1
|
Teed JA, Robichaud MO, Duren M, Gouda HN, Kennedy RD. State of the literature discussing smoke-free policies globally: A narrative review. Tob Induc Dis 2024; 22:TID-22-03. [PMID: 38188939 PMCID: PMC10767724 DOI: 10.18332/tid/174781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.
Collapse
Affiliation(s)
- Jacqueline A. Teed
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Meagan O. Robichaud
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Michelle Duren
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Hebe N. Gouda
- Tobacco Free Initiative, World Health Organization, Geneva, Switzerland
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| |
Collapse
|
2
|
Titus AR, Gamarel KE, Thrasher JF, Elliott MR, Fleischer NL. Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA. Int J Behav Med 2023; 30:448-454. [PMID: 35579845 PMCID: PMC9669255 DOI: 10.1007/s12529-022-10099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults. METHODS We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013-2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults. RESULTS In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean = - 0.50, 95% CI = - 0.89, - 0.12; hospitality law change in mean = - 0.72, 95% CI = - 1.14,-0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited. CONCLUSIONS We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities.
Collapse
Affiliation(s)
- Andrea R Titus
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael R Elliott
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Thaivalappil A, Bhattacharyya A, Young I, Gosselin S, Pearl DL, Papadopoulos A. Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research. Health Psychol Open 2023; 10:20551029231179157. [PMID: 37255528 PMCID: PMC10226319 DOI: 10.1177/20551029231179157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.
Collapse
Affiliation(s)
| | | | - Ian Young
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Sydney Gosselin
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - David L Pearl
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
4
|
Henderson E, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Gallus S, Lugo A, Semple S, Dobson R, Clancy L, Keogan S, Ruprecht A, Borgini A, Tzortzi A, Vyzikidou VK, Gorini G, López-Nicolás A, Soriano JB, Geshanova G, Osman J, Mons U, Przewozniak K, Precioso J, Brad R, López MJ. Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. ENVIRONMENTAL RESEARCH 2021; 200:111355. [PMID: 34022230 PMCID: PMC8417816 DOI: 10.1016/j.envres.2021.111355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. METHODS Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. RESULTS Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 μg/m3), in enclosed venues (2.97 IQR:0.80-5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure. CONCLUSIONS Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.
Collapse
Affiliation(s)
- Elisabet Henderson
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Esteve Fernández
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, S/n, 08907, L'Hospitalet de Llobregat, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Olena Tigova
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, S/n, 08907, L'Hospitalet de Llobregat, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Nuria Cortés-Francisco
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Ario Ruprecht
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Alessandro Borgini
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Str., Athens, 10557, Greece
| | - Vergina K Vyzikidou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Str., Athens, 10557, Greece
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Via Cosimo Il Vecchio, 2, 50139, Florence, Italy
| | - Angel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT), Plaza Cronista Isidoro Valverde, S/n, 30202, Cartagena, Spain
| | - Joan B Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Hospital Universitario La Princesa (IISP), Diego de León, 62, Planta 6, 28006, Madrid, Spain; Universidad Autónoma de Madrid (UAM), Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain; Instituto Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Gergana Geshanova
- Smoke-free Life Coalition, Slivnitsa Blvd, 257, 1202, Sofia, Bulgaria
| | - Joseph Osman
- OFT Conseil, Office Français de Santé et Bien-être Au Travail, Rue Gobert, 12, 75011Paris, France
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, 280, 69120, Heidelberg, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50923, Cologne, Germany
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena, 5, 02-781, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Warsaw, Poland; Collegium Civitas, 1 Defilad Square, 00-901, Warsaw, Poland
| | - José Precioso
- Instituto de Educação, Universidade do Minho, 4710-057, Braga, Portugal
| | - Ramona Brad
