1
|
de Guiran E, Josseran L, Catellin M. Dénormalisation du tabac et de son industrie par la société civile : mise en œuvre et évaluation de la campagne « Pouvoir de vivre » par l’ACT – Alliance contre le tabac. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 35:51-60. [PMID: 38423963 DOI: 10.3917/spub.235.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
This article examines the "denormalization" approach, which has gradually gained ground in the field of tobacco control. This process encompasses a wide range of practices and aims to renew tobacco control by extending its scope beyond the usual individual and health considerations; it also considers smoking as a societal problem. This contribution illustrates the implementation of this approach, as embodied in France by the Alliance Contre le Tabac denormalization program launched in 2019, through campaigns addressing a diverse range of themes. The latest campaign, carried out in January 2023, demonstrates that smoking also exacerbates the social and economic difficulties of the most disadvantaged members of society. Its presentation illustrates the deployment of such a campaign, the methodology used, the tools mobilized, and the results obtained by carrying out a post-test.
Collapse
|
2
|
Dahne J, Wahlquist AE, Garrett-Mayer E, Heckman BW, Cummings KM, Carpenter MJ. State Tobacco Policies as Predictors of Evidence-Based Cessation Method Usage: Results From a Large, Nationally Representative Dataset. Nicotine Tob Res 2019; 20:1336-1343. [PMID: 29059345 DOI: 10.1093/ntr/ntx192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 08/24/2017] [Indexed: 11/14/2022]
Abstract
Introduction Evidence-based cessation methods including nicotine replacement therapy (NRT), non-NRT medications, quitlines, and behavioral treatments are underutilized by smokers attempting to quit. Although a number of studies have demonstrated a relationship between state-level tobacco policies (eg, taxation, appropriations) and cessation, whether such state-level factors influence likelihood of using an evidence-based treatment is unclear. Accordingly, the aims of the present study were: (1) to describe evidence-based cessation method utilization by state and (2) to examine the effect of state-level factors on cessation method utilization above and beyond individual-level predictors. Methods Data were utilized from the 2010-2011 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Participants included 9232 smokers who reported a past-year quit attempt. Data on 11 state-level predictors were collated from national datasets. Analyses were based on: (1) descriptive characterization of quit method usage, (2) logistic regression models to determine state-level factors as predictors of quit method utilization, controlling for individual-level predictors, (3) cluster analyses grouping states with similar state-level factors, and (4) examination of cluster as a predictor of cessation method. Results Tobacco control appropriations significantly predicted NRT, quitline, and behavioral treatment utilization. Additional state-level factors that demonstrated significant relationships included Medicaid coverage of non-NRT medications and behavioral treatment, tobacco tax rate, smoking prevalence, and percentage of population uninsured. State clustering significantly predicted quit method across all four methods. Conclusions State-level factors influence the likelihood of residents utilizing evidence-based quit methods. Results are discussed in terms of implications for tobacco policy at the state level. Implications Results from the present study highlight state tobacco control appropriations as a robust predictor of evidence-based cessation method utilization. Other significant state-level predictors of evidence-based cessation method utilization included Medicaid coverage of non-NRT medications and behavioral treatment, tobacco tax rate, smoking prevalence, and percentage of population uninsured. Moreover, state-level predictors clustered together to significantly predict evidence-based cessation method utilization. Thus, increasing tobacco control appropriations, extending health insurance coverage, maximizing revenue from tobacco taxation and tobacco settlements, and ultimately decreasing smoking prevalence are important targets for individual states to promote utilization of evidence-based cessation methods.
Collapse
Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, MUSC, Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Department of Public Health Sciences, MUSC, Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Department of Public Health Sciences, MUSC, Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| |
Collapse
|
3
|
Nazar GP, Chang KCM, Srivastava S, Pearce N, Karan A, Millett C. Impact of India's National Tobacco Control Programme on bidi and cigarette consumption: a difference-in-differences analysis. Tob Control 2018; 29:103-110. [PMID: 30554161 PMCID: PMC6952846 DOI: 10.1136/tobaccocontrol-2018-054621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023]
Abstract
Background Despite the importance of decreasing tobacco use to achieve mortality reduction targets of the Sustainable Development Goals in low-income and middle-income countries (LMICs), evaluations of tobacco control programmes in these settings are scarce. We assessed the impacts of India’s National Tobacco Control Programme (NTCP), as implemented in 42 districts during 2007–2009, on household-reported consumption of bidis and cigarettes. Methods Secondary analysis of cross-sectional data from nationally representative Household Consumer Expenditure Surveys (1999–2000; 2004–2005 and 2011–2012). Outcomes were: any bidi/cigarette consumption in the household and monthly consumption of bidi/cigarette sticks per person. A difference-in-differences two-part model was used to compare changes in bidi/cigarette consumption between NTCP intervention and control districts, adjusting for sociodemographic characteristics and time-based heterogeneity. Findings There was an overall decline in household-reported bidi and cigarette consumption between 1999–2000 and 2011–2012. However, compared with control districts, NTCP districts had no significantly different reductions in the proportions of households reporting bidi (adjusted OR (AOR): 1.03, 95% CI: 0.84 to 1.28) or cigarette (AOR: 1.01 to 95% CI: 0.82 to 1.26) consumption, or for the monthly per person consumption of bidi (adjusted coefficient: 0.07, 95% CI: −0.13 to 0.28) or cigarette (adjusted coefficient: −0.002, 95% CI: −0.26 to 0.26) sticks among bidi/cigarette consuming households. Interpretation Our findings indicate that early implementation of the NTCP may not have produced reductions in tobacco use reflecting generally poor performance against the Framework Convention for Tobacco Control objectives in India. This study highlights the importance of strengthening the implementation and enforcement of tobacco control policies in LMICs to achieve national and international child health and premature NCD mortality reduction targets.
Collapse
Affiliation(s)
- Gaurang P Nazar
- Health Promotion Division, Public Health Foundation of India, Gurugram, India.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Kiara C-M Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Swati Srivastava
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Neil Pearce
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Anup Karan
- Indian Institute of Public Health, Delhi (IIPHD), Public Health Foundation of India, Gurugram, India
| | - Christopher Millett
- Health Promotion Division, Public Health Foundation of India, Gurugram, India.,Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.,Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Wu D, Yang T, Stillman F, Guo W, Zhou H, Feng X. Assessment of tobacco control advocacy behavioural capacity among public health faculty and students: a cluster intervention study. Public Health 2018; 165:95-105. [DOI: 10.1016/j.puhe.2018.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 08/08/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
|
5
|
Cohen DA, Knopman DS. Existing Regulatory Approaches to Reducing Exposures to Chemical- and Product-Based Risk and Their Applicability to Diet-Related Chronic Disease. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:2041-2054. [PMID: 29665622 DOI: 10.1111/risa.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/06/2017] [Accepted: 03/17/2018] [Indexed: 06/08/2023]
Abstract
We aimed to identify and categorize the types of policies that have been adopted to protect Americans from harmful exposures that could also be relevant for addressing diet-related chronic diseases. This article examines and categorizes the rationales behind government regulation. Our interest in the historical analysis is to inform judgments about how best to address newly emergent risks involving diet-related chronic disease within existing regulatory and information-based frameworks. We assessed exemplars of regulation with respect to harmful exposures from air, water, and food, as well as regulations that are intended to modify voluntary behaviors. Following the comparative analysis, we explored how exposures that lead to diet-related chronic diseases among the general population fit within models of regulation adopted for other comparable risks. We identified five rationales and five approaches that protect people from harmful exposures. Reasons for regulation include: protection from involuntary exposure to risk, high risk of death or chronic illness, ubiquity of risk, counteraction to limit compulsive behaviors, and promotion of population health. Regulatory approaches include: mandatory limits on use, mandatory limits on exposure, mandatory controls on quality, mandatory labeling, and voluntary guidance. In contrast to the use of mandates, the prevention of diet-related chronic diseases thus far has largely relied on information-only approaches and voluntary adoption of guidelines. There is ample precedent for mandatory regulatory approaches that could address harms related to exposure to unhealthy diets, but several barriers to action would need to be overcome.
