh, and gathered preliminary evidence of its effectiveness. METHODS A feasibility cluster randomized controlled trial of SFI was conducted in 24 schools in Mirpur, an urban area within Dhaka. Using simple stratified randomization, schools were allocated to: Arm A (SFI only), Arm B (SFI plus reminders), and Arm C (the control group). A total of 781 year-5 children (10-12 years old) in the consenting schools, participated in the study. Outcomes including "smoke-free homes" and "social visibility" that is, not smoking in front of children at home were assessed through questionnaire-based children's surveys, administered by researchers, at baseline and at weeks 1, 12, 27, and 52 in all arms. RESULTS "Smoke-free homes" were significantly higher in Arm A (odds ratio [OR] = 4.8; 95% CI = 2.6-9.0) and in Arm B (OR = 3.9; 95% CI = 2.0-7.5) than in Arm C, when controlled for the baseline levels, at year 1. Similarly, "social visibility" was significantly reduced in Arm A (OR = 5.8; 95% CI = 2.8-11.7) and in Arm B (OR = 7.2; 95% CI = 3.3-15.9) than Arm C, when controlled for the baseline levels, at year 1. We observed an increasing trend (Cochrane Armitage test statistic [Z] = 3.8; p < .0001) in homes becoming smoke-free with increasing intensity of the intervention (control < Arm A < Arm B), and a decreasing trend (Z = -5.13; p < .0001) in social visibility at homes. CONCLUSION SFI has the potential to encourage children to negotiate a smoke-free environment in their homes.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh;
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | | | - Heather Thomson
- Office of the Director of Public Health, Leeds City Council, Leeds, UK
| | - Amanda Amos
- Centre for Population Health Sciences Medical School, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences/Hull York Medical School, University of York, York, UK
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Hilton S, Wood K, Bain J, Patterson C, Duffy S, Semple S. Newsprint coverage of smoking in cars carrying children: a case study of public and scientific opinion driving the policy debate. BMC Public Health 2014; 14:1116. [PMID: 25351408 PMCID: PMC4230725 DOI: 10.1186/1471-2458-14-1116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Media content has been shown to influence public understandings of second-hand smoke. Since 2007 there has been legislation prohibiting smoking in all enclosed public places throughout the United Kingdom (UK). In the intervening period, interest has grown in considering other policy interventions to further reduce the harms of second-hand smoke exposure. This study offers the first investigation into how the UK newsprint media are framing the current policy debate about the need for smoke-free laws to protect children from the harms of second-hand smoke exposure whilst in vehicles. METHODS Qualitative content analysis was conducted on relevant articles from six UK and three Scottish national newspapers. Articles published between 1st January 2004 and 16th February 2014 were identified using the electronic database Nexis UK. A total of 116 articles were eligible for detailed coding and analysis that focused on the harms of second-hand smoke exposure to children in vehicles. RESULTS Comparing the period of 2004-2007 and 2008-2014 there has been an approximately ten-fold increase in the number of articles reporting on the harms to children of second-hand smoke exposure in vehicles. Legislative action to prohibit smoking in vehicles carrying children was largely reported as necessary, enforceable and presented as having public support. It was commonly reported that whilst people were aware of the general harms associated with second-hand smoke, drivers were not sufficiently aware of how harmful smoking around children in the confined space of the vehicle could be. CONCLUSIONS The increased news reporting on the harms of second-hand smoke exposure to children in vehicles and recent policy debates indicate that scientific and public interest in this issue has grown over the past decade. Further, advocacy efforts might draw greater attention to the success of public-space smoke-free legislation which has promoted a change in attitudes, behaviours and social norms. Efforts might also specifically highlight the particular issue of children's developmental vulnerability to second-hand smoke exposure, the dangers posed by smoking in confined spaces such as vehicles, and the appropriate measures that should be taken to reduce the risk of harm.