- Healthy Romania Generation 2035 Association, Bucharest, Romania
| | - Maria J López
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| |
Collapse
|
5
|
Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999-2014. Nicotine Tob Res 2021; 23:1527-1535. [PMID: 33690865 PMCID: PMC8372649 DOI: 10.1093/ntr/ntab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little is known about the relationship between smoke-free laws and persistent disparities in secondhand smoke (SHS) exposure among nonsmoking adults in the United States. AIMS AND METHODS We constructed time-varying smoke-free law measures representing whether or not at least 50% of each US county's population was covered by smoke-free laws in workplaces and hospitality venues (restaurants/bars). We merged these data with restricted data on cotinine-derived SHS exposure among nonsmokers from the National Health and Nutrition Examination Survey, 1999-2014 (N = 25 444). Using logistic regression, we estimated associations between smoke-free law coverage and SHS exposure among all nonsmokers, and within age strata (25-39, 40-59, 60+). We explored differential associations by gender, race/ethnicity, education, and poverty-income ratio (PIR) by testing the significance of interactions terms for the full sample and within age strata. RESULTS In adjusted models, hospitality coverage was associated with lower odds of SHS exposure in the full sample (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.51-0.76), and within each age group, with ORs ranging from 0.58 (ages 25-39) to 0.67 (ages 60+). Workplace coverage was associated with lower SHS exposure only among younger adults (OR = 0.81; 95% CI = 0.65-0.99). Within the full sample and among adults ages 40-59, hospitality laws were associated with narrowing SHS exposure differentials between males and females. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females, but worsening exposure disparities by PIR. CONCLUSIONS Smoke-free laws may reduce SHS exposure among adult nonsmokers, but may be insufficient to improve disparities in SHS exposure. IMPLICATIONS In a repeated cross-sectional sample of adult nonsmokers, smoke-free laws in hospitality venues were consistently associated with lower odds of SHS exposure and appeared to narrow exposure differentials between males and females. Associations between workplace smoke-free laws and SHS exposure were variable by age. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females while exacerbating exposure differentials by PIR. Differential patterns of association highlight the need to examine the impacts of tobacco control policies on downstream health equity.
Collapse
Affiliation(s)
- Andrea R Titus
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
6
|
Brillinger J, Marsh L, Hoek J. Bar Atmospherics and Smoking: A Qualitative Analysis of New Zealand Young Adult Smokers. Nicotine Tob Res 2021; 23:724-731. [PMID: 33165535 DOI: 10.1093/ntr/ntaa227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking among young adults is often associated with social contexts and alcohol use. Although many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalize young adult smoking and explored potential policy implications. METHODS We conducted in-depth interviews with 22 young adults who had recently smoked in a New Zealand bar or nightclub and investigated how physical design attributes (atmospherics) influenced experiences of smoking in outside bar settings. We used qualitative description to identify recurring accounts of the outdoor bar environment and thematic analysis to explore how participants experienced the bar in relation to smoking. RESULTS Participants valued outdoor smoking areas that were comfortable and relaxing, and saw attributes such as seating, tables, heating, protection from inclement weather, and minimal crowding, as important. We identified four themes; these explained how participants used smoking to gain respite and make social connections, showed how bar settings enabled them to manage smoking's stigma, and identified potential policy measures that would decouple smoking and alcohol co-use. CONCLUSIONS Evidence bar environments facilitate and normalize smoking among young adults questions whether smokefree policies should be expanded to include all bar areas. Introducing more comprehensive smokefree outdoor policies could reduce the influence of design attributes that foster smoking while also reframing smoking as outside normal social practice. IMPLICATIONS Bar environments contain many stimuli that cue and reinforce smoking and integrate smoking into social experiences. Expanding smokefree bar settings to include outdoor areas would reduce exposure to these stimuli, decrease opportunities for casual smoking, help maintain young people's smokefree status, and support longer-term goals of sustained reductions in smoking prevalence.
