Clean Indoor Air Laws Research Articles

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis.

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.

Assessing association between paternal smoking status and child malnutrition in Albania: An application of ordinal regression model

In this study, an attempt has been made to seek out the impact of paternal smoking status over child malnutrition in Albania. For analysis purposes, data were extracted from Albania Demographic and Health Survey (ADHS), 2017/18. The bivariate analysis set up with chi-square test as well as gamma measure were performed to examine the association between child malnutrition and selected covariates. To measure the consequence of paternal smoking status on malnutrition, two different ordinal regression models (Model I: considering only one covariate such as father’s smoking status, Model II: covariates of the model I along with demographic and clinical variables) were considered. Father’s smoking status was found to be strongly associated with the increased risk of child malnutrition in Albania and it was statistically significant in both regression models. After controlling all of our demographic and clinical variables, the odds ratio for a smoker father compared to a non-smoker father was 1.109 with 95% confidence interval (1.114, 1.472) for child malnutrition. This study provides strong evidence for an adverse relationship between father’s smoking status and child malnutrition in Albania. Implementing and enforcing several policies such as significant taxes escalation on cigarettes, promoting cessation for the health care system, and implementation of clean indoor air laws would not only reduce the current smoking rates but also smoking prevalence by raising awareness among the young Albanian generation. • This study tries to establish a relationship between paternal smoking status and child malnutrition in Albania. • In Albania, parental smoking status is highly associated with an increased risk of malnutrition in children aged 0–59 months. • Child’s age, father’s and mother’s education, wealth index, mother’s BMI are other factors for child malnutrition in Albania.

Tobacco control policies and smoking cessation treatment utilization: A moderated mediation analysis.

BackgroundTobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the associations between tobacco policies and treatment use varies across sociodemographic groups.MethodsWe used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who reported smoking cigarettes during the past-year. We built on prior structural equation models used to quantify the degree to which smoking cessation treatment use (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet resources) mediated the association between clean indoor air laws, cigarette excise taxes, and recent smoking cessation. In the current study, we added selected moderators to each model to investigate whether associations between tobacco polices and smoking cessation treatment use varied by sex, race/ethnicity, education, income, and health insurance status.ResultsAssociations between clean indoor air laws and the use of prescription medication and nicotine replacement therapies varied significantly between racial/ethnic, age, and education groups in 2003. However, none of these moderation effects remained significant in 2010/11. Higher cigarette excise taxes in 2010/2011 were associated with higher odds of using counseling among older adults and higher odds of using prescription medications among younger adults. No other moderator reached statistical significance. Smoking cessation treatments did not mediate the effect of taxes on smoking cessation in 2003 and were not included in these analyses.ConclusionsSociodemographic differences in associations between clean indoor air laws and smoking cessation treatment use have decreased from 2003 to 2010/11. In most cases, policies appear to stimulate smoking cessation treatment use similarly across varied sociodemographic groups.

Statewide Prevalence of Smoke-Free and Vape-Free Homes, by Tobacco Product Use, Minnesota, 2018.

IntroductionSecuring clean indoor air laws is a major tobacco control accomplishment of the past 15 years. The public quickly adopted and supported such policies both in public and private spaces. Clean indoor air is now threatened by the emergence of e-cigarettes. E-cigarette aerosol contains nicotine, heavy metals, and carcinogens, and the long-term effect of secondhand exposure is unknown. Surveillance is necessary to track voluntary rules on smoking and vaping in the home.MethodsThe Minnesota Adult Tobacco Survey (MATS) is a series of cross-sectional, random-digit–dial telephone surveys on smoking, vaping, and other tobacco-related behaviors, attitudes, and beliefs among Minnesota adults. MATS measured voluntary smoke-free rules in the home in 2014 (N = 9,304) and measured both smoke-free and vape-free home rules in 2018 (N = 6,055).ResultsThe prevalence of smoke-free home rules among Minnesota adults in 2018 was 91.5% (95% CI, 90.5%–92.5%), up slightly from 89.3% (95% CI, 88.4%–90.2%) in 2014. In comparison, 84.0% (95% CI, 82.7%–85.3%) reported vape-free home rules. Although 70.0% (95% CI, 66.0%–73.0%) of smokers in 2018 reported smoke-free home rules, only 23.3% (95% CI, 15.0%–31.6%) of e-cigarette users reported vape-free home rules. Living with children younger than 18 years significantly increased the odds of having smoke-free and vape-free home rules.ConclusionAlthough widespread adoption of voluntary smoke-free and vape-free home rules demonstrates a positive change in social norms, most e-cigarette users allow vaping in their homes, including those who live with children younger than 18. Tracking voluntary smoke-free and vape-free home rules and efforts to encourage them are important to improve the public’s health.

