Socially cued smoking in bars, nightclubs, and gaming venues: a case for introducing smoke-free policies

Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change

Introduction

This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages.

Methods

Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis.

Results

Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase.

Conclusion

Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.

This Free Life Campaign: Increasing Intention to Quit Among LGBTQ+ Young Adult Nondaily Smokers in Minneapolis

PURPOSE

LGBTQ+ young adults smoke at disproportionately higher rates than their non-LGBTQ+ counterparts, but prevention efforts are limited. Furthermore, prior to This Free Life (TFL), no known campaigns target LGBTQ+ nondaily smokers. In this study Blue Cross and Blue Shield of Minnesota evaluated a local partnership extension of the Food and Drug Administration (FDA) Center for Tobacco Products' TFL campaign.

METHODS

The intervention featured a variety of LGBTQ+-tailored events, social/digital media, and out-of-home media placed in locations with a high density of LGBTQ+ young adults. Cross-sectional surveys (n = 1215) were collected from LGBTQ+ young adult (18-26) nondaily smokers at 4 time points between 2016 and 2019. The national TFL campaign was tracked in a separate evaluation conducted by the FDA.

RESULTS

43.0% of nondaily LGBTQ+ smokers reported awareness of the campaign (n = 522), and 63.4% of those also engaged with TFL (n = 330). Engagement was highest for gay, lesbian and transgender participants, and for Asian and Black/African American participants. Each additional instance of campaign engagement increased participants' odds of intending to quit smoking by 20% (AOR = 1.20; 95% CI = 1.05, 1.36). The relationship between campaign engagement and intention to quit was fully mediated by the campaign's impact on attitudes against smoking and perceived normative trends, but not by perceived behavioral control.

CONCLUSION

The local extension of TFL increased intentions to quit for LGBTQ+ nondaily smokers. Future research should further explore the relationship between perceived behavioral control and intentions to quit for nondaily smokers.

Determinants of good academic performance among university students in Ethiopia: a cross-sectional study

BACKGROUND

Education plays a pivotal role in producing qualified human power that accelerates economic development and solves the real problems of a community. Students are also expected to spend much of their time on their education and need to graduate with good academic results. However, the trend of graduating students is not proportional to the trend of enrolled students and an increasing number of students commit readmission, suggesting that they did not perform well in their academics. Thus, the study aimed to identify the determinants of academic performance among university students in Southern Ethiopia.

METHOD

Institution-based cross-sectional study was conducted from December 1 to 28, 2020. A total of 659 students were enrolled and data was collected using a self-administered questionnaire. A multistage sampling technique was applied to select study participants. Data were cleaned and entered into Epi-Data version 4.6 and exported to SPSS version 25 software for analysis. Bivariable and multivariable data analysis were computed and a p-value of ≤0.05 was considered statistically significant. Smoking, age, and field of study were significantly associated with academic performance.

RESULT

Four hundred six (66%) of students had a good academic performance. Students aged between 20 and 24 years (AOR = 0.43, 95% CI = 0.22-0.91), and medical/ health faculty (AOR = 2.46, 95% CI = 1.45-4.20) were significant associates of good academic performance. Students who didn't smoke cigarettes were three times more likely to score good academic grades compared to those who smoke (AOR = 3.15, 95% CI = 1.21-7.30).

CONCLUSION

In this study, increased odds of good academic performance were observed among students reported to be non-smokers, adults, and medical/health science students. Reduction or discontinuation of smoking is of high importance for good academic achievement among these target groups. The academic environment in the class may be improved if older students are invited to share their views and particularly their ways of reasoning.

Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries

OBJECTIVE

Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants.

METHODS

Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants.

RESULTS

Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m³ and increased during nighttime (1.45 IQR:0.65-4.79 μg/m³), in enclosed venues (2.97 IQR:0.80-5.80 μg/m³), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m³), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m³), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m³). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure.

CONCLUSIONS

Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.

Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey

INTRODUCTION

Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries.

METHODS

In 2017-2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses.

RESULTS

Overall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. 'Other indoor settings' (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence.

CONCLUSIONS

We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people.

TRIAL REGISTRATION NUMBER

NCT02928536.

Outdoor smoking in Nigeria: prevalence, correlates and predictors

BACKGROUND

There is a lack of data on smoking in outdoor-open bars in Nigeria that may translate into effective legislation on public smoking.

METHOD

This study determined the prevalence, demographic and clinical correlates as well as predictors of smoking among a community sample of 1119 patrons of open place bars in Ibadan, Nigeria. Data on current smoking was obtained using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), while smoking intensity was calculated using the Pack-Year. Prevalence of alcohol use was determined using the Alcohol Use Disorders Identification Test (AUDIT), while depression was diagnosed using the Mini International Neuropsychiatry Interview (MINI). Analysis was carried out by SPSS version 20.0 software using Chi square statistics, t test and ANOVA, and was set at 95% confidence interval.

RESULTS

Prevalence of current smoking was 63.8% and the mean pack years of smoking of all respondents was 19.38 ± 17.16 years. Predictors of outdoor smoking were depression OR = 1.41, 95% CI (1.09-1.83) and alcohol use OR = 2.12, 95% CI (1.44-3.13). Predictors of high pack years were depression OR = 1.47, 95% CI (1.08-2.01), being married, OR = 1.78, 95% CI (1.29-2.45), high income, OR = 1.95, 95% CI (1.42-2.68) and alcohol use OR = 2.82, 95% CI (1.51-5.27). There was no significant relationship between stage of readiness to quit smoking and mean pack years of smoking, F = 0.3, p = 0.5.

CONCLUSION

The high prevalence of outdoor smoking in the sample calls for urgent public health initiatives for intervention. Thus, outdoor bars are potential tobacco use intervention sites to minimize the health consequences of smoking.