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Affiliation(s)
- Shona Hilton
- />MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Karen Wood
- />MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Josh Bain
- />MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Chris Patterson
- />MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Sheila Duffy
- />Action on Smoking & Health (Scotland), 8 Frederick Street, Edinburgh, EH2 2HB UK
| | - Sean Semple
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, University of Aberdeen, AB25 2ZD Aberdeen, UK
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Serafin A, Franklin S, Mehta R, Crosby S, Lee D, Edlin B, Bewick BM. NHS patients, staff, and visitor viewpoints of smoking within a hospitals' ground: a qualitative analysis. BMC Public Health 2014; 14:1015. [PMID: 25266492 PMCID: PMC4247108 DOI: 10.1186/1471-2458-14-1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking is a public health concern and an avoidable cause of morbidity and mortality. Widening tobacco control policies might help shift social norms, the acceptability of exposing others to second-hand smoke, and cultural attitudes towards smoking. This study explored patient, staff, and visitor viewpoints of smoking within the grounds of a National Health Service hospital. METHODS Analysis of free text responses given as part of a larger repeat cross sectional questionnaire study. Free text qualitative responses analysed using thematic analysis. Pinderfields Hospital, a UK National Health Service hospital in the county of Yorkshire, provides a health service to around half a million people living in the Wakefield and North Kirklees area. Surveys were distributed 10th-18th September and 17th-21st December 2012. Of the n=952 participants who completed an anonymous survey n=306 participants provided a response to the optional free text question. RESULTS Thematic analysis revealed 5 distinct themes: (1) smoking is a dirty problem; (2) smokers are free to do as they wish; (3) the poor smoker; (4) smoke in our space: the battleground; and (5) no smoking please. Of the n=272 represented by the five themes, generally people accepted that smoking is socially unacceptable but their understanding of smoking behaviours and attitudes towards management and control of smoking differed. There was a strong sense that action is needed to separate the space smokers and non-smokers share. We identified a distinct group of participants that supported a hard line approach and suggested enforcing the no smoking policy through fines and monitoring. CONCLUSIONS Smoking on hospital grounds remains a contentious issue. Participants acknowledge that smoking is an increasingly unacceptable social behaviour but their understanding and acceptance of smokers vary. There is a strong sense of dislike about the impact of smoke and smokers on the shared hospital environment, with a focus on the hospital entrance. Participants suggest separating smokers and non-smokers and moving smokers away from the hospital entrance with the introduction of smoking shelters. These results suggest a complex narrative that should be investigated further to inform the implementation of the no-smoking policy across hospital settings.
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Affiliation(s)
- Alina Serafin
- />Leeds Teaching Hospital NHS Trust, St James’s University Hospital, Leeds, LS9 7TF UK
| | - Sarah Franklin
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Rashesh Mehta
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Scott Crosby
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Diane Lee
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Becky Edlin
- />Magpie Creative Communications Ltd, Leeds, LS2 9NG UK
| | - Bridgette M Bewick
- />Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9LJ UK
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Chan SSC, Cheung YTD, Leung DYP, Mak YW, Leung GM, Lam TH. Secondhand smoke exposure and maternal action to protect children from secondhand smoke: pre- and post-smokefree legislation in Hong Kong. PLoS One 2014; 9:e105781. [PMID: 25166507 PMCID: PMC4148325 DOI: 10.1371/journal.pone.0105781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background Smokefree legislation may protect children from secondhand smoke (SHS) in the home from smoking parent(s). We examined the effect of the 2007 smokefree legislation on children’s exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. Methods Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005–2006, n = 333) and after the legislation (2007–2008, n = 742) which led to a major extension of smokefree places in Hong Kong. Main outcomes included children’s SHS exposure in the home, nicotine level in mothers’ and children’s hair and home environment, mothers’ action to protect children from SHS, and their support to the fathers to quit. Results Fewer mothers post-legislation reported children’s SHS exposure in the home (87.2% versus 29.3%, p<0.01), which was consistent with their hair nicotine levels (0.36ng/mg versus 0.04ng/mg, p<0.01). More mothers post-legislation in the last month took their children away from cigarette smoke (6.3% versus 92.2%; p<0.01) and advised fathers to quit over 3 times (8.3% versus 33.8%; p<0.01). No significant change was found in the content of smoking cessation advice and the proportion of mothers who took specific action to support the fathers to quit. Conclusions SHS exposure in the home decreased and maternal action to protect children from SHS increased after the 2007 smokefree legislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation.