Collapse
Affiliation(s)
- Julia Brillinger
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Louise Marsh
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
7
|
Harutyunyan A, Hayrumyan V, Sargsyan Z, Torosyan A, Dekanosidze A, Kegler M, Sturua L, Berg CJ. Smokers' and non-smokers' secondhand smoke experiences and interactions to reduce exposure in Armenia and Georgia. Tob Prev Cessat 2021; 7:6. [PMID: 33537511 PMCID: PMC7845734 DOI: 10.18332/tpc/131059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Armenia and Georgia have high rates of smoking and secondhand smoke exposure (SHSe). Greater progress in recent smoke-free legislation in Georgia and Armenia provides a pivotal time for examining the impact on smokers' and non-smokers' experiences and interactions regarding SHSe. METHODS Surveys were conducted in 28 communities in Armenia (n=705) and Georgia (n=751) in 2018 and assessed past 30-day SHSe and smoking in different contexts, as well as attitudes toward and interactions regarding SHSe. RESULTS In this sample (mean age 43.4 years, SD=13.5; 60.5% female; 27.3% smokers), SHSe among non-smokers was usually in homes (42.7%), cars (42.4%), and outdoor public places (38.2%); smokers also reported smoking usually in these places (70.0%, 62.1%, and 60.0%, respectively). Smokers indicated greater likelihood of putting out cigarettes and non-smokers indicated greater likelihood of asking smokers to put them out in places where smoking was prohibited versus allowed (76.5% vs 57.3%, and 46.6% vs 30.7%, respectively). Moreover, 89.9% of smokers indicated being very likely to put out cigarettes around small children if asked and 75.8% indicated trying to minimize SHSe. While 39.7% of participants reported seeing requests to smokers to put out cigarettes in the past 6 months, only 23.3% of smokers reported being asked to do so. Non-smokers in Georgia versus Armenia reported greater likelihood of engaging in behaviors to lower SHSe (p<0.001). CONCLUSIONS Smoke-free legislation may catalyze more behaviors to lower SHSe, particularly among non-smokers; however, private settings (e.g. homes) remain prominent SHSe sources. Public health efforts must consider implications of such policies on SHSe in private settings.
Collapse
Affiliation(s)
- Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Yerevan, Armenia
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, United States
- Winship Cancer Institute, Emory University, Atlanta, United States
| | - Lela Sturua
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| |
Collapse
|
8
|
Lin HX, Liu Z, Chang C. The Effects of Smoke-Free Workplace Policies on Individual Smoking Behaviors in China. Nicotine Tob Res 2020; 22:2158-2163. [PMID: 32597480 DOI: 10.1093/ntr/ntaa112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Studies have shown that smoke-free (SF) workplace policies can create an SF environment, but most of them have focused only on reducing secondhand smoke (SHS) exposure or changing smoking behavior. Our study aims to explore the effects of SF workplace policies and the pathway between workplace SF policies and SHS exposure. METHOD 14 195 employees from 79 companies in China participated in this survey. Binary logistic regression is used to examine the direct effects of SF workplace policies. Structured Equation Modeling approach is used to test other indirect effects. The Sobel test is used to estimate the mediation effect. RESULTS Working in a company with SF policies was associated with lower SHS exposure (odds ratio = 0.56; 95% confidence interval = 0.51 to 0.60). Such policy were associated with lower smoking prevalence (Coef. = -0.05, p < .05) and positively associated with smoking harm awareness (Coef. = 0.07, p < .05) and SHS harm awareness (Coef. = 0.05, p < .05). Sobel test suggests that approximately 16.3% of the effects on SHS exposure reduction are mediated through the channel of lower smoking prevalence for males. For smokers, we did not identify a direct effect of such policies on quitting intentions, but a significant indirect effect via increased smoking harm awareness (Coef. = 0.07, p < .05) and lower smoking consumption (Coef. = -0.10, p < .05) were found. CONCLUSION This study finds that SF workplace policies are not only associated with lower SHS exposure but also related to some indirect effects. Further mediation analyses for males confirmed that the effect on SHS exposure reduction is mediated through the channel of lower smoking prevalence. IMPLICATIONS This study joins the debate in recent years on the effects of workplace SF policies and provides evidence with more comprehensive data from Asia Best Workplace Mainland China program. It shows that SF workplace policies not only can reduce SHS exposure but also are associated with lower smoking prevalence, fewer cigarettes smoked, and higher smoking harm-related awareness. These findings provide valuable evidence to promote such policies in all workplaces and underline the need for more stringent SF policies to be enacted in all countries.
Collapse
Affiliation(s)
- Hao-Xiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| |
Collapse
|
9
|
Walton K, Gentzke AS, Murphy-Hoefer R, Kenemer B, Neff LJ. Exposure to Secondhand Smoke in Homes and Vehicles Among US Youths, United States, 2011-2019. Prev Chronic Dis 2020; 17:E103. [PMID: 32915130 PMCID: PMC7553226 DOI: 10.5888/pcd17.200107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this study, we report the prevalence of self-reported secondhand smoke (SHS) exposure in homes and vehicles among US middle and high school students in 2019 and changes in SHS exposure over time. Data were from 7 years of the National Youth Tobacco Survey (NYTS; 2011, 2013, and 2015–2019). In 2019, 25.3% (an estimated 6.7 million) of students reported home SHS exposure and 23.3% (6.1 million) reported vehicle SHS exposure. Home and vehicle SHS exposure significantly declined during 2011 through 2018, except for home exposure among non-Hispanic black students. Implementation of smoke-free policies in public and private settings can reduce SHS exposure.