Correlated Factors with Quitting Attempts Among Male Smokers in Vietnam: A QUITLINE-Based Survey

Despite its decreasing prevalence, cigarette smoking remains the second leading cause of preventable death worldwide. In Vietnam, despite recent smoking cessation efforts, the prevalence of tobacco consumption remains high, particularly among males. In this study, we aim to evaluate the self-efficacy in quitting smoking (i.e., quitting confidence), intention to quit, and identifying associated factors among both rural and urban Vietnamese male populations. A cross-sectional study was conducted on 321 patients (52.7% urban and 47.4% rural inhabitants) who utilized QUITLINE services of Bach Mai Hospital (Hanoi, Vietnam). Socio-economic status, smoking history, cigarette usage data, and intent to quit were assessed. Baseline data were correlated with quitting confidence, to identify significant associated factors. The majority (75.9%) of participants were in the planning phase of cessation, yet 90.8% lacked complete confidence in their quitting ability. Older age, fewer cigarettes per day and previous quitting attempts were associated with quitting confidence (p < 0.05) and plans to quit (p < 0.05). Older smokers and previous quitters were more confident in their ability to quit in the near future and more likely to have made plans to quit. Future smoking cessation efforts should focus on improving self-efficacy, particularly among younger and newer smokers.

Smoking relapse situations among a community-recruited sample of Spanish daily smokers

INTRODUCTION

Relapse is a common factor within the behavior change process. However, there is scarce and limited knowledge of smoking relapse situations in population-based samples. The aim of this study was to identify smoking relapse situations among a sample of Spanish relapsers from the general population.

METHODS

A sample of 775 relapsers was recruited among the general population using a snowball method. Participants completed a survey including sociodemographic, smoking-related and psychopathology variables. Smoking relapse situations were identified through specific questions assessing different aspects related to the last relapse episode.

RESULTS

The majority of smoking relapse situations were attributed to positive affect (36.6%) and negative affect (34.3%), followed by lack of control (10.1%), smoking habit (6.7%), craving or nicotine withdrawal (6.3%), and social pressure (5.9%). Being unemployed and having a mental disorder in the past increased the likelihood of relapse in situations of negative affect. Being single and having quit smoking to save money were associated with an increased likelihood of relapse in situations of positive affect.

CONCLUSIONS

Affect plays a significant role in smoking relapse among a community sample of unassisted Spanish smokers. Relapse may be much more of an affective and situational process than a habit, physiological or social pressure. Findings from this study may help develop tailored community smoking relapse prevention strategies or programs.

Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults

Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.

The effect of smoke-free air law in bars on smoking initiation and relapse among teenagers and young adults

BACKGROUND

Existing evidence has shown that most smoking uptake and escalation occurs while smokers are teenagers or young adults. Effective policies that reduce smoking uptake and escalation will play an important role in curbing cigarette smoking. This study aims to investigate the effect of smoke-free air (SFA) laws in bars on smoking initiation/relapse while controlling for other confounders.

METHODS

The national longitudinal Survey of Youth 1997 (NLSY97) from 1997-2009 was linked to state-level scores for the strength of SFA laws in order to carry out the analysis.

RESULTS AND CONCLUSION

We find that SFA laws in bars with exemptions significantly reduce (p ≤ 0.01) the probability of smoking initiation (one-puff, daily, and heavy smoking initiation). The 100% SFA law in bars without exemption significantly deters smoking relapse from abstinence into daily smoking (p ≤ 0.05) or relapse from abstinence into heavy smoking (p ≤ 0.01) among people age 21 or older. The reduction of one-puff and daily smoking initiation is larger among ages 20 or younger than ages 21 or older, while the reduction in relapse does not differ by whether respondents reach the drinking age. Results also indicate that higher cigarette taxes significantly reduce daily smoking initiation and relapse into nondaily and light smoking.

Understanding the sources of normative influence on behavior: the example of tobacco

Despite extensive research on social norms, the sources of norm formation are not well understood. Social exposure to a behavior (defined as the composite of ways through which people see that behavior in their social, physical, and symbolic environments) can serve as a source of normative influence. Using tobacco as a case study, we propose that research should move beyond categories of individuals as sources of norms and focus on a broader range of sources of normative influences. An understanding of social exposure as a source for norms may be important to better understand and intervene in environments to promote public health. We make policy recommendations arising from the explication of social exposure and propose directions for future research.

Measuring visual exposure to smoking behaviours: a viewshed analysis of smoking at outdoor bars and cafés across a capital city's downtown area

Background

The influence of visual exposure to health-related behaviours, such as smoking, is increasingly acknowledged in the public health literature. Social contagion or normalisation is thought to operate through the visibility of those behaviours. There has been a lack of systematic and comprehensive approaches to quantifying visual exposure to these behaviours over a relatively large geographic area. We describe the novel application of a geographic tool, viewshed analysis, to estimate visual exposure to smoking outside bars/cafés across a downtown area.

Methods

Smoking was observed for different times and days of the week at 14 outdoor areas of bars/cafés throughout downtown Wellington, New Zealand. We used these data to extrapolate to other bars/cafés with outdoor seating. We then conducted viewshed analyses to estimate visual exposure to smoking at bars/cafés for all public outdoor spaces.

Results

We observed a smoking point prevalence of 16%. Visibility analyses indicated that estimated visible smoking was highest in the evenings (7-8 pm), where the average values across Wednesday and Friday ranged from zero up to 92 visible smokers (mean = 1.44). Estimated visible smoking at midday ranged from zero to 13 (mean = 0.27). Values were also higher at the end of the week compared with midweek in the evening. Maps indicate that streets with high levels of retail shops and hospitality areas had high values of estimated visible smokers, particularly in the evening where numbers were consistently above 50.

Conclusions

This paper highlights a useful method for measuring the extent of visual exposure to smoking behaviours across relatively large areas using a geospatial approach. Applying this method in other locations would require consideration of place-specific characteristics which impact on visibility and could be improved through more sophisticated extrapolation of observational data across the study area. The findings of this and similar research could ultimately support the expansion of smokefree public spaces.