Cigarette excise taxes, clean indoor air laws, and use of smoking cessation treatments: A mediation analysis

The role of smoking cessation treatments in the link between clean indoor air laws and cigarette taxes with smoking cessation is not known. This study examined whether the use of smoking cessation treatments mediates the association between clean indoor air laws and cigarette excise taxes, on the one hand, and recent smoking cessation, on the other hand. Using data on 62,165 adult participants in the 2003 and 2010–2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we employed structural equation models to quantify the degree to which smoking cessation treatments (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet-based resources) mediate the association between clean indoor air laws, cigarette excise taxes and recent smoking cessation. Recent smoking cessation was associated with clean indoor air laws in 2003 and with both clean indoor air laws and excise taxes in 2010–2011. Smoking cessation treatments explained between 29% to 39% of the effect of clean indoor air laws and taxes on recent smoking cessation. While clean indoor air laws remained significantly associated with the recent smoking cessation over the first decade of the 2000s, excise taxes gained a more prominent role in later years of that decade. The influence of these policies was partly mediated through the use of smoking cessation treatments, underscoring the importance of policies that make these treatments more widely available.

Associations between public e-cigarette use and tobacco-related social norms among youth

ImportanceE-cigarette use in public places may renormalise tobacco use.ObjectiveTo measure associations between e-cigarette use in public places and social norms among youth.DesignCross-sectional survey.SettingSchool-based.Participants24 353 never tobacco users in US 6th–12th...

Cigarette smokers’ concurrent use of smokeless tobacco: dual use patterns and nicotine exposure

BackgroundThe concurrent use of cigarettes with other tobacco products, such as smokeless tobacco (SLT), is increasingly common. Extant work with cigarette smokers who also use SLT is based heavily on...

Further Evidence on the Effect of Clean Indoor Air Laws on Smoking: The Italian Case

The evidence about the effectiveness of anti‐smoking legislation on smoking behavior is mixed. We provide new estimates for Italy using unexplored data drawn from the Household Budget Survey. We show that the smoking ban introduced in 2005 has a significant effect on smoking incidence. According to our baseline specification, the ban reduces household‐based smoking prevalence by 1.3 percentage points. Results are robust to the various empirical strategies proposed in the literature, even accounting for seasonality.

The Role of Marketing Practices and Tobacco Control Initiatives on Smokeless Tobacco Sales, 2005–2010

Background: Little is known about how policies and industry activities impact smokeless tobacco demand. We examined how tobacco control policies and retail promotion may affect smokeless tobacco sales. Methods: We used Nielsen market-level retail scanner data for smokeless tobacco sales in convenience stores in 30 US regions from 2005 to 2010. Tobacco policy variables, including excise taxes, state tobacco control program expenditures, and clean indoor air laws, were merged to Nielsen markets. We estimated regression models for per capita unit sales. Results: Higher cigarette tax was significantly associated with lower sales volume of smokeless tobacco. Sales of smokeless tobacco in markets with a weight-based SLT excise tax were higher than in markets with an ad valorem tax. A higher average product price was associated with decreased sales overall but results varied by package quantity and brand. Conclusions: This study observed that smokeless tobacco products were both complements and substitutes to cigarettes. Thus, smokeless tobacco may act as complements for some population segments and substitutes for others. A weight-based tax generally favors premium smokeless tobacco products.

Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003–2011

There was an increase in the number and coverage of state and local clean indoor air laws in the US during the past fifteen years. These laws coincided with increases in federal, state, and local cigarette excise taxes. In light of these changes, the objective of this study was to examine the association between clean indoor air laws, cigarette excise taxes and smoking patterns between 2003 and 2011. Using data on 62,165 adult participants in the 2003 and 2010/2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we examined the association of state and county workplace, bar, and restaurant clean indoor air laws and cigarette excise taxes with quitting and current every-day smoking. Between 2003 and 2011, quitting increased and daily smoking among those who continued to smoke decreased significantly. Participants living in states and counties with higher excise taxes and more comprehensive clean indoor air laws had a higher likelihood of quitting and lower likelihood of everyday smoking. Based on the assumption of no uncontrolled confounding, changes in taxes and laws accounted for 64.8% of the increase in smoking cessation and all of the reduction in everyday smoking. Implementation of state and county-level clean indoor air laws and cigarette taxes appears to have achieved the intended goal of encouraging smokers to either quit or reduce their frequency of smoking.

Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels).

E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)—efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults—including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products.

State Clean Indoor Air Laws and smoking among adults with poor mental health.

Persons with mental illness smoke at twice the rate of the general United States (US) population and die an average of 25-years younger, often from preventable diseases. This study seeks to determine whether disparities in smoking have increased over the past decade and whether Clean Indoor Air Laws (CIALs) are associated with changes in smoking among those with poor mental health. We used a fixed-effects model for estimation. CIALs were associated with 15 per cent decreased odds of smoking among adults in the US. Among those with poor mental health, these same laws had no effect. Between 2000 and 2010, the disparity in smoking rates between these two populations has steadily increased from 1.8 to 2.2 times greater. Given the lack of association between tobacco laws and smoking among those with poor mental health, alternative and more targeted tobacco reduction efforts may be necessary.

Should electronic cigarette use be covered by clean indoor air laws?

BackgroundSome jurisdictions have passed legislation that bans electronic cigarette (e-cig) use (vaping) in public places similarly to smoking. Many other jurisdictions have not yet determined how to regulate vaping in...

Neuberger JS, LaClair B. Implementation of Clean Indoor Air Laws: Complaints, Citations, and Fines or Sanctions Related to Possible Violations of the Kansas Clean Indoor Air Act. J Public Health Manag Pract. 2016;22(1):57-64.

Neuberger JS, LaClair B. Implementation of Clean Indoor Air Laws: Complaints, Citations, and Fines or Sanctions Related to Possible Violations of the Kansas Clean Indoor Air Act. J Public Health Manag Pract. 2016;22(1):57-64.

Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007

ABSTRACTAfrican American young adults ages 18–25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18–25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues—selected on the basis of youth reports of popular venues—were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.

E-Cigarette Marketing Online: A Systematic Content Analysis of Manufacturers and Retailers

Abstract Purpose: To identify the current atmosphere of online sales of Electronic Nicotine Delivery Systems (ENDS) in regards to key health-related and legal claims being made and to analyze the legal framework for regulating such claims. Methods: In December 2014, a systematic search protocol was employed with 3 popular search engines using six terms: 1) e-cigarettes, 2) e-cigs, 3) e-juice, 4) e-liquid, 5) e-hookah, and 6) vape pen. Websites from ENDS manufacturers and retailers were eligible for inclusion, and excluded review sites, blogs, or other non-commercial sites. Three pages of content were examined for each search term. In Phase I, included sites were independently coded for several health-related and legal themes, including: Modified or Reduced Risk, Cessation, Smoke anywhere, Health Benefits, Cleanliness, Environmentally Friendly, and Modern. In Phase II, gathered qualitative data was further coded for primary (explicit) and secondary (implicit) claims. Results: The final web search (n = 115) identified eligible sites and these were divided into two categories Manufacturers (n = 78) and Retailers (n = 32). Between both groups, the most common claims were Modified or reduced risk claims (63.6%), Cessation claims (41.8%), and Claims regarding one's ability to get around clean indoor air laws (42.7%) for Manufacturers and Retailers, combined. Overall, Manufacturers were more likely to make any health or legal claim than Retailers. Conclusions: The unregulated marketing of ENDS has led to a proliferation of health-related claims. Applying a legal/regulatory perspective, this research reveals the different types of health-related claims being made by ENDS manufacturers and retailers on their websites. For claims that are misleading or deceptive, the specifics content and context of each claim may influence whether the FDA has the current regulatory authority to address it. This research demonstrates that the FDA should complete the proposed “deeming” rule and develop a comprehensive regulatory scheme to addresses health-related claims by ENDS manufacturers and retailers.

Revisiting the Rise of Electronic Nicotine Delivery Systems Using Search Query Surveillance.