Collapse
|
6
|
Fishman SH, Morgan SP, Hummer RA. Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States. POPULATION RESEARCH AND POLICY REVIEW 2018; 37:795-824. [PMID: 30906091 PMCID: PMC6424129 DOI: 10.1007/s11113-018-9487-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant-white low birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a "Hispanic Paradox." A significant portion of Hispanic immigrants' birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants' birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.
Collapse
Affiliation(s)
- Samuel H Fishman
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
| | - S Philip Morgan
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
| | - Robert A Hummer
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
| |
Collapse
|
7
|
Brown CC, Tilford JM, Bird TM. Improved Health and Insurance Status Among Cigarette Smokers After Medicaid Expansion, 2011-2016. Public Health Rep 2018; 133:294-302. [PMID: 29620480 DOI: 10.1177/0033354918763169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The high concentration of smokers among subgroups targeted by the Affordable Care Act and the historically worse health and lower access to health care among smokers warrants an evaluation of how Medicaid expansion affects smokers. We evaluated the impact of Medicaid expansion on smoking behavior, access to health care, and health of low-income adults, and we compared outcomes of all low-income people with outcomes of low-income current smokers by states' Medicaid expansion status. METHODS We obtained data from the Behavioral Risk Factor Surveillance System (2011-2016) for low-income adults aged 18-64. We estimated multivariable linear ordinary least squares probability models using a quasi-experimental difference-in-difference approach to compare smoking behavior, access to health care, and health between people in expansion states and nonexpansion states and, specifically, on low-income adults and the subgroup of low-income current smokers. RESULTS Compared with low-income smokers in nonexpansion states, low-income smokers in expansion states were 7.6 percentage points (95% confidence interval [CI], 5.7-9.6; P < .001) more likely to have health insurance, 3.2 percentage points (95% CI, 1.3-5.2; P = .001) more likely to report good or better health, and 2.0 percentage points (95% CI, -3.9 to -0.1; P = .044) less likely to have cost-related barriers to care. Health and insurance gains among current smokers in expansion states were larger relative to health gains (1.6 percentage points; 95% CI, 0.5-2.7; P = .003) and insurance gains (4.6 percentage points; 95% CI, 3.5-5.8; P < .001) of all low-income adults in these states. CONCLUSIONS Greater improvements among low-income smokers in Medicaid expansion states compared with nonexpansion states could influence future smoking behaviors and warrant longer-term monitoring. Additionally, health and insurance gains among low-income smokers in expansion states suggest the potential for Medicaid expansion to improve health among smokers compared with nonsmokers.
Collapse
Affiliation(s)
- Clare C Brown
- 1 Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Mick Tilford
- 1 Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - T Mac Bird
- 1 Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
8
|
Abstract
BACKGROUND Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. OBJECTIVES To assess the effectiveness of mass media interventions in reducing smoking among adults. SEARCH METHODS The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in November 2016. SELECTION CRITERIA Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included.Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, or odds of being a smoker. DATA COLLECTION AND ANALYSIS Two authors independently assessed all studies for inclusion criteria and for study quality (MB, LS, RTM). One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form. MAIN RESULTS Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined. AUTHORS' CONCLUSIONS There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.
Collapse
Affiliation(s)
- Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine; Department of Hygiene and Dietetics; Systematic Reviews Unit ‐ Polish Cochrane BranchKopernika 7KrakowPoland31‐034
| | | | - Roman Topor‐Madry
- Institute of Public Health, Jagiellonian University Medical CollegeDepartment of Epidemiology and Population StudiesGrzegórzecka 20KrakowPoland31‐531
| | | |
Collapse
|
9
|
Dealy BC, Horn BP, Bohara AK, Berrens RP, Bryan AD. The impact of behavioural risk reduction interventions on willingness to pay to avoid sexually transmitted infections: a stated preference study of justice-involved youth. APPLIED ECONOMICS 2017; 49:5673-5685. [PMID: 32753764 PMCID: PMC7402595 DOI: 10.1080/00036846.2017.1332744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Risky health behaviours, such as smoking, drinking and risky sex, are substantial contributors to US morbidity rates and healthcare costs. While economic models typically regard preferences as stable, a growing literature suggests that information, including how it interacts with intentions and attitudes, plays an important role in unhealthy behaviours. Relatedly, a large health literature demonstrates that theory-based behavioural interventions can successfully change risky behaviour. This study uses the contingent valuation survey method to investigate the impact of behavioural interventions on a novel outcome measure: the willingness to pay (WTP) to avoid the consequences associated with risky behaviour. Using novel pre- and post-intervention data from Project MARS (Motivating Adolescents to Reduce Sexual Risk) this study estimates the impact of the intervention on elicited WTP to avoid sexually transmitted infections (STI). It is found that after the intervention, participants' elicited WTP to avoid STIs were significantly higher, and more sensitive to differences in infection severity. These results suggest that the intervention may affect risky sexual behaviour by changing the perceived value of avoiding the consequences of risky sexual behaviour. Additionally, these findings contribute to an ongoing debate regarding the construct validity of contingent valuation studies in health economics.
Collapse
Affiliation(s)
- B. C. Dealy
- US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - B. P. Horn
- Department of Economics, University of New Mexico, MSC 05 3060, 1 University of New Mexico, Albuquerque, NM 87131, USA
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
| | - A. K. Bohara
- Department of Economics, University of New Mexico, MSC 05 3060, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - R. P. Berrens
- Department of Economics, University of New Mexico, MSC 05 3060, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - A. D. Bryan
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO 80309-0345, USA
| |
Collapse
|
10
|
Linden A. Challenges to validity in single-group interrupted time series analysis. J Eval Clin Pract 2017; 23:413-418. [PMID: 27630090 DOI: 10.1111/jep.12638] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Single-group interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single unit of observation is studied; the outcome variable is serially ordered as a time series, and the intervention is expected to "interrupt" the level and/or trend of the time series, subsequent to its introduction. The most common threat to validity is history-the possibility that some other event caused the observed effect in the time series. Although history limits the ability to draw causal inferences from single ITSA models, it can be controlled for by using a comparable control group to serve as the counterfactual. METHOD Time series data from 2 natural experiments (effect of Florida's 2000 repeal of its motorcycle helmet law on motorcycle fatalities and California's 1988 Proposition 99 to reduce cigarette sales) are used to illustrate how history biases results of single-group ITSA results-as opposed to when that group's results are contrasted to those of a comparable control group. RESULTS In the first example, an external event occurring at the same time as the helmet repeal appeared to be the cause of a rise in motorcycle deaths, but was only revealed when Florida was contrasted with comparable control states. Conversely, in the second example, a decreasing trend in cigarette sales prior to the intervention raised question about a treatment effect attributed to Proposition 99, but was reinforced when California was contrasted with comparable control states. CONCLUSIONS Results of single-group ITSA should be considered preliminary, and interpreted with caution, until a more robust study design can be implemented.