Secondhand smoke exposure among young adult sexual minority bar and nightclub patrons

OBJECTIVES

We compared exposure to secondhand smoke (SHS) and attitudes toward smoke-free bar and nightclub policies among patrons of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT bars and nightclubs.

METHODS

We conducted randomized time-location sampling surveys of young adults (aged 21-30 years) in 7 LGBT (n = 1113 patrons) and 12 non-LGBT (n = 1068 patrons) venues in Las Vegas, Nevada, in 2011, as part of a cross-sectional study of a social branding intervention to promote a tobacco-free lifestyle and environment in bars and nightclubs.

RESULTS

Compared with non-LGBT bars and nightclubs, patrons of LGBT venues had 38% higher adjusted odds of having been exposed to SHS in a bar or nightclub in the past 7 days but were no less likely to support smoke-free policies and intended to go out at least as frequently if a smoke-free bar and nightclub law was passed.

CONCLUSIONS

The policy environment in LGBT bars and nightclubs appears favorable for the enactment of smoke-free policies, which would protect patrons from SHS and promote a smoke-free social norm.

Evaluating the Effectiveness of France's Indoor Smoke-Free Law 1 Year and 5 Years after Implementation: Findings from the ITC France Survey

France implemented a comprehensive smoke-free law in two phases: Phase 1 (February 2007) banned smoking in workplaces, shopping centres, airports, train stations, hospitals, and schools; Phase 2 (January 2008) banned smoking in hospitality venues (bars, restaurants, hotels, casinos, nightclubs). This paper evaluates France’s smoke-free law based on the International Tobacco Control Policy Evaluation Project in France (the ITC France Project), which conducted a cohort survey of approximately 1,500 smokers and 500 non-smokers before the implementation of the laws (Wave 1) and two waves after the implementation (Waves 2 and 3). Results show that the smoke-free law led to a very significant and near-total elimination of observed smoking in key venues such as bars (from 94–97% to 4%) and restaurants (from 60–71% to 2–3%) at Wave 2, which was sustained four years later (6–8% in bars; 1–2% in restaurants). The reduction in self-reported smoking by smoking respondents was nearly identical to the effects shown in observed smoking. Observed smoking in workplaces declined significantly after the law (from 41–48% to 18–20%), which continued to decline at Wave 3 (to 14–15%). Support for the smoke-free laws increased significantly after their implementation and continued to increase at Wave 3 (p<.001 among smokers for bars and restaurants; p<.001 among smokers and p = .003 for non-smokers for workplaces). The findings demonstrate that smoke-free policies that are implemented in ways consistent with the Guidelines for Article 8 of the WHO Framework Convention on Tobacco Control (WHO FCTC) lead to substantial and sustained reductions in indoor smoking while also leading to high levels of support by the public. Moreover, contrary to arguments by opponents of smoke-free laws, smoking in the home did not increase after the law was implemented and prevalence of smoke-free homes among smokers increased from 23.2% before the law to 37.2% 5 years after the law.

Use and perception of electronic cigarettes among college students

OBJECTIVE

This study provides insight into how electronic cigarettes (e-cigarettes) may affect the social normative environment for tobacco use among college students.

PARTICIPANTS

Participants were 244 freshman and sophomore students.

METHODS

Students completed an online self-report survey in April 2011.

RESULTS

There is a higher acceptance rate of e-cigarette smoking in public than traditional tobacco. For intention to use an e-cigarette, the strongest predictor is current tobacco use, followed by a positive orientation toward public use of e-cigarettes. Positive orientation toward public use of e-cigarettes is significantly predicted by the use of alternate tobacco, intention to use or try e-cigarettes, positive orientation toward public use of tobacco, positive attitude toward e-cigarettes, positive perception of social norms for use of e-cigarettes, and favorable orientation toward e-cigarettes as an innovation.

CONCLUSIONS

These models suggest attitudinal, social normative, innovation, and behavioral factors may combine to bring the e-cigarette into wider use among college students.

The long-term decline of adult tobacco use in Victoria: changes in smoking initiation and quitting over a quarter of a century of tobacco control

OBJECTIVE

To examine changes in regular smoking prevalence among demographic and socioeconomic groups of Victorian adults from 1984 to 2008.

METHODS

Data were drawn from face-to-face and telephone surveys of randomly sampled Victorians conducted annually from 1984 to 2008.

RESULTS

Regular smoking in Victoria declined from 33.2% in 1984 to 15.5% in 2008, a relative decline of 53%. This change was largely accounted for by significant drops in 'ever smoking' among 18-29 year olds (from 59% to 35%, a relative decline of 41%) and by increased quitting among those aged 30 and older (from a quit proportion [% of those ever smoked who have quit] of 37% to 61% among 30-49 year olds, a relative increase of 64%; and from 53% to 79% among 50+ years, an increase of 48%). Over time, smoking prevalence became more similar between males and females. Regular smoking declined significantly across all socioeconomic status (SES) groups. Victorians living in low SES areas experienced the greatest relative increase in quit proportions of 75% (from 34% to 60%), helping to reduce the gap between low and higher SES groups in terms of smoking prevalence.

CONCLUSIONS

Regular smoking in Victoria has declined substantially across all demographic groups. Victorians are taking up smoking at much lower levels than 25 years ago, while quit proportions have more than doubled.

IMPLICATIONS

The continuation and extension of comprehensive, multi-level approaches to tobacco control is likely to be required for the maintenance of the downward trend in smoking.

Comparative impact of smoke-free legislation on smoking cessation in three European countries

BACKGROUND

Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success.

METHODS

Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England).

RESULTS

In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England.

CONCLUSION

The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation.

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.

The association between seeing retail displays of tobacco and tobacco smoking and purchase: findings from a diary-style survey

AIMS

To assess the impact of retail displays of tobacco on tobacco smoking and purchase by smokers and attempting quitters.

