Community-based Tobacco Research Articles

Estimating the association between cigarette and e-cigarette use patterns and SARS-CoV-2 negative conversion time: retrospective online survey in China

BackgroundCigarette smoking has been reported to be associated with SARS-CoV-2 negative conversion, while little is known about the effect of its dual use with e-cigarettes. This study aimed to investigate whether tobacco product use patterns including e-cigarette use were linked with delayed negative conversion of SARS-CoV-2.MethodsAn online national survey was conducted from January 28 through February 21, 2023, targeting a community-based population in mainland of China after peak waves of the coronavirus disease 2019 (COVID-19). Participants were followed from the onset of COVID-19 symptoms until the negative conversion day or the day of answering the questionnaire as the endpoint of the study. Multi-variable adjusted Cox proportional hazard models were used to compare the negative conversion time of SARS-CoV-2 across different cigarette and e-cigarette use patterns.ResultsA total of 66,537 participants infected with COVID-19 were enrolled and 13,294 were included in the analyses. During the median duration of 7 days (interquartile range 5 to 10 days), a total of 11,587 (87.2%) had a negative conversion. Compared with never users, current exclusive smokers (multi-variable adjusted HR 0.59, 95% CI 0.48–0.71), current dual users (HR 0.31, 95% CI 0.22–0.44), and previous smokers (HR 0.56, 95% CI 0.37–0.83) took longer to turn negative after 10 days of follow-up.ConclusionsBoth current exclusive cigarette use and dual use of cigarettes and e-cigarettes were associated with the delayed negative conversion of SARS-CoV-2, which strengthens the importance of smoking and vaping cessation messaging and community-based tobacco control strategies during pandemics like COVID-19 next time.

The influence of sociodemographic, tobacco use, and mental health characteristics on treatment adherence among adults enrolled in a community-based tobacco cessation program

BackgroundWhile counseling and pharmacological interventions are known to facilitate smoking cessation, poor adherence can impact their effectiveness. Therefore, this study aimed to identify personal and clinical factors that influenced adherence to smoking cessation treatment among socioeconomically disadvantaged adult Oklahomans enrolled in a publicly available tobacco treatment program and observational research study. MethodsAdult participants (N = 442) were enrolled in a community-based tobacco treatment program. Logistic regression models identified sociodemographic, mental health, and substance use characteristics associated with treatment adherence. Adherence was measured by counseling session attendance and weeks of moderate/high medication adherence assessed via the Medication Adherence Questionnaire. Analyses were conducted using SAS 9.4 with p < 0.05. ResultsParticipants (mean age of 53, 55 % female, and 42.3 % racially minoritized), smoked 16 (SD = 10) cigarettes/day for 30 years on average (SD = 15), and 44.8 % reported depression (Center for Epidemiological Studies Depression Scale [CESD] score ≥ 10). Self-efficacy, White race, increasing age, and years of smoking were positively associated with counseling adherence, while menthol use, being uninsured, and depression predicted lower counseling adherence. Medication adherence was lower among individuals who used menthol cigarettes, lived with someone who smoked, and had higher levels of expired carbon monoxide. ConclusionsThis study highlights key factors that influenced adherence to smoking cessation treatment in a socioeconomically disadvantaged population. Tailored interventions are needed to address social, behavioral, and environmental factors, such as living situations and mental health, in smoking cessation interventions to enhance treatment outcomes for underserved populations. Future tobacco cessation programs should consider these factors to improve adherence and, ultimately, success rates.

A Pilot Feasibility Study of Delivering a Quit & Win Tobacco-Free Contest in Community Mental Health Programs.

Quit & Win contests are a community-based tobacco cessation strategy that has demonstrated success in supporting tobacco cessation efforts in the general population. However, such contests have not been implemented and evaluated among people living with mental illnesses (MIs). This pilot study aimed to evaluate the feasibility of implementing Quit & Win contests in terms of program delivery, engagement, and cessation outcomes among people with MIs. A single-group posttest design to evaluate the feasibility of Quit & Win contests conducted at three community mental health programs. Flyers introducing the contest were posted at study sites 2 weeks prior to recruitment. Recruitment occurred on 2 days over a 2-week period. Eligible participants received a pamphlet with information about tobacco treatment resources. At the follow-up, postsurveys and expired CO levels were obtained. Participants (N = 28) were mostly male, Non-Hispanic White, with a high school or higher education, unemployed, and 46.4% had a primary substance use disorder diagnosis. Among those who engaged in the program, seven (25.0%) returned for the follow-up, of which three (42.9%) successfully stopped cigarette use. Four (57.1%) described using nicotine replacement therapy in their attempt to stop using cigarettes. Challenges to cessation included difficulty finding available tobacco treatment programs, limited access to treatment medications, and experiencing nicotine withdrawal symptoms. Our findings suggest the feasibility of Quit & Win interventions in community mental health settings. Further efforts are required to enhance recruitment, engagement, and retention, and to support access to community-based tobacco treatment resources.