Collapse
Affiliation(s)
- Kimp Walton
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341. E-mail:
| | - Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Murphy-Hoefer
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brandon Kenemer
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda J Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
10
|
Lagerweij NA, Kunst AE, Mélard N, Rimpelä A, Alves J, Hoffmann L, Richter M, Kuipers MA. Where do teens smoke? Smoking locations of adolescents in Europe in relation to smoking bans in bars, schools and homes. Health Place 2019; 60:102213. [DOI: 10.1016/j.healthplace.2019.102213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022]
|
11
|
Chattel or Child: The Liminal Status of Companion Animals in Society and Law. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8050158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Companion animals in the U.S. are increasingly regarded as members of the family with whom one may share a strong emotional bond. However, despite an evolving social construction that has elevated their status in the dominant culture, companion animals lack meaningful legal rights, and “family member” is a provisional status that can be dissolved at will based on the discretion of the sole rights-holder in the relationship: the human owner. Because they are still defined within the U.S. legal system as property, it is a common lament within the animal protection movement that the law has not kept pace with the emergent cultural perception of companion animals as family or best friends who may occupy a significant place in one’s constellation of interpersonal relationships. But how divergent are the laws that govern our treatment of companion animals from prevailing social norms? This article examines current trends in animal law and society to shed light on this question. I find that while a new family member cultural status is emerging for companion animals in the U.S., their legal status as property is a countervailing force, enabling contradictory practices and beliefs that construct animals as expendable. The fact that their cultural status is in flux in turn reinforces their status under the law. I conclude with proposed policy reforms that will facilitate the integration of companion animals into society as true rather than rhetorical family members.
Collapse
|
12
|
Gentzke AS, Wang TW, Marynak KL, Trivers KF, King BA. Exposure to Secondhand Smoke and Secondhand E-Cigarette Aerosol Among Middle and High School Students. Prev Chronic Dis 2019; 16:E42. [PMID: 30950787 PMCID: PMC6464049 DOI: 10.5888/pcd16.180531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Youth exposure to secondhand smoke (SHS) and secondhand aerosol from e-cigarettes (SHA) may contribute to the renormalization of tobacco product use behaviors. Our study assessed self-reported SHS or SHA exposures in indoor or outdoor public places among US students. Methods Data came from the 2015 and 2017 National Youth Tobacco Survey, a school-based survey of US students in grades 6 through 12. Past 30-day exposure to SHS and SHA in indoor and outdoor public places was assessed. The prevalence of exposure was assessed overall and by covariates for each year. We used adjusted prevalence ratios (aPRs) to assess determinants of exposure. Results We observed no significant change from 2015 through 2017 in exposure to SHS (52.6% to 50.5%), SHA (25.2% to 25.6%), or either SHS or SHA (56.7% to 55.1%). Following multivariable adjustment, in 2017, exposure to either SHS or SHA in public was higher among female students versus male students (aPR = 1.29), high school students versus middle school students (aPR = 1.15), current e-cigarette users versus nonusers (aPR = 2.89), and current users of other tobacco product versus nonusers (aPR = 1.21). Exposure was higher for students who reported that a household member used tobacco products. Conclusion In 2017, more than half (55.1%, 14.3 million) of US middle and high school students reported exposure to secondhand tobacco product emissions in indoor or outdoor public places. E-cigarette use may complicate the enforcement of existing smoke-free policies and contribute to the renormalization of tobacco use behaviors. Continued efforts are warranted to reduce the social acceptability of tobacco product use and protect bystanders from all tobacco product emissions.