DESIGN

Population-based diary style survey.

SETTING

NSW, Australia.

PARTICIPANTS

A total of 998 smokers and 111 attempting quitters.

MEASUREMENTS

Demographic measures and 4-hourly records over 4 days: number of cigarettes smoked and bought; exposure to cigarette smoking by friends/family or other smokers; and exposure to retail displays of tobacco.

FINDINGS

Subjects reported seeing cigarettes for sale in more than 40% of the time-periods when they were outside their home. After allowing for factors which are known to increase smoking, people who saw cigarettes for sale were more likely to smoke, and smoked more cigarettes, even if they did not buy cigarettes in the same time-period. There was marginally significant evidence that people exposed to retail displays of tobacco in one time-period were more likely to buy in the following time-period.

CONCLUSIONS

In an environment which permits point-of-sale displays, smokers were found to see tobacco displays in more than 40% of the 4-hour periods that they were outside the home. Exposure to such tobacco displays was associated with a higher probability of smoking, and with higher levels of smoking, even when subjects did not purchase cigarettes.

Preventing smoking in open public places in university campus settings

Purpose

The purpose of the study was to evaluate the effectiveness of interventions using situational crime prevention approaches to reduce the smoking rate in outdoor areas of a university campus.

Design/methodology/approach

A prospective intervention design was designed for the study. Surveys and observations were used to measure the impacts of both the campaign generally and specific strategies on levels of smoking in public places and use of designated smoking areas. Pre‐ and post‐implementation measures were taken. The intervention strategies entailed encouraging voluntary compliance with a “Smoke‐less Campaign”, which asked staff, students and visitors to smoke only in nominated areas. The campaign was supported by “situational” strategies to facilitate compliance, such as making smoking areas available, setting rules and posting instructions, and using campaign ambassadors.

Findings

At the end of the three‐month trial the campaign was considered to have had a positive impact. After the campaign at the intervention campus there was a significant increase of 14.4 percent in the proportion of people who reported that they were not affected by second‐hand smoke – from 52.7 percent to 67.1 percent. In addition, 6 percent of survey respondents who smoked reported quitting, while 17 percent of smokers indicated the campaign had helped them to quit or cut down. Observational data showed that 98 percent of smokers complied with directions to smoke in nominated smoking areas.

Originality/value

This study is original in explicitly applying the techniques of situational crime prevention to the problem of smoking in public places. The results provide evidence for the effectiveness of the situational techniques, including “facilitating compliance”, through the availability of smoking areas, “setting rules” and “posting instructions”, and “extending guardianship”, through the use of campaign ambassadors.

Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents

PURPOSE

Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey.

DESIGN

Cross-sectional, multistage, probability sample survey.

SETTING

Schools (308 middle and high schools) in Maryland.

SUBJECTS

Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n  =  57,072).

MEASURES

Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region.

ANALYSIS

Chi-square and multiple logistic regression analyses controlling for clustering.

RESULTS

Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation.

CONCLUSIONS

Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

The population impact of smoke-free workplace and hospitality industry legislation on smoking behaviour. Findings from a national population survey

AIMS

To study the impact of implementing smoke-free workplace and hospitality industry legislation on smoking behaviour.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional population survey from 2001 to 2008 (n ≈ 18,000 per year) was used to assess trends and seasonal patterns in smoking and quitting, and to examine whether changes could be observed after the workplace smoking ban in the Netherlands in 2004 and the hospitality industry ban in 2008.

MEASUREMENTS

Outcome measures were smoking prevalence, quit attempts and successful quit attempts. Interactions with educational level (socio-economic status) and bar visiting (exposure to the hospitality industry ban) were tested.

FINDINGS

The workplace ban was followed by a decrease in smoking prevalence (OR = 0.91, P < 0.001), but the hospitality industry ban was not (OR = 0.96, P = 0.127). Both bans, especially the workplace ban, were followed by an increase in quit attempts and successful quit attempts: workplace ban, OR = 1.31, P < 0.001; OR = 1.49, P < 0.001; hospitality industry ban, OR = 1.13, P = 0.013; OR = 1.44, P < 0.001. The workplace ban had a larger effect on successful quitting among higher-educated (OR = 0.35, P < 0.001) than on lower-educated respondents (OR = 0.74, P = 0.052). The hospitality industry ban had a larger effect on quit attempts among frequent bar visitors (OR = 1.48, P = 0.003) than on non-bar visitors (OR = 0.71, P = 0.014).

CONCLUSIONS

A workplace smoking ban in the Netherlands was followed by more changes in smoking and quitting than a hospitality industry ban. The hospitality industry ban only appeared to have an impact on quit attempts, and not on smoking prevalence.

Daily patterns of conjoint smoking and drinking in college student smokers

Epidemiological data indicate a robust association between smoking and alcohol use. However, a critical question that is less resolved is the extent to which the smoking event takes place during the time of alcohol consumption. The present study used data from an 8-week prospective web-based study of college student smokers to examine daily associations between smoking and alcohol use, using measures of both likelihood and level of use. Findings indicated that consumption of alcohol and smoking covaried on a daily basis per person. In addition, consistent with the idea of smoking as a social activity for college students, light smokers were more likely than heavier smokers to smoke while drinking and to smoke more cigarettes while drinking. Smoking behavior among light smokers may be influenced by external social contextual cues, in contrast to heavier smokers who may be more affected by internal cues. Implications of findings for prevention work suggest the importance of targeting social situations in which smoking and drinking co-occur.

Compliance and support for bans on smoking in licensed venues in Australia: findings from the International Tobacco Control Four-Country Survey

OBJECTIVE

To examine attitudes towards and compliance with the recent Australian bans on smoking in licensed venues, and to explore effects on smoking behaviour.