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Affiliation(s)
| | | | - Doris Yin Ping Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Gabriel M. Leung
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Heo S, Lee JT. Disease burdens from environmental tobacco smoke in Korean adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2014; 25:330-348. [PMID: 25155457 DOI: 10.1080/09603123.2014.945513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this study, we estimated the disease burdens attributable to environmental tobacco smoke (ETS) exposure in Korean adults in 2010 and analyzed the trend of that from 2005 to 2010. We obtained information on the study population from the 2010 Cause of Death Statistic and estimated the ETS-attributable fraction using data from the Korean Community Health Survey and the Korean National Health and Nutrition Examination Survey. The numbers of ETS-attributable deaths in female and male non-smokers were estimated to be 4.1 and 69.6% of the numbers of deaths attributable to current smoke, respectively. The deaths attributable to ETS were larger in female than in male non-smokers (710 vs. 420). The ETS-attributable deaths increased slightly in 2005-2008 but decreased in 2009-2010. The number of potential years of life lost from ETS was 9077.24 years in 2010. If there were no exposure to ETS in adult non-smokers, we would expect to see 1130 fewer deaths (9.9% of the deaths from current smoke). The results suggest that ETS poses considerable disease burdens for non-smokers, especially women, in Korea.
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Affiliation(s)
- Seulkee Heo
- a Department of Public Health Science , Graduate School, Korea University , Seoul , Republic of Korea
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46
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Kairouz S, Lasnier B, Mihaylova T, Montreuil A, Cohen JE. Smoking restrictions in homes after implementation of a smoking ban in public places. Nicotine Tob Res 2014; 17:41-7. [PMID: 25140045 DOI: 10.1093/ntr/ntu125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This Canadian study examines the prevalence of smoking restrictions in homes before and after the implementation of a public smoking ban, and their relation to tobacco use and cessation among a cohort of smokers. METHODS Data were from a longitudinal cohort study of 1,058 smokers in the province of Québec, Canada. Baseline data were collected through a population-based survey conducted 1 month before the implementation of the smoking ban with a representative sample of smokers. Follow-up data were collected 18 months after the ban with a response rate of 68%. Logistic regressions, paired t tests and chi-square statistics were used to examine the factors associated with smoking restrictions in homes, cigarette consumption, and quit attempts. RESULTS Many smokers imposed partial or full smoking restrictions in their homes but proportions of smoke-free homes did not change significantly between baseline and follow-up. The presence of young children and nonsmokers significantly predicted full smoking restriction in the home. Knowledge about risks associated with exposure to secondhand smoke (SHS) and skepticism about the efficacy of methods to reduce exposure in the home also predicted maintenance of voluntary smoking restrictions in homes. The uptake of smoke-free homes was not associated with the quantity of cigarettes smoked or quit attempts. CONCLUSIONS No significant change in home smoking bans was found 18 months after implementation of a public smoking ban. There remains a need for efforts to better inform smokers about health risks from exposure to SHS in homes and the reality that strategies other than a total smoking ban inside the home are ineffective.
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Affiliation(s)
- Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, Montreal, Québec, Canada;
| | - Benoit Lasnier
- Institut National de Santé Publique du Québec, Surveillance, Research, and Evaluation, Tobacco Unit, Montréal, Québec, Canada
| | - Tsvetelina Mihaylova
- Lifestyle and Addiction Research Lab, Concordia University, Montreal, Québec, Canada
| | - Annie Montreuil
- Institut National de Santé Publique du Québec, Surveillance, Research, and Evaluation, Tobacco Unit, Montréal, Québec, Canada
| | - Joanna E Cohen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Fenton B, Thankappan KR, Champagne B, Lv J, Anthony D. Increased knowledge of the effects of smoking and second-hand smoke encourages smoke-free homes. J Res Nurs 2014. [DOI: 10.1177/1744987114525963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To establish the drivers for smoke-free homes among current daily smokers. Design A cross-sectional study employing interviews (adults) and self-completed surveys (schoolchildren). Sample Children aged 12 and 14 in schools in four cities in China, India, Mexico and England. Adults in the community. Measurements Knowledge, attitude, beliefs and behaviour relevant to second-hand smoke in home. Intervention None. Results A total of 8994 adults and 14,756 children were surveyed. Knowledge of some of the effects of tobacco is high, but other effects are poorly understood in all cities. In Thiruvananthapuram, there is a lack of awareness of the addictiveness of tobacco, and Hangzhou has poor knowledge in general. Conclusions Messages about reducing tobacco usage are effective in support of smoke-free homes in the city with poorest knowledge (Hangzhou) but other factors are more important where knowledge is high.