Collapse
Affiliation(s)
- Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S107-7, Atlanta, GA, 30341. E-mail:
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristy L Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katrina F Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
13
|
Mayne SL, Auchincloss AH, Tabb LP, Stehr M, Shikany JM, Schreiner PJ, Widome R, Gordon-Larsen P. Associations of Bar and Restaurant Smoking Bans With Smoking Behavior in the CARDIA Study: A 25-Year Study. Am J Epidemiol 2018; 187:1250-1258. [PMID: 29860468 PMCID: PMC5982712 DOI: 10.1093/aje/kwx372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 11/17/2017] [Accepted: 12/07/2017] [Indexed: 11/14/2022] Open
Abstract
Indoor smoking bans have often been associated with reductions in smoking prevalence. However, few studies have evaluated their association with within-person changes in smoking behaviors. We linked longitudinal data from 5,105 adults aged 18-30 years at baseline from the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985-2011) to state, county, and local policies mandating 100% smoke-free bars and restaurants by census tract. We used fixed-effects models to examine the association of smoking bans with within-person change in current smoking risk, smoking intensity (smoking ≥10 cigarettes/day on average vs. <10 cigarettes/day), and quitting attempts, using both linear and nonlinear adjustment for secular trends. In models assuming a linear secular trend, smoking bans were associated with a decline in current smoking risk and smoking intensity and an increased likelihood of a quitting attempt. The association with current smoking was greatest among participants with a bachelor's degree or higher. In models with a nonlinear secular trend, pooled results were attenuated (confidence intervals included the null), but effect modification results were largely unchanged. Findings suggest that smoking ban associations may be difficult to disentangle from other tobacco control interventions and emphasize the importance of evaluating equity throughout policy implementation.
Collapse
Affiliation(s)
- Stephanie L Mayne
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Loni Philip Tabb
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mark Stehr
- School of Economics, LeBow College of Business, Drexel University, Philadelphia, Pennsylvania
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel Widome
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Benowitz-Fredericks C, McQuoid J, Sheon N, Olson S, Ling PM. Voluntary Smoke-Free Measures Among Oklahoma Nightlife Owners: Barriers and Facilitators. Health Promot Pract 2018; 20:196-205. [PMID: 29606038 DOI: 10.1177/1524839918764897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Smoke-free policies prevent exposure to secondhand smoke and encourage tobacco cessation. Local smoke-free policies that are more comprehensive than statewide policies are not allowed in states with preemption, including Oklahoma, which has the sixth highest smoking prevalence in the United States. In states with preemption, voluntary smoke-free measures are encouraged, but little research exists on venue owners' and managers' views of such measures, particularly in nightlife businesses such as bars and nightclubs. This article draws from semistructured interviews with 23 Oklahoma bar owners and managers, examining perceived risks and benefits of adopting voluntary smoke-free measures in their venues. No respondents expressed awareness of preemption. Many reported that smoke-free bars and nightclubs were an inevitable societal trend, particularly as younger customers increasingly expected smoke-free venues. Business benefits such as decreased operating and cleaning costs, improved atmosphere, and employee efficiency were more convincing than improved employee health. Concerns that voluntary measures created an uneven playing field among venues competing for customers formed a substantial barrier to voluntary measures. Other barriers included concerns about lost revenue and fear of disloyalty to customers, particularly older smokers. Addressing business benefits and a level playing field may increase support for voluntary smoke-free nightlife measures.
Collapse
Affiliation(s)
| | - Julia McQuoid
- University of California San Francisco, San Francisco, CA, USA
| | - Nicolas Sheon
- University of California San Francisco, San Francisco, CA, USA
| | - Sarah Olson
- University of California San Francisco, San Francisco, CA, USA
| | - Pamela M Ling
- University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
15
|
Staples AH, Gallien TL, Martin R, Lee J, Cremeens-Matthews J. How restaurant and bar owners view clean indoor air legislation five years after implementation in North Carolina, 2015. Tob Prev Cessat 2017; 3:122. [PMID: 32432196 PMCID: PMC7232802 DOI: 10.18332/tpc/75914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoke-free policies are effective in eliminating health hazards that can lead to chronic diseases and premature death. How hospitality businesses experience clean indoor air policies may provide leverage in States that have not adopted such policies. This study assessed whether North Carolina restaurants and bars receive complaints and/or experience benefits five years after implementation of the State’s smoke-free law. METHODS A 2015 mail survey was used to assess problems, benefits, and voluntary policies (i.e., policies related to the use of electronic cigarettes indoors and outside smoke-free seating areas) among restaurant and bar owners/managers. The survey yielded 135 responses for a response rate of 20.3%. RESULTS The two most frequently selected benefits among respondents were customers breathing less tobacco smoke (65.2%) and fewer complaints about secondhand smoke (58.5%). The majority of restaurants (79.7%) and bars (71.4%) reported experiencing at least one benefit from the law. Restaurants were significantly more likely than bars to restrict the use of electronic cigarettes inside. No significant difference was found between restaurants and bars in smoke-free outdoor customer areas. Bars were more likely to report problems with the smoke-free law (e.g. lack of outdoor space for smoking, compliance issues). CONCLUSIONS This study reveals successes of North Carolina’s smoke-free law. The majority of respondents reported experiencing at least one benefit of the law and some reported that they had implemented additional voluntary policies. Learning more about how hospitality businesses experience smoke-free laws can help other states and communities deal with similar policy changes in the future.