METHODS

Three Australian states (Queensland, Tasmania and Western Australia) implemented a total ban on smoking in all enclosed licensed premises in 2006, and two others (Victoria and New South Wales) did so in mid-2007. We used data from smokers residing in these states for each of the six waves of the ITC-4 country survey (2002-2007; average n=1,694).

RESULTS

Consistent with the majority of international findings, observed compliance was reported by more than 90% of smokers from a pre-ban situation of indoor smoking being the norm. Attitudes became more positive in the year before the ban, but more than doubled in the year the bans were implemented. The associations found for the leading states were replicated by the lagging states a year later. We found no evidence for any increase in permitting smoking inside the home after the bans took effect. Further, we were unable to find any evidence of reductions in daily cigarette consumption or any increase in quitting activity due to the bans.

IMPLICATIONS

These results add to a growing body of international research that suggests that smokers are readily able to comply with, and increasingly support, smoke-free bars, though the bans may have limited effect on their smoking habits.

College students' exposure to tobacco marketing in nightclubs and bars

OBJECTIVE

to examine whether a college student's exposure to tobacco marketing in nightclubs and bars was affected by the presence of a smoke-free law.

PARTICIPANTS

a random sample (N = 478) of students participated in the survey (no smoke-free law, n = 240; smoke-free law, n = 238). The analysis was limited to students who reported being in nightclubs and bars (n = 171).

METHODS

a nonexperimental, cross-sectional, 2-group design was used.

RESULTS

students in the smoke-free law city were more likely to be approached by tobacco marketers (34.7% versus 20.2%, p = .02), offered free gifts (41.7% versus 24.2%, p = .02), and take free gifts for themselves (34.7% versus 19.2%, p = .02). They were more likely to be exposed to direct marketing strategies (1.83 versus 1.12, p = .02). There was no difference on indirect tobacco marketing by site.

CONCLUSIONS

tobacco marketing is pervasive in nightclubs and bars. Smoke-free laws may protect against exposure to secondhand smoke but not the "pro" smoking messages students encounter.

Smoking and attitudes on smoke-free air laws among club-going young adults

This report assesses smoking rates and support for indoor smoking bans among club-going young adults in New York City. Nearly half of the sample were smokers. Gay, lesbian, and bisexual young adults were more likely to smoke than were heterosexual participants. No differences in smoking rates were found between sexes or between Whites and non-Whites. Support for the smoking ban exists among young adults (68.6%). This is universal, as no differences in support for the ban were found by sex, race, or sexual identity. Smokers supported the ban (57.8%) less than nonsmokers did (77.3%). Yet, it remains notable that a majority support the smoking ban among smokers.

Unintended consequences of smoke-free bar policies for low-SES women in three California counties

BACKGROUND

To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES.

METHODS

The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited.

RESULTS

Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke.

CONCLUSIONS

Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

The Home Smoking Environment: Influence on Behaviors and Attitudes in a Racially Diverse Adolescent Population

Although studies indicate that public policy can influence the decrease in smoking behaviors, these policies have not necessarily transferred to home environments at the same rate. The authors surveyed 4,296 students in a southern urban area. African American students were 76.3% of the respondents and Caucasians accounted for 23.7%. African American homes are less likely to have full bans on smoking inside the home. Home smoking bans impact smoking behaviors, acceptance of smoking, susceptibility to smoking, smoking beliefs, and motivation to quit smoking. Along with home smoking bans, there are differences among African American and Caucasian youth in smoking exposure, behaviors, beliefs, and motivation to quit smoking. This study suggests that particularly in African American youth, educational efforts should be directed toward more restrictive home smoking policies to thwart the initiation of smoking in adolescents and to encourage positive attitudes toward smoking behaviors.

A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom

INTRODUCTION

The longitudinal ITC Scotland/U.K. survey was used to investigate adult smokers' support for smoke-free legislation and whether this support was associated with higher quit intentions at follow-up, either directly or indirectly, via the mediation of perceived social unacceptability of smoking.

METHODS

Structural equation modeling was employed to compare differences between the two samples (507 adult smokers from Scotland and 507 from the rest of the United Kingdom) across two waves (February/March 2006 and March 2007). During these two waves, a smoking ban was introduced in Scotland but not the rest of the United Kingdom.

RESULTS

For smokers in both samples, support for smoke-free legislation at baseline significantly heightened perceived unacceptability of smoking, although perceptions of unacceptability were somewhat stronger in Scotland than the rest of the United Kingdom postban. Unlike the rest of the United Kingdom, support for a ban at baseline among smokers in Scotland was associated with higher quit intentions at follow-up. For both samples, quit intentions were significantly associated with heightened perceived unacceptability at follow-up. The overall variance explained in quit intentions was greater in Scotland than in the rest of the United Kingdom but not significantly so.

DISCUSSION

Support for smoke-free legislation at baseline significantly increased support at follow-up for both samples. However, this did not independently increase quit intentions among smokers from both Scotland and the rest of the United Kingdom. The findings suggest that normative influences are one of the mechanisms through which comprehensive smoke-free legislation influences quit intentions.

Smoke-free air policy: subcultural shifts and secondary health effects among club-going young adults

In March 2003, New York City implemented legislation that called for a ban of smoking in bars, restaurants, nightclubs, and other establishments. The express purpose of this legislation was to protect the health of employees and patrons from second-hand smoke. In addition to the stated goal of protection from second-hand smoke for employees, key secondary health effects of this law have emerged in the lives of club-going youth. This paper is based upon data derived from an ethnographic research project on club-related health issues in NYC. Drawing upon ethnographic fieldwork during the implementation of the ban and in-depth interviews with club-going youth, the paper provides a grounded analysis of youth reactions to the smoking ban and a descriptive profile of the secondary health effects of the smoking ban in nightclubs. It explores the attitudes of club-going youth towards the ban and the ways in which the legislation shapes the behaviours of habitual smokers, 'social smoking', and the use of drugs within bars and clubs. In particular, the data suggest a tension between the desire to remain subculturally involved and the desire to smoke. It also highlights the adaptive character of subcultures and the importance of social relations in behavioural patterns.