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Affiliation(s)
- Brenda Fenton
- Director, Community-based Research and Evaluation, MATRIX Public Health Solutions Inc., USA
| | - Kavumpurathu Raman Thankappan
- Professor, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
| | | | - Jun Lv
- Associate Professor, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Denis Anthony
- Statistical consultant, Oxford Health Alliance, UK; Chair in Applied Health Research, University of Leeds, UK
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Martínez-Sánchez JM, Sureda X, Fu M, Pérez-Ortuño R, Ballbè M, López MJ, Saltó E, Pascual JA, Fernández E. Secondhand smoke exposure at home: assessment by biomarkers and airborne markers. ENVIRONMENTAL RESEARCH 2014; 133:111-6. [PMID: 24912142 DOI: 10.1016/j.envres.2014.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 05/13/2023]
Abstract
OBJECTIVE We assessed and characterized the relationship among biomarkers of secondhand smoke (SHS) exposure in non-smokers according to their exposure at home as measured by airborne markers. METHODS We conducted an observational study on exposure to SHS at home using airborne markers (nicotine and benzene) and biomarkers from the non-smokers living in these homes. We selected 49 non-smoking volunteers from different homes: 25 non-smokers living with at least one smoker and 24 non-smokers living in smoke-free homes. We installed two passive devices to measure nicotine and benzene concentrations in the main room of the house (i.e., the living room). One week later, the researcher returned to the volunteer's home to collect the two devices, obtain saliva and urine samples, and administer a SHS questionnaire. RESULTS Salivary and urinary cotinine concentrations highly correlated with air nicotine concentrations measured at the volunteers'homes (rsp=0.738 and rsp=0.679, respectively). The concentrations of airborne markers of SHS and biomarkers in non-smokers increased with increasing self-reported intensity and duration of SHS exposure at home during the previous week (p<0.05). The multivariable regression model showed a significant association with nicotine in air at home (β=0.126, p=0.002 for saliva and β=0.115, p=0.010 for urine). CONCLUSIONS Our findings suggest that, even in countries with comprehensive smoke-free legislation, exposure to SHS at home continues to be the main source of exposure for non-smokers who live in non-smoke-free homes. Therefore, public health policies should promote smoke-free homes.
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Affiliation(s)
- Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet, 08908 L'Hospitalet de Llobregat, 199-203 Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet, 08908 L'Hospitalet de Llobregat, 199-203 Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet, 08908 L'Hospitalet de Llobregat, 199-203 Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet, 08908 L'Hospitalet de Llobregat, 199-203 Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María J López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica-IBB Sant Pau, Barcelona, Spain
| | - Esteve Saltó
- Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Spain; Department of Public Health, Universitat de Barcelona, Barcelona, Spain
| | - José A Pascual
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Experimental and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet, 08908 L'Hospitalet de Llobregat, 199-203 Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
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Eyal N. Nudging by shaming, shaming by nudging. Int J Health Policy Manag 2014; 3:53-6. [PMID: 25114942 DOI: 10.15171/ijhpm.2014.68] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nir Eyal
- Center for Bioethics, Harvard Medical School, and Department of Global Health and population, Harvard School of Public Health, Boston, MA, USA
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50
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Environmental tobacco smoke exposure and brain development: The case of attention deficit/hyperactivity disorder. Neurosci Biobehav Rev 2014; 44:195-205. [DOI: 10.1016/j.neubiorev.2013.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 02/06/2013] [Accepted: 03/14/2013] [Indexed: 11/22/2022]
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