Collapse
Affiliation(s)
- Ann H Staples
- Division of Public Health, Tobacco Prevention & Control Branch, North Carolina, USA
| | | | - Ryan Martin
- East Carolina University, North Carolina, USA
| | - Joseph Lee
- East Carolina University, North Carolina, USA
| | | |
Collapse
|
16
|
Becker CM, Lee JGL, Hudson S, Hoover J, Civils D. A 14-year longitudinal study of the impact of clean indoor air legislation on state smoking prevalence, USA, 1997-2010. Prev Med 2017; 99:63-66. [PMID: 28188797 DOI: 10.1016/j.ypmed.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/21/2017] [Accepted: 01/28/2017] [Indexed: 11/17/2022]
Abstract
While clean indoor air legislation at the state level is an evidence-based recommendation, only limited evidence exists regarding the impact of clean indoor air policies on state smoking prevalence. Using state smoking prevalence data from 1997 to 2010, a repeated measures observational analysis assessed the association between clean indoor air policies (i.e., workplace, restaurant, and bar) and state smoking prevalence while controlling for state cigarette taxes and year. The impacts from the number of previous years with any clean indoor air policy, the number of policies in effect during the current year, and the number of policies in effect the previous year were analyzed. Findings indicate a smoking prevalence predicted decrease of 0.13 percentage points (p=0.03) for each additional year one or more clean indoor air policies were in effect, a predicted decrease of 0.12 percentage points (p=0.09) for each policy in effect in the current year, and a predicted decrease of 0.22 percentage points (p=0.01) for each policy in effect in the previous year on the subsequent year. Clean indoor air policies show measurable associations with reductions in smoking prevalence within a year of implementation above and beyond taxes and time trends. Further efforts are needed to diffuse clean indoor air policies across states and provinces that have not yet adopted such policies.
Collapse
Affiliation(s)
- Craig M Becker
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA.
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Suzanne Hudson
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA
| | - Jeanne Hoover
- Joyner Library, East Carolina University, Greenville, NC, USA
| | - Donald Civils
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| |
Collapse
|
17
|
Morrison C, Lee JP, Gruenewald PJ, Mair C. The Reliability of Naturalistic Observations of Social, Physical and Economic Environments of Bars. ADDICTION RESEARCH & THEORY 2016; 24:330-340. [PMID: 27695393 PMCID: PMC5042343 DOI: 10.3109/16066359.2016.1145674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Drinking in bars contributes to numerous public health problems, including violence and motor vehicle crashes. In order to formulate effective preventive interventions it is essential to identify which specific features of bar environments are related to increased risks. Unobtrusive ethnographic observations are one approach that has been used to characterize these features; however no studies have assessed reliability in a representative sample of bars. We performed brief scouting assessments in all 165 bars in six purposively selected California cities, followed by unobtrusive observations from a subsequent representative sample of 97 bars which were located in low and high bar density areas of the cities. Inter-rater reliability between two independent observers assessed individual item reliability, and principal components analyses assessed the reliability of a series of scales describing the physical, social, and economic characteristics of the bars. For the scouting assessment, items exhibited at least moderate reliability (κ or r ≥ 0.40). For the unobtrusive observations, items assessing physical and economic environments (e.g., pool table present, κ = 0.90; index beer cost, r = 0.82) had moderate to outstanding reliability (κ or r > 0.80). Items describing the social environment generally had poorer reliability, though group aspects (e.g., patron count, r = 0.78; patron circulation, r = 0.64) had better reliability than individual behaviors (e.g., derogatory speech, κ = 0.12). Scales constructed from specific sets of items exhibited modest reliability. The individual metrics and principal components we present will enable future studies seeking to disaggregate relationships between bar characteristics and public health problems.