Collapse
Affiliation(s)
- Ariel Linden
- Linden Consulting Group, LLC, Ann Arbor, MI, USA.,Division of General Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Crosbie E, Sosa P, Glantz SA. The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica. Tob Control 2017; 26:60-68. [PMID: 26856614 PMCID: PMC4977207 DOI: 10.1136/tobaccocontrol-2015-052701] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. METHOD Review of tobacco control legislation, newspaper articles and interviewing key informants. RESULTS Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. CONCLUSIONS The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation.
Collapse
Affiliation(s)
- Eric Crosbie
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Patricia Sosa
- International Advocacy Center, Campaign for Tobacco Free Kids, Washington DC, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
12
|
Jongenelis MI, Pettigrew S, Wakefield M, Slevin T, Pratt IS, Chikritzhs T, Liang W. Investigating Single- Versus Multiple-Source Approaches to Communicating Health Messages Via an Online Simulation. Am J Health Promot 2016; 32:979-988. [DOI: 10.1177/0890117116673819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To assess whether exposing drinkers to information about the alcohol–cancer link via multiple and diverse sources in an online simulation produces larger improvements in attitudes and intentions relative to exposure to a single source of information. Design: Experimental; unequal randomization with respondents allocated to either the single-source (20%) or multiple-source condition (80%). Alcohol-related behavioral intentions were assessed preexposure and postexposure. Setting: Australia. Participants: A total of 2087 drinkers consuming alcohol at least twice per month. Measures: Scales were used to assess attitudes toward the messages (believability, convincingness, and personal relevance) and behavioral intentions (extent to which participants believed that they should and would reduce their alcohol consumption and their intention to consume 5 or more drinks in a single session). Analysis: Hierarchical linear regression. Results: Source condition was significantly associated with all 3 attitudinal variables ( P < .001). Those exposed to an alcohol warning statement from multiple sources found the message more believable, convincing, and personally relevant compared to those exposed to a warning statement via a single source. They also reported significantly greater change preexposure to postexposure on the 2 behavioral beliefs that they should (Δ M = 0.25 vs Δ M = 0.09) and would (Δ M = 0.23 vs Δ M = 0.00) reduce their current alcohol consumption ( P < .001). Further, those in the multiple-source condition reported reduced intentions to consume 5 or more standard drinks in a single sitting (Δ M = 0.21 vs Δ M = 0.14; P < .001). Conclusion: Findings from the online simulation provide support for the suggestion that integrated approaches involving the combination of multiple sources to deliver a message produce superior outcomes compared to relying on a single source (eg, warning labels on alcoholic beverages).
Collapse
Affiliation(s)
- Michelle I. Jongenelis
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Terry Slevin
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Iain S Pratt
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Wenbin Liang
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
13
|
Best A, Stokols D, Green LW, Leischow S, Holmes B, Buchholz K. An Integrative Framework for Community Partnering to Translate Theory into Effective Health Promotion Strategy. Am J Health Promot 2016; 18:168-76. [PMID: 14621414 DOI: 10.4278/0890-1171-18.2.168] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework—with several health promotion models that could integrate existing theories—and applying it to comprehensive health promotion strategy. An Integrative Framework. We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation–Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. Integrating the Models: The Need for Systems Theory and Thinking. Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. Vision for Healthy Communities. (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion “best practices” guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. Conclusions and Recommendations. We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.
Collapse
Affiliation(s)
- Allan Best
- Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
14
|
Stokols D, Grzywacz JG, McMahan S, Phillips K. Increasing the Health Promotive Capacity of Human Environments. Am J Health Promot 2016; 18:4-13. [PMID: 13677958 DOI: 10.4278/0890-1171-18.1.4] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article offers an integration of two different perspectives on health promotion research and practice: one emphasizing the concept of community capacity for health improvement and the other focusing on the notion of health supportive environments. These two approaches generally have emphasized different kinds of community assets for health promotion. Specifically, community capacity research has focused on the cultivation of human resources (e.g., collaborative coalitions, participatory decision-making, health education strategies) for health promotion, whereas environmentally oriented research has underscored the influence of material resources (e.g., the built environment, natural resources, technological infrastructure) on important health behaviors and outcomes. Combining these two streams of health promotion research yields a broader understanding of the health promotive capacity of human environments and suggests several “best process” guidelines for enhancing health promotion practice.
Collapse
Affiliation(s)
- Daniel Stokols
- Department of Planning, Policy, and Design, School of Social Ecology, University of California, Irvine, CA, 92697-7075, USA
| | | | | | | |
Collapse
|
15
|
Dolcini MM, Canin L, Gandelman A, Skolnik H. Theoretical Domains: A Heuristic for Teaching Behavioral Theory in HIV/STD Prevention Courses. Health Promot Pract 2016; 5:404-17. [PMID: 15358913 DOI: 10.1177/1524839903257997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The HIV/STD epidemics have broadened the need for better behavioral intervention programs and highlighted the importance of providing training in behavioral theory to frontline program practitioners. However, there is a lack of effective methods for teaching theoretical concepts to people who may not have a background in behavioral science. This article presents a solution to this challenge by introducing a new heuristic for teaching theory and for placing individual theories/models in a broader context. Using a broad framework, we identify five domains that influence behavior: risk appraisal, self-perceptions, emotions and arousal, relationships and social influence, and environmental and structural factors. Each domain is described, and a brief overview of supporting literature is provided. Following the presentation of domains, we discuss course structure and activities.
Collapse
Affiliation(s)
- M Margaret Dolcini
- Department of Medicine, Center for AIDS Prevention Studies and the Center for Health and Community, University of California San Francisco, 94143-0848, USA.
| | | | | | | |
Collapse
|
16
|
Abbatangelo-Gray J, Cole GE, Kennedy MG. Guidance for Evaluating Mass Communication Health Initiatives. Eval Health Prof 2016; 30:229-53. [PMID: 17693617 DOI: 10.1177/0163278707304041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In May 2004, 12 experts in evaluating large-scale health communication programs came to the Centers for Disease Control and Prevention to participate in an electronic focus group discussion. They offered advice on topics ranging from the role of logic models to the best strategies for controlling for self-selection bias in surveys regarding outcomes of exposure to mass media health messages. The experts also highlighted health communication evaluation topics that have received too little scientific attention. Finally, they made strategic policy recommendations. Use of the state-of-the-art evaluation methods that they recommended could improve the communication of factual and persuasive health messages and help to guard the public health of the nation. Their advice may also advance evaluation practice in other substantive areas, especially where it is difficult or impossible to implement randomized designs.
Collapse
|
17
|
Hoffman SJ, Tan C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health 2015; 15:744. [PMID: 26242915 PMCID: PMC4526291 DOI: 10.1186/s12889-015-2041-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/08/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. METHODS An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored. RESULTS Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention. CONCLUSION When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.
Collapse
Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, 57 Louis Pasteur Street, Ottawa, K1N 6N5, ON, Canada.
- Department of Clinical Epidemiology & Biostatistics and McMaster Health Forum, McMaster University, Hamilton, ON, Canada.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
18
|
Randheer K, Almotairi M, Naeem HA. Anti-smoking environment: a perspective from Murray's psychogenic needs theory. Glob J Health Sci 2013; 6:99-106. [PMID: 24373269 PMCID: PMC4825265 DOI: 10.5539/gjhs.v6n1p99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/27/2013] [Indexed: 12/05/2022] Open
Abstract
Smoking emerged as a social problem in many nations. Smoking is inflicting injuries to society including addiction, diseases, health damage, and loss of productivity. Individuals, institutions and governments are working to contain the menace of smoking. Many policies, programs and activities are being designed and implemented. To extend a helping hand to fight against smoking this study brought to light the amalgamation of Murray’s psychogenic needs theory with anti-smoking activities to create an effective anti-smoking environment. Conceptual methodology is adopted and five propositions were drafted. This study conclude that anti-smoking activities general education, campaigning, counseling, social welfare, and medical camps when moderated by Murray’s psychogenic needs power, affiliation and achievement can create an effective anti-smoking environment further leading to quitting or reduction in the smoking.