Promoting tobacco-free school policies through a statewide media campaign

BACKGROUND

Comprehensive, enforced tobacco-free school (TFS) policies lead to significant reductions in youth tobacco use. North Carolina is the first state in the United States to develop a statewide mass media campaign to promote the adoption of and compliance with TFS policies.

METHODS

In order to guide campaign development, researchers conducted a literature review as well as interviews with 45 TFS-policy experts, stakeholders, and North Carolina legislators. The experts included state and national TFS researchers and advocates, and the majority of stakeholders were North Carolina school administrators and personnel selected because of their personal knowledge of and experience with TFS policy. Interviewees provided information on messages they believed would be most salient to highlight in the media campaign and the best type of people to appear in ads.

RESULTS

Recommended themes included (1) a positive message about TFS becoming the norm in the state, (2) experiences of school districts that had successfully passed TFS policies, (3) the importance of adult role modeling, and (4) personal stories from youth about the importance of TFS policy. Recommended people to appear in ads included youth and adults with a personal connection to and experience with TFS policy. Using these recommended themes and people, the TFS media campaign began in the fall of 2006. In the 8 months following the campaign launch, 9 additional school districts adopted TFS policies, increasing the total from 78 to 87 (out of 115) by June 2007. In July 2007, the North Carolina legislature passed legislation mandating that all school districts adopt TFS policies by August 2008.

CONCLUSIONS

Media campaigns can serve as part of a comprehensive strategy to advance TFS policies. Other states should consider these results in designing and evaluating a media campaign to promote adoption of and compliance with TFS policies.

The natural history of light smokers: a population-based cohort study

INTRODUCTION

Among cigarette smokers, lower levels of consumption, defined as smoking fewer cigarettes per day (CPD) or not smoking daily, are becoming more common. The relationship between cigarette consumption and smoking frequency (daily or nondaily) is not well characterized, and the natural history of light smoking (defined here as smoking < or =10 CPD) is poorly understood.

METHODS

We assessed changes in CPD and smoking frequency over time among light smokers (< or =10 CPD) and very light smokers (< or =5 CPD), using a population-based longitudinal survey of 3,083 adult smokers in Massachusetts who were interviewed three times over a 4-year follow-up period (in 2000-2001, 2002-2003, and 2005-2006). We used logistic regression to identify factors associated with light smokers' progression to heavier smoking or smoking reduction/quitting.

RESULTS

Seventy percent of very light smokers were nondaily smokers. Very light nondaily smokers differed from very light daily smokers by younger age, higher socioeconomic status, a social smoking pattern, later smoking initiation, less evidence of nicotine addiction, and more recent and planned cessation efforts. Very light nondaily smokers and smokers consuming 6-10 CPD were more likely to remain in the same smoking category and were less likely to increase consumption than were very light daily smokers. Factors independently associated with increasing consumption among very light smokers were smoking daily, nicotine dependence, White ethnicity, social smoking, and having more friends who smoked; among smokers consuming 6-10 CPD, male gender and lack of quitting self-efficacy were associated with increasing consumption.

CONCLUSION

Our findings indicate that most light smoking is not a gateway to heavier smoking.

Secondhand tobacco smoke exposure, nicotine dependence, and smoking cessation

OBJECTIVE

To explore the association among the number of sources of secondhand tobacco smoke (SHS) exposure, nicotine dependence (ND), and smoking cessation.

DESIGN

A secondary analysis of cross-sectional data. Responses for the main study were obtained in 2001 from a controlled trial of the Quit and Win Tobacco Free Contest in Kentucky.

SAMPLE

822 current smokers.

MEASUREMENTS

Demographic variables (age, gender, educational status, income, and ethnicity) the number of sources of SHS exposure, smoking frequency, length of abstinence from smoking, age of smoking initiation, smoking cessation attempts, intentions to quit smoking, and ND.

RESULTS

The number of sources of SHS exposure was associated with higher ND and smoking frequency, and related to low intentions and attempts to quit smoking. The number of sources of SHS exposure contributed to 11% of the variance in the final ND model, after accounting for control and potential mediating variables.

CONCLUSIONS

The number of sources of SHS exposure may be an important factor influencing ND and intentions and attempts to quit smoking. Further studies are needed to explore the association between SHS exposure and ND among smokers to guide treatment and policy development.

The Community Readiness Model: evaluating local smoke-free policy development

The purpose of this article is to review the literature on community readiness and assess the utility of the community readiness model (CRM) for understanding and affecting smoke-free policy development and implementation. The CRM evaluates a community's capacity for successfully developing and implementing prevention or treatment interventions. The purposes of evaluating a community's readiness are to: (a) identify the stage of readiness for policy change, and (b) determine stage-specific strategies to advance a community toward policy change.

Smoke-free spaces over time: a policy diffusion study of bylaw development in Alberta and Ontario, Canada

Policy diffusion is a process whereby political bodies 'learn' policy solutions to public health problems by imitating policy from similar jurisdictions. This suggests that diffusion is a critical element in the policy development process, and that its role must be recognised in any examination of policy development. Yet, to date, no systematic work on the diffusion of smoke-free spaces bylaws has been reported. We examined the diffusion of municipal smoke-free bylaws over a 30-year period in the provinces of Alberta and Ontario, Canada, to begin to address this gap and to determine whether spatial patterns could be identified to help explain the nature of policy development. Bylaw adoption and change were analysed within local, regional, and provincial contexts. Geographical models of hierarchical and expansion diffusion in conjunction with the diffusion of innovations framework conceptually guided the analyses. Study findings contribute to a broader understanding of how and why health policies diffuse across time and place. Policy development can be a powerful mechanism for creating environments that support healthy decisions; hence, an understanding of policy diffusion is critical for those interested in policy interventions aimed at improving population health in any jurisdiction.