Collapse
Affiliation(s)
- Christopher Morrison
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Paul J. Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Christina Mair
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh Pennsylvania
| |
Collapse
|
18
|
Abstract
The enactment of California's Proposition 215 stipulates that patients may use marijuana for medical reasons, provided that it is recommended by a physician. Yet, medical marijuana patients risk being stigmatized for this practice. This article examines the way in which medical marijuana patients perceive and process stigma, and how it affects their interactions and experiences with others. Eighteen semi-structured interviews of medical marijuana patients were carried out using a semi-structured interview guide. Most patients circumvented their own physicians in obtaining a recommendation to use medicinal marijuana, and also used a host of strategies in order to justify their medical marijuana use to family, friends, and colleagues in order to stave off potential stigma. The stigmatization of medical marijuana thus has a profound effect on how patients seek treatment, and whether they seek medical marijuana treatment at all.
Collapse
Affiliation(s)
- Travis D Satterlund
- a Research Analyst, Center for Program Design and Evaluation , Dartmouth College , Lebanon , NH
| | | | | |
Collapse
|
19
|
Rose SW, Emery SL, Ennett S, McNaughton Reyes HL, Scott JC, Ribisl KM. Public Support for Family Smoking Prevention and Tobacco Control Act Point-of-Sale Provisions: Results of a National Study. Am J Public Health 2015; 105:e60-7. [PMID: 26270303 DOI: 10.2105/ajph.2015.302751] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed public and smoker support for enacted and potential point-of-sale (POS) tobacco-control policies under the Family Smoking Prevention and Tobacco Control Act. METHODS We surveyed a US nationally representative sample of 17, 507 respondents (6595 smokers) in January through February 2013, and used linear regression to calculate weighted point estimates and identify factors associated with support for POS policies among adults and smokers. RESULTS Overall, nonsmokers were more supportive than were smokers. Regardless of smoking status, African Americans, Hispanics, women, and those of older ages were more supportive than White, male, and younger respondents, respectively. Policy support varied by provision. More than 80% of respondents supported minors' access restrictions and more than 45% supported graphic warnings. Support was lowest for plain packaging (23%), black-and-white advertising (26%), and a ban on menthol cigarettes (36%). CONCLUSIONS Public support for marketing and POS provisions is low relative to other areas of tobacco control. Tobacco-control advocates and the Food and Drug Administration should build on existing levels of public support to promote and maintain evidence-based, but controversial, policy changes in the retail environment.
Collapse
Affiliation(s)
- Shyanika W Rose
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Sherry L Emery
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Susan Ennett
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Heath Luz McNaughton Reyes
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - John C Scott
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Kurt M Ribisl
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| |
Collapse
|
20
|
Chaiton M, Diemert L, Zhang B, Kennedy RD, Cohen JE, Bondy SJ, Ferrence R. Exposure to smoking on patios and quitting: a population representative longitudinal cohort study. Tob Control 2014; 25:83-8. [PMID: 25352563 DOI: 10.1136/tobaccocontrol-2014-051761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Smoke-free policies not only reduce harm to non-smokers, they may also reduce harm to smokers by decreasing the number of cigarettes smoked and increasing the likelihood of a successful quit attempt. However, little is known about the impact of exposure to smoking on patios on smoking behaviour. DESIGN AND PARTICIPANTS Smokers from the Ontario Tobacco Survey, a longitudinal population representative cohort of smokers (2005-2011). There were 3460 current smokers who had completed one to six follow-ups and were asked at each follow-up whether or not they had been exposed to smoking on patios in the month. MAIN OUTCOME MEASURES Generalised estimating equations and survival analysis were used to examine the association between exposure to patio smoking and smoking behaviour changes (making a quit attempt and time to relapse after a quit attempt), controlling for potential confounders. RESULTS Smokers who were exposed to smoking on patios (adjusted incident rate ratio (aIRR) = 0.89; 95% CI 0.81 to 0.97) or had been to a patio (aIRR = 0.86; 95% CI 0.74 to 0.99) were less likely to have made a quit attempt than smokers who had not visited a patio. Smokers who were exposed to smoking on patios were more likely to relapse (adjusted HR=2.40; 95% CI 1.07 to 5.40)) after making a quit attempt than those who visited a patio but were not exposed to smoking. CONCLUSIONS Exposure to smoking on patios of a bar or restaurant is associated with a lower likelihood of success in a quit attempt. Instituting smoke-free patio regulations may help smokers avoid relapse after quitting.