Collapse
Affiliation(s)
- Kokku Randheer
- College of Business Administration, King Saud University.
| | | | | |
Collapse
|
19
|
Huang SL, Lin IF, Chen CY, Tsai TI. Impact of tobacco control policies on adolescent smoking: findings from the Global Youth Tobacco Survey in Taiwan. Addiction 2013; 108:1829-35. [PMID: 23714267 DOI: 10.1111/add.12259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/04/2013] [Accepted: 05/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS To assess the impact of a set of comprehensive tobacco control policies implemented in Taiwan in 2009, including extensive smoke-free policy, advertisement ban, pictorial warning and price increase, on adolescent smoking prevalence. DESIGN Five waves of cross-sectional surveys. SETTING Taiwan, 2004-11. PARTICIPANTS Nationally representative sample of junior high schools aged 13-15 years, in a biennial survey, total sample size 101,100. MEASURES Core questionnaire of the Global Youth Tobacco Survey, including ever smoking, 30-day smoking and number of cigarettes smoked. The magnitude of prevalence change before and after the 2009 policy implementation was quantified by adjusted odds ratios estimated by piecewise logistic regression models. FINDINGS The 30-day smoking prevalence demonstrated an upward trend [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02-1.10] between 2004 and 2008. Significant decline in 30-day smoking prevalence after the 2009 law implementation was observed (OR = 0.84, 95% CI = 0.71-0.99). Those living in non-city areas demonstrated a greater magnitude of change. In addition to changes in prevalence, we observed some delay in the age starting smoking, reduction in smokers who smoke fewer than one cigarette per day, and decrease in smokers who did not buy cigarettes. The decline in smoking prevalence was contributed primarily by the reduction in experimenters. CONCLUSION The comprehensive tobacco control programme introduced in Taiwan in 2009 was associated with a reduction in adolescent smoking, particularly among those in earlier stages of smoking and those who resided in non-city areas.
Collapse
Affiliation(s)
- Song-Lih Huang
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | | | | | | |
Collapse
|
20
|
|
21
|
Bala MM, Strzeszynski L, Topor-Madry R, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev 2013:CD004704. [PMID: 23744348 DOI: 10.1002/14651858.cd004704.pub3] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. OBJECTIVES To assess the effectiveness of mass media interventions in reducing smoking among adults. SEARCH METHODS The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in February 2013. SELECTION CRITERIA Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series. Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes. The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker. DATA COLLECTION AND ANALYSIS Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form. MAIN RESULTS Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined. AUTHORS' CONCLUSIONS There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.
Collapse
Affiliation(s)
- Malgorzata M Bala
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | | | | | | |
Collapse
|
22
|
Rayens MK, York NL, Adkins SM, Kaufman EL, Hahn EJ. Political climate and smoke-free laws in rural Kentucky communities. Policy Polit Nurs Pract 2013; 13:90-7. [PMID: 23044483 DOI: 10.1177/1527154412456434] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose was to determine factors associated with rural communities' political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials' perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.
Collapse
Affiliation(s)
- Mary Kay Rayens
- University of Kentucky College of Nursing, Lexington, KY 40526, USA.
| | | | | | | | | |
Collapse
|
23
|
Lightwood J, Glantz SA. The effect of the California tobacco control program on smoking prevalence, cigarette consumption, and healthcare costs: 1989-2008. PLoS One 2013; 8:e47145. [PMID: 23418411 PMCID: PMC3572143 DOI: 10.1371/journal.pone.0047145] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/11/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous research has shown that tobacco control funding in California has reduced per capita cigarette consumption and per capita healthcare expenditures. This paper refines our earlier model by estimating the effect of California tobacco control funding on current smoking prevalence and cigarette consumption per smoker and the effect of prevalence and consumption on per capita healthcare expenditures. The results are used to calculate new estimates of the effect of the California Tobacco Program. METHODOLOGY/PRINCIPAL FINDINGS Using state-specific aggregate data, current smoking prevalence and cigarette consumption per smoker are modeled as functions of cumulative California and control states' per capita tobacco control funding, cigarette price, and per capita income. Per capita healthcare expenditures are modeled as a function of prevalence of current smoking, cigarette consumption per smoker, and per capita income. One additional dollar of cumulative per capita tobacco control funding is associated with reduction in current smoking prevalence of 0.0497 (SE.00347) percentage points and current smoker cigarette consumption of 1.39 (SE.132) packs per smoker per year. Reductions of one percentage point in current smoking prevalence and one pack smoked per smoker are associated with $35.4 (SE $9.85) and $3.14 (SE.786) reductions in per capita healthcare expenditure, respectively (2010 dollars), using the National Income and Product Accounts (NIPA) measure of healthcare spending. CONCLUSIONS/SIGNIFICANCE Between FY 1989 and 2008 the California Tobacco Program cost $2.4 billion and led to cumulative NIPA healthcare expenditure savings of $134 (SE $30.5) billion.
Collapse
Affiliation(s)
- James Lightwood
- School of Pharmacy and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, United States of America.
| | | |
Collapse
|
24
|
Rexing CJ, Ibrahim JK. State tobacco control plans: who falls outside the plans? Am J Health Promot 2012; 27:29-36. [PMID: 22950923 DOI: 10.4278/ajhp.100408-qual-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To review published state tobacco control plans (STCPs) to determine the extent to which the needs of the states' populations are being addressed. DESIGN A qualitative cross-sectional comparison of states' strategic plans for tobacco control as of March 2010. SETTING Online searches. PARTICIPANTS The 50 states and the District of Columbia. METHOD Internet-based searches were completed using tobacco and other keywords (control, prevention, strategies, comprehensive/strategic plan) to obtain all publicly available STCPs; telephone follow-up was conducted to ensure that all publicly available plans were captured. Each plan was coded by two researchers using a standardized protocol to assess provisions made for addressing disparate populations as defined by the states. RESULTS A total of 43 states addressed disparate populations. Thirty-six states addressed these populations within published STCPs, six states had separate stand-alone tobacco disparities plans, and one addressed it within their cancer plan. Specific populations addressed included racial and ethnic minorities, blue-collar employees, pregnant women, children under the age of 18, and college students. There were also several STCPs that cited the general goal of eliminating tobacco use disparities. CONCLUSION More work is needed to address tobacco disparities, including additional planning efforts in some states and effective implementation and evaluation among states with plans. States can look to the experiences of other states to help guide tobacco control planning for their own populations.
Collapse
Affiliation(s)
- Christen J Rexing
- Department of Public Health, Temple University, Philadelphia, Pennsylvania 19122, USA
| | | |
Collapse
|
25
|
Abstract
PURPOSE A key goal of this paper is to illustrate the impact of behavioral medicine on the factors that influence population health. A second goal is to consider the delicate balance between relevance and excellence as we bring our science to bear on important social and public health problems. If we are to increase the translation of our evidence and accelerate our impact, we must increase our relevance while maintaining excellence in our scientific methods. METHODS What are the pressing questions facing those that we would like to use our work, and how we can increase our relevance to theirs? We must work on the marriage of relevance and excellence-use rigorous methodologies, but be flexible in our approach, using study designs and methods that will get rapid yet rigorous answers to the questions that are facing practice and policy settings. CONCLUSION We have the tools and the knowledge to impact the health of our nation.