Occasional tobacco use among young adult women: a longitudinal analysis of smoking transitions

OBJECTIVE

To describe prospective transitions in smoking among young adult women who were occasional smokers, and the factors associated with these transitions, by comparing sociodemographic, lifestyle and psychosocial characteristics of those who changed from occasional smoking to daily smoking, non-daily smoking or non-smoking.

DESIGN

Longitudinal study with mailed questionnaires.

PARTICIPANTS/SETTING

Women aged 18-23 years in 1996 were randomly selected from the Medicare Australia database, which provides the most complete list of people in Australia.

MAIN OUTCOME MEASURES

Self-reported smoking status at survey 1 (1996), survey 2 (2000) and survey 3 (2003), for 7510 participants who took part in all three surveys and who had complete data on smoking at survey 1.

RESULTS

At survey 1, 28% (n = 2120) of all respondents reported smoking. Among the smokers, 39% (n = 829) were occasional smokers. Of these occasional smokers, 18% changed to daily smoking at survey 2 and remained daily smokers at survey 3; 12% reported non-daily smoking at surveys 2 and 3; 36% stopped smoking and remained non-smokers; and 33% moved between daily, non-daily and non-smoking over surveys 2 and 3. Over the whole 7-year period, approximately half stopped smoking, one-quarter changed to daily smoking and the remainder reported non-daily smoking. Multivariate analysis identified that a history of daily smoking for > or = 6 months at baseline predicted reversion to daily smoking at follow-up. Being single and using illicit drugs were also associated with change to daily or non-daily smoking, whereas alcohol consumption was associated with non-daily smoking only. Compared with stopping smoking, the change to daily smoking was significantly associated with having intermediate educational qualifications. No significant associations with depression and perceived stress were observed in the multivariate analysis.

CONCLUSIONS

Interventions to reduce the prevalence of smoking among young women need to take account of occasional smokers, who made up 39% of all smokers in this study. Targeted interventions to prevent the escalation to daily smoking and to promote cessation should allow for the social context of smoking with alcohol and other drugs, and social and environmental influences in vocational education and occupational settings.

Potential for smoke-free policies in social venues to prevent smoking uptake and reduce relapse: a qualitative study

The purpose of this article is to better understand the utility of smoking in pubs/bars and nightclubs and explore perceptions of how smoke-free policies might influence smoking behavior. Qualitative focus group methodology was used involving young social smokers and older regular smokers. Pubs/bars and nightclubs were valued as the few remaining indoor public places where people could relax and smoke. These venues were perceived to provide encouragement for smoking more cigarettes by increasing smoking rate and facilitating smoking relapse. For young social smokers, smoking provided an opportunity to be part of a "cool" in-group. Older regular smokers felt pubs/bars provided strong cues for smoking relapse. Smokers felt they would adapt to smoke-free policies and expected these policies to reduce their smoking or assist quitting. Smoke-free policies in pubs/bars and nightclubs may assist smokers to quit and make it less likely that young social smokers will progress to regular smoking.

Phased-in smoke-free workplace laws: reported impact on bar patronage and smoking, particularly among young adults in South Australia

OBJECTIVES

To measure the reported impact of phased-in smoke-free bar laws on bar patronage and smoking behaviour, particularly among young adults.

METHODS

Cross-sectional survey of a representative sample of 2,004 South Australian adults, conducted four months into Phase I of the new laws. A comparable survey was conducted in 2003.

RESULTS

Awareness of and support for the smoke-free laws were high. Phase I of the new laws did not reduce patronage. Young adults (18-24 years) reported higher patronage of bars and greater impact of the new laws on patronage, current smoking and future likelihood of quitting.

CONCLUSIONS AND IMPLICATIONS

Smoke-free laws are an effective public health measure to protect against second-hand smoke. Evidence is now emerging that they may also reduce smoking among young people, as bars are social settings with potential to alter social norms about smoking and promote reduced consumption and quitting.

Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey

OBJECTIVE

To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004.

DESIGN

Quasi-experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n = 769) and the UK (n = 416), surveyed before the law (December 2003 to January 2004) and 8-9 months after the law (December 2004 to January 2005).

MAIN OUTCOME MEASURES

Respondents' reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law.

RESULTS

The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke-free law was a "good" or "very good" thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post-legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit.

CONCLUSION

The Ireland smoke-free law stands as a positive example of how a population-level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.

Teen smokers reach their mid twenties

PURPOSE

Most outcome studies of adolescent smokers have focused on tobacco use in the short term. Few have reported on the health of adolescent smokers as they reach young adulthood.

METHODS

The design was a 10-year, eight-wave cohort study of a state-wide community sample of 1943 participants in Victoria, Australia. Participants were initially aged 14 to 15 years. Tobacco use was assessed with self-reported frequency of use and a seven-day retrospective diary. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence in young adulthood. A computerized interview assessment was used during the teens and in young adulthood.

RESULTS

Former daily smokers in adolescence accounted for most cases of nicotine dependence and high-dose (10+ cigarettes per day) smoking in young adulthood. Other substance abuse and psychiatric morbidity in young adulthood were also markedly elevated in this group. This was most clearly evident for cannabis dependence, where close to two-thirds of all cases were formerly daily tobacco smokers. Male smokers were more likely to continue as young adults. Persistent symptoms of depression and anxiety during the teens predicted progression to nicotine dependence, as did having a parent smoking daily.

CONCLUSIONS

The poor health outcomes of daily adolescent smokers as they reach young adulthood provide a rationale for greater tobacco control initiatives directed at early users. Clinical interventions might usefully consider factors such as psychiatric morbidity and parental smoking.

One year of smokefree bars and restaurants in New Zealand: impacts and responses

Background

New Zealand introduced a smokefree bars and restaurants policy in December 2004. We reviewed the data available at December 2005 on the main public health, societal and political impacts and responses within New Zealand to the new law.