Public perceptions of electronic nicotine delivery systems (ENDS) remain poorly understood because surveys are too costly to regularly implement and, when implemented, there are long delays between data collection and dissemination. Search query surveillance has bridged some of these gaps. Herein, ENDS' popularity in the U.S. is reassessed using Google searches. ENDS searches originating in the U.S. from January 2009 through January 2015 were disaggregated by terms focused on e-cigarette (e.g., e-cig) versus vaping (e.g., vapers); their geolocation (e.g., state); the aggregate tobacco control measures corresponding to their geolocation (e.g., clean indoor air laws); and by terms that indicated the searcher's potential interest (e.g., buy e-cigs likely indicates shopping)-all analyzed in 2015. ENDS searches are rapidly increasing in the U.S., with 8,498,000 searches during 2014 alone. Increasingly, searches are shifting from e-cigarette- to vaping-focused terms, especially in coastal states and states where anti-smoking norms are stronger. For example, nationally, e-cigarette searches declined 9% (95% CI=1%, 16%) during 2014 compared with 2013, whereas vaping searches increased 136% (95% CI=97%, 186%), even surpassing e-cigarette searches. Additionally, the percentage of ENDS searches related to shopping (e.g., vape shop) nearly doubled in 2014, whereas searches related to health concerns (e.g., vaping risks) or cessation (e.g., quit smoking with e-cigs) were rare and declined in 2014. ENDS popularity is rapidly growing and evolving. These findings could inform survey questionnaire development for follow-up investigation and immediately guide policy debates about how the public perceives the health risks or cessation benefits of ENDS.

Implementation of Clean Indoor Air Laws: Complaints, Citations, and Fines or Sanctions Related to Possible Violations of the Kansas Clean Indoor Air Act.

To determine how well the Kansas Clean Indoor Air Act was being observed and enforced. A survey inquired about complaints, citations, and fines or sanctions after the implementation of the Kansas Clean Indoor Air Act; inquiry was also made about the law's effectiveness. Descriptive statistics and Poisson tests of statistical significance were used. Each of the 55 Kansas cities with more than 5000 in population. Law enforcement personnel. Monthly rates of complaints, citations, fines or sanctions, and reports of the law's effectiveness during the 30-month period after implementation of the act. Responses were received from 100% of the sampled cities. The number of citizen complaints and citations decreased over time from 4.33 to 2.42 per month and from 3.17 to 0.92 per month, respectively. The number of fines or sanctions decreased from 1.67 per month to 0.50 per month. In 51 of 55 cities (92.7%), respondents reported that the Kansas Clean Indoor Act appeared to be working effectively. There was a statistically significant difference between the first and second and first and third time periods for citations and fines or sanctions. However, there was only a statistically significant difference between the first and third time periods for citizen complaints. The law appears to be functioning effectively. This approach could be used to supplement measured or self-reported exposures to secondhand smoke in future studies in other jurisdictions, particularly in identifying areas with potential problems. Given the conservative nature of Kansas, adoption of such a law in the remaining states seems realistic.

The Effects of Workplace Clean Indoor Air Law Coverage on Workers' Smoking-Related Outcomes.

This study investigated the effects of workplace clean indoor air law (CIAL) coverage on worksite compliance with CIALs, smoking participation among indoor workers, and secondhand smoke (SHS) exposure among nonsmoker indoor workers. This study improved on previous research by using the probability of a resident in a county covered by workplace CIALs, taking into account the state, county, and city legislation. The county-level probability of being covered by a CIAL is merged into two large nationally representative US surveys on smoking behaviors: Tobacco Use Supplement of the Current Population Survey (2001-2010) and Behavioral Risk Factor Surveillance System (2000-2006) based on the year of the survey and respondent's geographic location to identify respondents' CIAL coverage. This study estimated several model specifications of including and not including state or county fixed effects, and the effects of workplace CIALs are consistent across models. Increased coverage by workplace CIALs significantly increased likelihood of reporting a complete smoking restriction by 8% and 10% for the two different datasets, decreased smoking participation among indoor workers by 12%, and decreased SHS exposure among nonsmokers by 28%. Copyright © 2015 John Wiley & Sons, Ltd.

Does Cigarette Smoking Affect Body Weight? Causal Estimates from the Clean Indoor Air Law Discontinuity

This paper examines the causal effect of smoking on body weight in Italy. We take advantage of the discontinuity in smoking habits introduced by the Italian smoking ban in 2005. Our estimates indicate that the ban reduced smoking intensity by half a cigarette per day and smoking participation rate by 2 percentage points. We estimate a significant effect on body weight of about 1 kg. Heterogeneous effects are also found, highlighting a smaller impact on men, employees and overweight and obese people. Most of the weight variations are attributed to quitting smoking, whereas reductions in cigarette consumption are not significant.