Collapse
Affiliation(s)
- Karen Emmons
- Center for Community-Based Research, Harvard School of Public Health, Boston, MA 02215, USA.
| |
Collapse
|
26
|
The Minnesota Adolescent Community Cohort Study: design and baseline results. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:201-10. [PMID: 21360063 DOI: 10.1007/s11121-011-0205-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Minnesota Adolescent Community Cohort (MACC) Study is a population-based, longitudinal study that enrolled 3,636 youth from Minnesota and 605 youth from comparison states ages 12 to 16 years in 2000-2001. Participants have been surveyed by telephone semi-annually about their tobacco-related attitudes and behaviors. The goals of the study are to evaluate the effects of the Minnesota Youth Tobacco Prevention Initiative and its shutdown on youth smoking patterns, and to better define the patterns of development of tobacco use in adolescents. A multilevel sample was constructed representing individuals, local jurisdictions and the entire state, and data are collected to characterize each of these levels. This paper presents the details of the multilevel study design. We also provide baseline information about MACC participants including demographics and tobacco-related attitudes and behaviors. This paper describes variability in smoking prevalence and demographic characteristics for local units, and compares MACC participants to the state as a whole.
Collapse
|
27
|
Abadie A, Diamond A, Hainmueller J. Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program. J Am Stat Assoc 2010. [DOI: 10.1198/jasa.2009.ap08746] [Citation(s) in RCA: 2116] [Impact Index Per Article: 151.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Miller LS, Max W, Sung HY, Rice D, Zaretsky M. Evaluation of the economic impact of California's Tobacco Control Program: a dynamic model approach. Tob Control 2010; 19 Suppl 1:i68-76. [PMID: 20382654 PMCID: PMC2976474 DOI: 10.1136/tc.2008.029421] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 01/08/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term net economic impact of the California Tobacco Control Program. METHODS This study developed a series of dynamic models of smoking-caused mortality, morbidity, health status and healthcare expenditures. The models were used to evaluate the impact of the tobacco control programme. Outcomes of interest in the evaluation include net healthcare expenditures saved, years of life saved, years of treating smoking-related diseases averted and the total economic value of net healthcare savings and life saved by the programme. These outcomes are evaluated to 2079. Due to data limitations, the evaluations are conducted only for men. RESULTS The California Tobacco Control Program resulted in over 700,000 person-years of life saved and over 150,000 person-years of treatment averted for the 14.7 million male California residents alive in 1990. The value of net healthcare savings and years of life saved resulting from the programme was $22 billion or $107 billion in 1990 dollars, depending on how a year of life is discounted. If women were included, the impact would likely be much greater. CONCLUSIONS The benefits of California's Tobacco Control Program are substantial and will continue to accrue for many years. Although the programme has resulted in increased longevity and additional healthcare resources for some, this impact is more than outweighed by the value of the additional years of life. Modelling the programme's impact in a dynamic framework makes it possible to evaluate the multiple impacts that the programme has on life, health and medical expenditures.
Collapse
Affiliation(s)
- Leonard S Miller
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Wendy Max
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Dorothy Rice
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Malcolm Zaretsky
- Department of Molecular and Cell Biology, University of California, Berkeley, California, USA
| |
Collapse
|
29
|
Alesci NL, Forster JL, Erickson DJ. Did youth smoking behaviors change before and after the shutdown of Minnesota Youth Tobacco Prevention Initiative? Nicotine Tob Res 2009; 11:1196-204. [PMID: 19633274 PMCID: PMC2746837 DOI: 10.1093/ntr/ntp124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 05/22/2009] [Indexed: 11/13/2022]
Abstract
INTRODUCTION No previous studies document the effects of both comprehensive tobacco control and its defunding on youth smoking. This study tests the effect of the youth-focused Minnesota Youth Tobacco Prevention Initiative (MYTPI) and its shutdown on youth smoking and determines whether these effects differed by age. METHODS The Minnesota Adolescent Community Cohort is a population-based, observational study designed to evaluate the MYTPI. The sample included cohorts of youth aged 12-16 years at baseline in Minnesota (N = 3,636) and a comparison group in six other Midwestern states (n = 605). Biannual surveys assessed youth smoking from October 2000, 5 months after the MYTPI launch, through October 2005, 2 years postshutdown. Adjusted piecewise linear trajectories predicted smoking stage (measured on a 1-6 continuum) comparing Minnesota with a comparison group during the MYTPI (Slope 1) and postshutdown (Slope 2) for each baseline age cohort. Analysis then compared baseline age cohorts with each other by centering their intercepts on age 16. RESULTS Neither slope of smoking stage differed between Minnesota and comparison groups, showing no period effects for the MYTPI or shutdown. However, younger cohorts, with early teen experience of MYTPI, smoked less than older cohorts by the same age. Mean smoking stage at age 16 differed by almost a half stage from the youngest (2.04) to the oldest (2.46) age cohort. DISCUSSION The study offers no evidence of period effects for the MYTPI or its shutdown. Design limitations, national or continued post-MYTPI statewide tobacco control efforts, or program flaws could explain the findings.
Collapse
Affiliation(s)
- Nina L Alesci
- Division of Epidemiology & Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454, USA.
| | | | | |
Collapse
|
30
|
Quick BL, Bates BR, Quinlan MM. The utility of anger in promoting clean indoor air policies. HEALTH COMMUNICATION 2009; 24:548-561. [PMID: 19735032 DOI: 10.1080/10410230903104939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This investigation examined antecedents associated with support for clean indoor air policies. Participants (N = 550) living in a Midwestern county (population = 62,223) were randomly sampled. Results suggest that beliefs in the health risks associated with secondhand smoke are positively associated with favorable attitudes toward clean indoor air policies, whereas trait reactance is negatively associated with these attitudes. Findings also indicate that risks and trait reactance are indirectly associated with support for clean indoor air policies, mediated through anger arousal toward exposure to secondhand smoke. In addition, regression analyses revealed that health risks, trait reactance, and smoking status explained a significant amount of variance regarding anger toward exposure to secondhand smoke, but only health risks and smoking status accounted for a significant amount of variance toward clean indoor air attitudes. Finally, the Smoking Status x Health Risks interaction was supported for anger toward exposure to secondhand smoke and favorable attitudes toward clean indoor air policies. Our findings suggest the incorporation of anger appeals when promoting clean indoor air policies.
Collapse
Affiliation(s)
- Brian L Quick
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | | | | |
Collapse
|
31
|
Pizacani BA, Dent CW, Maher JE, Rohde K, Stark MJ, Biglan A, Thompson J. Smoking patterns in Oregon youth: effects of funding and defunding of a comprehensive state tobacco control program. J Adolesc Health 2009; 44:229-36. [PMID: 19237108 PMCID: PMC4186742 DOI: 10.1016/j.jadohealth.2008.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 07/01/2008] [Accepted: 07/08/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated. METHODS We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding. RESULTS Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period (p=.04) and was not significantly different from schools that were never-funded (p=.79). CONCLUSIONS In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment.