Methods

Data were collected from publicly available survey reports, and from government departments and interviews. This included data on smoking in bars, attitudes to smokefree bars, bar patronage, socially cued smoking, and perceived rights to smokefree workplaces.

Results

The proportion of surveyed bars with smoking occurring decreased from 95% to 3% during July 2004 – April 2005. Between 2004 and 2005, public support for smokefree bars rose from 56% to 69%. In the same period, support for the rights of bar workers to have smokefree workplaces rose from 81% to 91%. During the first ten months of the smokefree bars policy, there were only 196 complaints to officials about smoking in the over 9900 licensed premises. The proportion of smokers who reported that they smoked more than normal at bars, nightclubs, casinos and cafés halved between 2004 and 2005 (from 58% to 29%).

Seasonally adjusted sales in bars and clubs changed little (0.6% increase) between the first three quarters of 2004 and of 2005, while café and restaurant sales increased by 9.3% in the same period. Both changes continued existing trends. Compared to the same period in 2004, average employment during the first three quarters of 2005 was up 24% for 'pubs, taverns and bars', up 9% for cafés/restaurants, and down 8% for clubs (though employment in 'pubs, taverns and bars' may have been affected by unusually high patronage around a major sports-series).

The proportion of bar managers who approved of smokefree bars increased from 44% to 60% between November 2004 and May 2005. Bar managers also reported increased agreement with the rights of bar workers and patrons to smokefree environments. The main reported concerns of the national and regional Hospitality Associations, in 2005, were the perceived negative effects on rural and traditional pubs.

Conclusion

As in other jurisdictions, the introduction of smokefree bars in New Zealand has had positive overall health protection, economic and social effects; in contrast to the predictions of opponents.

How effective are tobacco industry bar and club marketing efforts in reaching young adults?

OBJECTIVE

Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts.

DESIGN AND PARTICIPANTS

Data were from 9364 young adult (18-29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking (only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking.

RESULTS

Social smokers comprised 30.0 (2.2)% of all current smokers, including experimenters. Nearly three quarters (74.5 (2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third (33.8 (1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% (57.9 (2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings.

CONCLUSIONS

About 20% of all young adults and about 30% of those at risk for future smoking (including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable.

Changes in smoking behaviour among young women over life stage transitions

OBJECTIVE

To examine changes in smoking behaviour among young women over four life stages: leaving home; employment or attending college or university; marriage; and parenthood.

METHODS

Young women participating in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996 and 2000.

RESULTS

Unmarried women who moved out of their parents' home between 1996 and 2000 had higher odds of adopting smoking than those who had not lived with their parents at either time (OR 1.8, 95% CI 1.2-2.6). Married women had lower odds of resuming smoking after quitting (OR 0.4, 95% CI 0.2-0.7) than unmarried women. Women who were pregnant in 2000 had higher odds of quitting smoking (OR 3.8, 95% CI 2.5-5.6) and women who were pregnant in 1996 and not in 2000 had higher odds of starting to smoke again (OR 3.2, 95% CI 1.6-6.2) than women who were not pregnant. The odds of being a current smoker or adopting smoking were significantly greater for women who binge drank alcohol or used cannabis and other illicit drugs.

CONCLUSIONS

Adoption, maintenance and cessation of smoking among young women is strongly related to major life stage transitions, illicit drug use and alcohol consumption.

IMPLICATIONS

Life changes such as marriage and actual or contemplated pregnancy provide opportunities for targeted interventions to help women quit smoking and not relapse after having a baby. Legislation to control smoking on licensed premises would reduce the social pressure on women to smoke.

Human personality traits are associated with individual environmental traits in male adolescents--a pilot study

The human personality seems to be formed by biological (internal) and environmental (external) factors, which function interactively. This pilot study examined the relationship between fundamental personality traits and individual environmental traits in healthy adolescents. A complex relationship between personality traits and candidate environmental traits was found in this sample. Parental smoking, one of the hypothetical environmental traits, was significantly associated with the sociability personality trait of adolescent offspring. Another hypothetical environmental trait-parent/child attachment status-"was related to novelty-seeking personality. Unexpectedly, these associations were observed only in male but not in female adolescents. The present study suggested that (1) parental smoking behavior might directly or indirectly affect offspring social behavior and related personality by nongenetic transmission; (2) past and present data indicated that the triad of a poor parent/child relationship, novelty-seeking personality, and risky/delinquent behavior is closely connected. Investigations of environmental traits at a nonclinical level may lead us to understand the overall human personality, as with research on genes and biological traits that are implicated in the formation of mental activity.

The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers

BACKGROUND

To effectively address the health burden of tobacco use, tobacco control programs must find ways of motivating smokers to quit. The present study examined the extent to which former smokers' motivation to quit was influenced by two tobacco control policies recently introduced in the Waterloo Region: a local smoke-free bylaw and graphic cigarette warning labels.

METHODS

A random digit-dial telephone survey was conducted with 191 former smokers in southwestern Ontario, Canada in October 2001. Former smokers who had quit in the previous three years rated the factors that influenced their decision to quit and helped them to remain abstinent.

RESULTS

Thirty-six percent of former smokers cited smoke-free policies as a motivation to quit smoking. Former smokers who quit following the introduction of a total smoke-free bylaw were 3.06 (CI95 = 1.02-9.19) times more likely to cite smoking bylaws as a motivation to quit, compared to former smokers who quit prior to the bylaw. A total of 31% participants also reported that cigarette warning labels had motivated them to quit. Former smokers who quit following the introduction of the new graphic warning labels were 2.78 (CI9 = 1.20-5.94) times more likely to cite the warnings as a quitting influence than former smokers who quit prior to their introduction. Finally, 38% of all former smokers surveyed reported that smoke-free policies helped them remain abstinent and 27% reported that warning labels helped them do so.

CONCLUSION

More stringent smoke-free and labelling policies were associated with a greater impact upon motivations to quit.