Collapse
Affiliation(s)
- Michael Chaiton
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lori Diemert
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | - Bo Zhang
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | - Ryan D Kennedy
- University of Waterloo, Waterloo, Ontario, Canada Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan J Bondy
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Roberta Ferrence
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Kaufman MR, Merritt AP, Rimbatmaja R, Cohen JE. 'Excuse me, sir. Please don't smoke here'. A qualitative study of social enforcement of smoke-free policies in Indonesia. Health Policy Plan 2014; 30:995-1002. [PMID: 25244917 PMCID: PMC4559114 DOI: 10.1093/heapol/czu103] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 01/09/2023] Open
Abstract
Objective District policies were recently put into place in Indonesia prohibiting smoking in public spaces. This study sought to (1) assess participants’ general knowledge of secondhand smoke (SHS) dangers; (2) assess participants’ awareness of and specific knowledge of smoke-free (SF) policies; and (3) assess the extent to which such policies are socially enforced and gather examples of successful social enforcement. Methods Qualitative in-depth interviews and focus group discussions were conducted in Bogor and Palembang cities with both community members and key informants such as government officials, non-government agency staff, religious leaders and health workers. Results Participants in both Palembang and Bogor find SF policy important. Although there was awareness of SHS dangers and SF policies, accurate knowledge of the dangers and an in-depth understanding of the policies varied. There was a high level of support for the SF policies in both cities among both smokers and non-smokers. Many participants did have experience asking a smoker not to smoke in an area where it was restricted, even if their comfort in doing so varied. There was, however, a higher level of comfort in telling smokers to stop or to move away from pregnant women and children. Hesitation to socially enforce the policies was especially present when asking men of status and/or community leaders to stop smoking, but overall participants felt they could comfortably ask someone to obey the law. Conclusion Palembang and Bogor may be evolving towards creating social norms in support of prohibiting smoking in public spaces. If provided with more support from government and law officials, such as government officials themselves promoting the policies and demonstrating compliance, and renewed efforts to promote and enforce policies in general were made, Indonesians in these cities may feel more confident protecting non-smokers from SHS.
Collapse
Affiliation(s)
- Michelle R Kaufman
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA, Lapangan Kecil, Jakarta, Indonesia and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alice Payne Merritt
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA, Lapangan Kecil, Jakarta, Indonesia and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Risang Rimbatmaja
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA, Lapangan Kecil, Jakarta, Indonesia and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA, Lapangan Kecil, Jakarta, Indonesia and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
22
|
Satterlund TD, Treiber J, Cassady D. Navigating local smoke-free multi-unit housing policy adoption. JOURNAL OF DRUG EDUCATION 2013; 43:33-47. [PMID: 24855882 DOI: 10.2190/de.43.1.c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
California state-funded local tobacco control projects have instituted smoke-free multi-unit housing (MUH) policy adoption campaigns in order to secure voluntary policy throughout the state. While landlords can legally prohibit smoking at MUH complexes in California, they often oppose such measures. The objective of this study was to analyze voluntary smoke-free policy campaigns of state-funded local projects by focusing on the challenges they faced. Specifically, we examined 40 local campaigns in California led by county health departments and community based organizations, focusing on the barriers the local projects often had to overcome to enact policy. Our results identify arguments and issues typically raised by MUH property landlords, including the notion of tenant smoker and privacy rights, potential negative effects of smoke-free policy, and issues concerning the enforcement of policy. Moreover, relationships between local project personnel and MUH management often soured, which sometimes derailed smoke-free policy campaigns altogether. Our findings provide agencies with insights from the MUH property landlord perspective that will serve to inform future campaign strategy.
Collapse
|