Collapse
Affiliation(s)
- Barbara A Pizacani
- Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon 97232, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Strasser AA, Cappella JN, Jepson C, Fishbein M, Tang KZ, Han E, Lerman C. Experimental evaluation of antitobacco PSAs: effects of message content and format on physiological and behavioral outcomes. Nicotine Tob Res 2009; 11:293-302. [PMID: 19246628 DOI: 10.1093/ntr/ntn026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Antitobacco media campaigns using public service announcements (PSAs) have shown promise in reducing smoking initiation and increasing intentions to quit. Research on what makes an effective PSA has had mixed outcomes. The present study tested the effects of specific message features in antitobacco PSAs, using theory-based physiological and self-report outcomes. METHODS PSAs were categorized as high or low in message sensation value (MSV) and strength of argument and presented to 200 current smokers in a 2 x 2 factorial design. Physiological responses-specifically, heart rate, skin conductance, zygomaticus major, and corrugator supercilii-were assessed while participants viewed the PSAs. Beliefs, attitudes, efficacy, norms, and intentions to quit were assessed immediately following viewing. RESULTS Corrugator activity was significantly greater in the high MSV condition. Among those low in sensation seeking, low MSV PSAs elicited higher self-efficacy, whereas the reverse was true for high sensation seekers. High MSV PSAs elicited higher negative beliefs in low sensation seekers. Adding physiological measures to a model predicting intention to quit did not improve the explained variance. DISCUSSION The present study represents the first comprehensive theory-based experimental investigation of the effects of different features of antitobacco PSAs and provides a framework for future research in identifying effective features of such PSAs. Results illustrate the importance of considering individual differences, characterizing both PSA content and format, and outcome and response measures when evaluating antitobacco PSAs.
Collapse
Affiliation(s)
- Andrew A Strasser
- Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Quick BL, Bates BR, Romina S. Examining antecedents of clean indoor air policy support: implications for campaigns promoting clean indoor air. HEALTH COMMUNICATION 2009; 24:50-59. [PMID: 19204858 DOI: 10.1080/10410230802606992] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This investigation sought to examine the association between knowledge of the risks associated with environmental tobacco smoke and voter support for clean indoor air policies. In doing so, 2 antecedents were employed to enhance understanding of this relationship: attitudes and subjective norms. In addition, differences between nonsmokers and smokers were assessed across the aforementioned variables. The study sampled participants (N = 550) living in the Appalachian foothills as a means of conducting formative research prior to developing messages promoting clean indoor air policies. The study controlled for tobacco usage, age, biological sex, and income. Results revealed that awareness of risk is a good predictor of attitudes and social norms, and in return, attitudes and social norms are good predictors of support for clean indoor air policies. In addition, results reveal that nonsmokers maintain a significantly stronger belief in the dangers associated with environmental tobacco smoke, as well as more favorable attitudes, subjective norms, and support for clean indoor air policies when compared with smokers. These findings are discussed with a focus on message design strategies for practitioners and academics with interests in promoting clean indoor air policies.
Collapse
Affiliation(s)
- Brian L Quick
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | | | | |
Collapse
|
34
|
York NL, Hahn EJ, Rayens MK, Talbert J. Community readiness for local smoke-free policy change. Am J Health Promot 2008; 23:112-20. [PMID: 19004161 DOI: 10.4278/ajhp.07021615] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to use the Community Readiness Model to examine local smoke-free policy development. DESIGN, SETTING, AND SUBJECTS A descriptive, cross-sectional design was used to assess 64 Kentucky communities. Dimensions of readiness included a community's knowledge of the problem and existing voluntary smoke-free policies; leadership for policy development; resources for policy development; climate surrounding policy development; existing voluntary policy efforts; and political climate for policy development. Dimension scores were summed to identify one of six overall readiness stages: (1) unawareness; (2) vague awareness; (3) preplanning; (4) preparation; (5) initiation; and (6) endorsement. ANALYSES Correlations between dimensions and overall readiness scores were evaluated. One-way analysis of variance was used to evaluate regional trends, and multiple regression was used to assess the influence of sociodemographic/political variables on policy readiness. RESULTS The knowledge dimension rated highest, and community climate rated lowest. Most communities were in the lower stages of readiness. No relationship was found between overall readiness and region (F [4,59] = 1.17; p > .05); nor were there regional differences among dimension scores. Smaller communities were less ready for local policy development than larger ones (adjusted R2 = .25; p = .003). CONCLUSIONS The Community Readiness Model is appropriate for understanding local policy development, and it provides advocates with information that may prove helpful in advancing smoke-free policy.
Collapse
Affiliation(s)
- Nancy L York
- University of Nevada Las Vegas, School of Nursing, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154-3018, USA.
| | | | | | | |
Collapse
|
35
|
Shelley D, Fahs M, Yerneni R, Das D, Nguyen N, Hung D, Burton D, Chin M, Chang MD, Cummings KM. Effectiveness of tobacco control among Chinese Americans: a comparative analysis of policy approaches versus community-based programs. Prev Med 2008; 47:530-6. [PMID: 18687355 PMCID: PMC2643380 DOI: 10.1016/j.ypmed.2008.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population. METHODS A pre-post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18-74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions. RESULTS From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community. CONCLUSION City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.
Collapse
Affiliation(s)
- Donna Shelley
- New York University College of Densitry, 423 East 23rd Street, New York, NY 10010, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Hornik R, Jacobsohn L, Orwin R, Piesse A, Kalton G. Effects of the National Youth Anti-Drug Media Campaign on youths. Am J Public Health 2008; 98:2229-36. [PMID: 18923126 DOI: 10.2105/ajph.2007.125849] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and report core evaluation results. METHODS From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times. Sample size ranged from 8117 in the first to 5126 in the fourth round (65% first-round response rate, with 86%-93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions. RESULTS Most analyses showed no effects from the campaign. At one round, however, more ad exposure predicted less intention to avoid marijuana use (gamma = -0.07; 95% confidence interval [CI] = -0.13, -0.01) and weaker antidrug social norms (gamma = -0.05; 95% CI = -0.08, -0.02) at the subsequent round. Exposure at round 3 predicted marijuana initiation at round 4 (gamma = 0.11; 95% CI = 0.00, 0.22). CONCLUSIONS Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. The evaluation challenges the usefulness of the campaign.
Collapse
Affiliation(s)
- Robert Hornik
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | | | | | | |
Collapse
|
37
|
Hamilton WL, Biener L, Brennan RT. Do local tobacco regulations influence perceived smoking norms? Evidence from adult and youth surveys in Massachusetts. HEALTH EDUCATION RESEARCH 2008; 23:709-722. [PMID: 17947246 PMCID: PMC2733799 DOI: 10.1093/her/cym054] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 07/09/2007] [Indexed: 05/25/2023]
Abstract
Smoking behavior has been shown to be influenced by individuals' perceptions of social norms about smoking. This study examines whether local regulations regarding clean indoor air and youth access to tobacco are associated with residents' subsequent perceptions of smoking norms. Data came from Massachusetts surveys of adults and youths and from records of local tobacco control policies. Indices of perceived smoking norms were based on perceived smoking prevalence and perceived community acceptance of smoking. Multilevel models tested the association between perceived norms and the presence of strong local regulations in four policy domains (restaurant smoking bans, smoking restrictions in other venues, enforcement of laws prohibiting sales to youths and youth-oriented marketing restrictions). The model controlled for town voting results on a tobacco tax referendum, which served as a measure of antismoking sentiment pre-dating the regulations. Results showed that youths perceived community norms to be significantly more 'antismoking' if they lived in a town that had strong regulations in at least three of the four domains. For adults, having strong regulations in as few as one to two domains was associated with perceiving community norms to be significantly more antismoking. Implementing and publicizing local regulations may help shape perceptions of community smoking norms.
Collapse
Affiliation(s)
| | - Lois Biener
- Center for Survey Research, University of Massachusetts, Boston, MA 02125, USA
| | - Robert T. Brennan
- Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115
| |
Collapse
|
38
|
Nelson DE, Mowery P, Asman K, Pederson LL, O'Malley PM, Malarcher A, Maibach EW, Pechacek TF. Long-term trends in adolescent and young adult smoking in the United States: metapatterns and implications. Am J Public Health 2008; 98:905-15. [PMID: 18382001 PMCID: PMC2374818 DOI: 10.2105/ajph.2007.115931] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to describe long-term adolescent and young adult smoking trends and patterns. METHODS We analyzed adolescent data from Monitoring the Future, 1976 to 2005, and young adult (aged 18-24 years) data from the National Health Interview Survey, 1974 to 2005, overall and in subpopulations to identify trends in current cigarette smoking prevalence. RESULTS Five metapatterns emerged: we found (1) a large increase and subsequent decrease in overall smoking over the past 15 years, (2) a steep decline in smoking among Blacks through the early 1990s, (3) a gender gap reversal among older adolescents and young adults who smoked over the past 15 years, (4) similar trends in smoking for most subgroups since the early 1990s, and (5) a large decline in smoking among young adults with less than a high school education. CONCLUSIONS Long-term patterns for adolescent and young adult cigarette smoking were decidedly nonlinear, and we found evidence of a cohort effect among young adults. Continued strong efforts and a long-term societal commitment to tobacco use prevention are needed, given the unprecedented declines in smoking among most subpopulations since the mid- to late 1990s.
Collapse
Affiliation(s)
- David E Nelson
- National Center for Chronic Disease Prevention and Health Promotion, Emerging Investigation and Analytic Methods Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-67, Atlanta, GA 30341-3717, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Dunlop SM, Wakefield M, Kashima Y. The contribution of antismoking advertising to quitting: intra- and interpersonal processes. JOURNAL OF HEALTH COMMUNICATION 2008; 13:250-266. [PMID: 18569357 DOI: 10.1080/10810730801985301] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study explored the roles of transportability-the tendency to become absorbed in a narrative-and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.
Collapse
|
40
|
Bemelmans W, van Baal P, Wendel-Vos W, Schuit J, Feskens E, Ament A, Hoogenveen R. The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action. Prev Med 2008; 46:127-32. [PMID: 17822752 DOI: 10.1016/j.ypmed.2007.07.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 07/20/2007] [Accepted: 07/23/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive lifestyle program (applied to 10% of overweight adults), and costs and cost-effectiveness were assessed. METHODS Costs and effects were based on two Dutch projects and verified by similar international projects. A markov-type simulation model estimated long-term health benefits, health care costs and cost-effectiveness. RESULTS Combined implementation of the interventions--at the above mentioned scale--reduces prevalence rates of overweight by approximately 3 percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost of 7 euros per adult capita per year. The cost-effectiveness ratio of combined implementation amounts to euro 6000 per life-year gained and euro 5700 per QALY gained (including costs of unrelated diseases in life years gained). Sensitivity analyses showed that these ratios are quite robust. CONCLUSIONS A realistic policy target is a decrease in overweight prevalence of three percentage points, compared to a situation with no interventions. In reality, large scale implementation of the interventions may not counteract the expected upward trends in The Netherlands completely. Nonetheless, implementation of the interventions is cost-effective.
Collapse
Affiliation(s)
- Wanda Bemelmans
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. OBJECTIVES To assess the effectiveness of mass media interventions in reducing smoking among adults. SEARCH STRATEGY The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in March 2007. SELECTION CRITERIA Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker. DATA COLLECTION AND ANALYSIS Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of included studies and are presented narratively and in table form. MAIN RESULTS Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined. AUTHORS' CONCLUSIONS There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign, while another (California) showed positive results only during the period of adequate funding and implementation. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.
Collapse
Affiliation(s)
- M Bala
- Jagiellonian University Medical College, 2nd Department of Internal Medicine, 8 Skawinska St, Krakow, Poland, 31-066.
| | | | | |
Collapse
|
42
|
Dietz NA, Delva J, Woolley ME, Russello L. The reach of a youth-oriented anti-tobacco media campaign on adult smokers. Drug Alcohol Depend 2008; 93:180-4. [PMID: 17964081 DOI: 10.1016/j.drugalcdep.2007.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 08/02/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND It remains unclear whether youth-targeted anti-tobacco media campaigns reach adults. We examined the reach of the youth-oriented Florida "truth" campaign to (a) determine the extent to which adult smokers were aware of the campaign and (b) test if that awareness was associated with an intention to quit smoking in the next 30 days. METHODS Data included 781 adult smokers who in 2001 participated in a 20-min telephone survey designed to examine the effects of the "truth" campaign in Florida. Participants were asked numerous questions aimed at measuring their awareness of the campaign and about their tobacco use. RESULTS Awareness of the campaign was mixed with 21% confirming the "truth" campaign theme, 45% the "truth" logo, 62% "truth" advertising events, and 68% the "truth" advertising theme. Awareness of industry manipulation was the only variable significantly associated with smokers' intentions to quit (OR=1.66; 95% CI=1.34-2.05) in the multivariate model. CONCLUSIONS The "truth" anti-tobacco campaign targeted 12-17 year olds in an effort to prevent them from starting to smoke. Despite the awareness, the campaign did not have the "unintended consequence" of influencing adults' intentions to smoke. To change the behavior of adults it is not sufficient to have a youth-focused program.
Collapse
Affiliation(s)
- Noella A Dietz
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Department of Epidemiology and Public Health, Miami, FL 33101, USA
| | | | | | | |
Collapse
|
43
|
Grosse SD, Teutsch SM, Haddix AC. Lessons from cost-effectiveness research for United States public health policy. Annu Rev Public Health 2007; 28:365-91. [PMID: 17222080 DOI: 10.1146/annurev.publhealth.28.021406.144046] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The application of cost-effectiveness analysis to health care has been the subject of previous reviews. We address the use of economic evaluation methods in public health, including case studies of population-level policies, e.g., environmental regulations, injury prevention, tobacco control, folic acid fortification, and blood product safety, and the public health promotion of clinical preventive services, e.g., newborn screening, cancer screening, and childhood immunizations. We review the methods used in cost-effectiveness analysis, the implications for cost-effectiveness findings, and the extent to which economic studies have influenced policy and program decisions. We discuss reasons for the relatively limited impact to date of economic evaluation in public health. Finally, we address the vexing question of how to decide which interventions are cost effective and worthy of funding. Policy makers have funded certain interventions with rather high cost-effectiveness ratios, notably nucleic acid testing for blood product safety. Cost-effectiveness estimates are a decision aid, not a decision rule.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|
44
|
Liu J, Peterson AV, Kealey KA, Mann SL, Bricker JB, Marek PM. Addressing challenges in adolescent smoking cessation: design and baseline characteristics of the HS Group-Randomized trial. Prev Med 2007; 45:215-25. [PMID: 17628650 PMCID: PMC2040060 DOI: 10.1016/j.ypmed.2007.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 04/23/2007] [Accepted: 05/20/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Well-documented challenges have hampered both intervention development and research in teen smoking cessation. Addressing these challenges, the Hutchinson Study of High School Smoking (HS Study), the largest group-randomized trial in adolescent smoking cessation to date, incorporates several design innovations to investigate the effect of a counselor-initiated, individually tailored telephone counseling smoking cessation intervention for older adolescents. This paper presents and discusses these innovative design features, and baseline findings on the resulting study population. METHOD The trial used a population-based survey to proactively identify and recruit all high school juniors who had smoked in the past month - potentially expanding intervention reach to all smokers, even those who smoked less than daily and those not motivated to quit. For ethical and intervention reasons, some nonsmokers were enrolled in the intervention, also. Other important design features included the random allocation of schools into experimental conditions (intervention vs. no-intervention control) and a multi-wave design. RESULTS AND CONCLUSION The design innovations address problems and challenges identified in adolescent smoking cessation literature. The heterogeneous baseline characteristics of the study population, well-balanced between the two arms, have three significant implications: They (1) demonstrate the effectiveness of the trial's design features, (2) highlight several intervention-related issues, and (3) provide assurance that the trial's evaluation of intervention effectiveness will be unbiased.
Collapse
Affiliation(s)
- Jingmin Liu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview, Ave N., M2-C826, P.O. Box 19024, Seattle, WA 98109-1024, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Jones AS, Austin WD, Beach RH, Altman DG. Funding of North Carolina tobacco control programs through the Master Settlement Agreement. Am J Public Health 2006; 97:36-44. [PMID: 17138928 PMCID: PMC1716246 DOI: 10.2105/ajph.2005.070466] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies.
Collapse
Affiliation(s)
- Alison Snow Jones
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | | | | | | |
Collapse
|
46
|
Carver V, Reinert B, Range LM. Sustaining tobacco control coalitions amid declining resources. Health Promot Pract 2006; 8:292-8. [PMID: 17105805 DOI: 10.1177/1524839906289820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mississippi is unique among the 50 states in settling a lawsuit against tobacco companies earlier than the Master Settlement Agreement, devoting a relatively high amount of per capita funding on tobacco control, and avoiding tobacco-control budget cuts. Using a social-ecological approach combining insider and outsider strategies, tobacco-prevention coalitions in Mississippi succeeded in sustaining funding despite serious obstacles. Lessons learned included taking specific actions to embed themselves in the local community, wisely aligning with legislators, choosing courageous and effective champions, and ensuring that people are keenly aware of their existence and efforts. In using these strategies, tobacco-prevention coalitions in Mississippi have become an institution of the community and in so doing helped sustain their funding.
Collapse
Affiliation(s)
- Vivien Carver
- University of Southern Mississippi in Hattiesburg, Mississippi, USA
| | | | | |
Collapse
|
47
|
Stokols D. Toward a science of transdisciplinary action research. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2006; 38:63-77. [PMID: 16791514 DOI: 10.1007/s10464-006-9060-5] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This paper offers a conceptual framework for establishing a science of transdisciplinary action research. Lewin's (1951) concept of action research highlights the scientific and societal value of translating psychological research into community problem-solving strategies. Implicit in Lewin's formulation is the importance of achieving effective collaboration among behavioral researchers, community members and policy makers. The present analysis builds on Lewin's analysis by outlining programmatic directions for the scientific study of transdisciplinary research and community action. Three types of collaboration, and the contextual circumstances that facilitate or hinder them, are examined: (1) collaboration among scholars representing different disciplines; (2) collaboration among researchers from multiple fields and community practitioners representing diverse professional and lay perspectives; and (3) collaboration among community organizations across local, state, national, and international levels. In the present analysis, transdisciplinary action research is viewed as a topic of scientific study in its own right to achieve a more complete understanding of prior collaborations and to identify strategies for refining and sustaining future collaborations (and their intended outcomes) among researchers, community members and organizations.
Collapse
Affiliation(s)
- Daniel Stokols
- Department of Planning, Policy, and Design, School of Social Ecology, University of California, 206-C Social Ecology I Building, Irvine, 92612, USA.
| |
Collapse
|
48
|
Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health 2006; 27:341-70. [PMID: 16533121 DOI: 10.1146/annurev.publhealth.27.021405.102137] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Given the growing attention on how environmental and policy interventions can affect chronic disease burden, our objectives are to describe (a) effective and promising interventions to address tobacco use, physical activity, and healthy eating and (b) lessons learned from the literature and practice experience in applying environmental and policy approaches. A total of 17 interventions were reviewed, organized across 3 domains affecting the physical environment/access, economic environment, and communication environment. Many of these interventions are effective. Several lessons are important to consider, such as the need to start with environmental and policy approaches, intervene comprehensively and across multiple levels, make use of economic evaluations, make better use of existing analytic tools, understand the politics and local context, address health disparities, and conduct sound policy research.
Collapse
Affiliation(s)
- Ross C Brownson
- Department of Community Health and Prevention Research Center, Saint Louis University School of Public Health, St. Louis, Missouri 63104, USA.
| | | | | |
Collapse
|
49
|
Deverell M, Randolph C, Albers A, Hamilton W, Siegel M. Diffusion of Local Restaurant Smoking Regulations in Massachusetts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2006; 12:262-9. [PMID: 16614562 DOI: 10.1097/00124784-200605000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to examine the diffusion of smoke-free restaurant regulations and identify socioeconomic and racial/ethnic disparities in health protection from secondhand smoke exposure in restaurants. METHODS We examined the relationship between adoption of local smoking regulations by restaurants for each of the 351 cities and towns in Massachusetts and a number of individual variables over nine time points, starting when there were no 100% smoke-free restaurant regulations and ending with the eventual imposition of the statewide ban on smoking in restaurants and bars. RESULTS We found that over the 10 years before the statewide ban went into effect, only 36 percent of the total population was covered by local regulations that protected them from secondhand smoke exposure in restaurants. We also observed a substantial disparity in protection based on educational status, with up to 7 percentage points fewer nongraduates protected by local smoke-free restaurant regulations.
Collapse
Affiliation(s)
- Michelle Deverell
- Social and Behavioral Sciences Department, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
| | | | | | | | | |
Collapse
|
50
|
Andersen PA, Buller DB, Voeks JH, Borland R, Helme D, Bettinghaus EP, Young WF. Predictors of support for environmental tobacco smoke bans in state government. Am J Prev Med 2006; 30:292-9. [PMID: 16530615 DOI: 10.1016/j.amepre.2005.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 12/19/2005] [Accepted: 12/19/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) is a major threat to public health, associated with a number of serious diseases, and a leading cause of death. Previous research demonstrates that enactment of government policies mandating clean indoor air is effective in creating more smoke-free public places and decreasing the incidence of smoking. Both researchers and community activists have an interest in understanding the factors that predict support for the regulation of ETS. METHODS This study examined predictors of support for regulating ETS by surveying 684 city and county public officials in Colorado who were interviewed by phone and mail (response rate 61%). RESULTS Thirty-five percent of public officials reported that it is a "serious" or "very serious" problem that nonsmokers breathe in other people's cigarette smoke, 21% were "neutral," and 42% said that it was "not serious" or "not serious at all." Results indicated that support for policies to control ETS and promote clean indoor air is significantly more prevalent among public officials who: (1) believe that tobacco use is a serious problem in their community, (2) believe that breathing environmental tobacco smoke is a serious problem for nonsmokers, (3) believe that city and county government should get involved with people's decisions about smoking, (4) support smoking-cessation programs for public employees, and (5) have smoked less than 100 cigarettes during their lifetime. CONCLUSIONS Both the harms of ETS and legislation to create smoke-free environments remain controversial among local officials. Smoke-free advocates should support officials who believe that ETS is a problem and persuade officials on the harms of ETS and the need for government intervention.
Collapse
Affiliation(s)
- Peter A Andersen
- School of Communication, San Diego State University, San Diego, California 92182-4561, USA.
| | | | | | | | | | | | | |
Collapse
|