A Study On Insight Into Cessation Attempts Among Current Smokeless Tobacco Users In An Urban Slum Of Ahmedabad

Introduction:According to GATS-2 report, one out of every five persons in Gujarat uses smokelesstobacco (SLT).Tobacco causes addiction &amp; dependence over a period of time.Tobacco cessation is anintegral part of the National Tobacco Control Programme.Objective:To estimate the proportion ofprevious quit attempts and its determinants among current SLT users of an urban slum inAhmedabad.Methods:A community-based, cross-sectional study using consecutive sampling wasconducted between June 2023 - August 2023 among 250 current SLT users in an urban slum ofAhmedabad( Ward number 15). A pre-tested, semi-structured questionnaire adapted from GATS-2(Global Adult Tobacco Survey-2) Tobacco Questions for Surveys was administered among theparticipants for eliciting sociodemographic characteristics, SLT consumption pattern and quittingattempts. Results:In this study, 68.8% of the participants had at least one past quit attempt out ofwhich 94.7% tried self- control methods. The most common reason for not being able to quit wasperceived as addiction (70.9%). A larger part of SLT users (89%) had noticed warning labels intobacco packets and 18.3% of them reported that they thought of quitting seeing that warning. Threefourth of the participants were advised by at least one person to not consume tobacco products &amp; in60% of the cases, it was the spouse.Conclusions and recommendations:The results suggest that there is an obvious lacuna in the community's utilization of services, despite the fact that National Tobacco Control Programme (NTCP) provides nationwide cessation services. This demonstrates theneed for extensive community-based tobacco cessation activities. Keywords:Smokelesstobacco(SLT), Addiction,Quit Attempt, National Tobacco Control Programme(NTCP)

Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes.

Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.

Inoculating Black/African American and LGBTQ Communities Against the Tobacco Industry: The Role of Community Connectedness and Tobacco Denormalization Beliefs.

The purpose of this study was to explore how connectedness to Black/African American or lesbian, gay, bisexual, transgender and queer (LGBTQ) communities can promote anti-tobacco industry beliefs and to examine the role of targeted anti-tobacco industry messaging (i.e., tobacco industry denormalization [TID] messages).We hypothesized that community connectedness would predict anti-tobacco industry motivation (H1) and that this effect would be mediated by community-specific anti-industry beliefs (H2). We also hypothesized that these effects would be greater (i.e., moderated) for individuals exposed to targeted TID messages (H3). This study was a secondary analysis of data from a web-based experiment focused on the effects of counter-industry messages (data collected in 2020). The sample consisted of 430 Black/African Americans and 458 LGBTQ young adults. Hypotheses were tested using structural equation modeling. In support of hypothesis 1, community connectedness was associated with anti-tobacco industry motivation for both the LGBTQ and Black/African American subsamples. Hypothesis 2 was also supported. The associations between community connectedness and anti-industry motivations were partially mediated by anti-industry beliefs. Hypothesis 3 was not supported. Exposure to counter-industry messages did not modify the structural model; however, counter-industry messages increased anti-industry beliefs in both subsamples. Fostering community connectedness may help to mobilize community-based tobacco control efforts. Furthermore, interventions targeting anti-tobacco industry beliefs may be effective at reducing tobacco-related disparities. Anti-tobacco industry beliefs can be increased using brief targeted TID messages. Collectively, these findings suggest that community-based approaches rooted in consciousness-raising action may provide a useful model for future tobacco control interventions.

A community-based tobacco cessation program for individuals experiencing homelessness

BackgroundTobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH. MethodsThe intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts. ResultsWe trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57–0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75–0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45–5.77). ConclusionsOur findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.

“STOP the PUFF! Tayo’y mag bagong BAGA, SIGARILYO ay ITIGIL”: A Pilot Community-based Tobacco Intervention Project in an Urban Settlement

The success rate for smoking cessation in the country remain low despite the intensified efforts of the government to curb smoking. There is a need to support tobacco control policies with clinical interventions for smoking cessation. However, cessation experts in the country are few and healthcare workers with training on tobacco interventions are limited. The project aimed to address the clinical aspect of tobacco control by establishing tobacco cessation services in the community. This was done by providing brief tobacco intervention training among health workers and community leaders, thus allowing this intervention to be integrated in the existing programs of the community health center. This also led to the creation of possible referral mechanisms to cessation support providers. This was complemented with health education activities that promote smoke-free behavior. Keywords: tobacco; cigarette smoking; tobacco dependence; smoking cessation; brief advice; brief tobacco intervention​​​​​

Assessment of outcomes of a hospital-based tobacco cessation intervention program

Background: Tobacco use among adult Indian population is 34.6% by Global adult tobacco survey (2016–2017) reported 6.8 crores urban, 19.9 crores rural Indians are tobacco consumers. M. P state fact file declares highest tobacco consumers residing in Madhya Pradesh. Methodology: The current study is an individual as well as community-based tobacco intervention program, to evaluate the trends of tobacco use, awareness related to tobacco hazard, quit tobacco regime, withdrawal, relapse in post intervention follow-up. Results: In the total regime of 3 months starting from detox groundwork of body for cessation to behavior modification, phase of nicotine replacement therapy (NRT) to pharmacological intervention at spaced out follow-up the graph gradually declined down of individuals positively motivated for quitting. Conclusion: Tobacco cessation (quitting) with behavior modification, NRT, and Pharmacological mode is a relatively novel approach of tobacco control in India. It is considered to be the most cost-effective intervention as compared to other tobacco control programs and other approaches of reducing tobacco menace.

Community-based Interventional Study for Tobacco Cessation in Urban Slums of Ahmedabad City: A Cluster-Randomized Trial.

Background:Tobacco is one of the most important preventable causes of death and a leading public health problem all over the world. The present study was conducted to determine the effect of community-based intervention for tobacco cessation in urban slums of Ahmedabad city.Materials and Methods:A total of 20 slums (10 slums each) in the intervention and control group were randomly selected through the process of randomization. A total of 200 participants each in the intervention and control group were studied through a cluster-randomized trial.Results:The outcome of the community-based tobacco intervention measured after 6 months depicted that the odds ratio (OR) of the prevalence of tobacco abstinence, quit rate, and reduction of more than 50% of tobacco use was significantly higher (30.37 times, 2.84 times, and 2.19 times respectively more) in the intervention as compared to the control group. However, after 1 year of the first and immediately after the second intervention, the OR of tobacco point prevalence abstinence, quit rate, and reduction of more than 50% was more pronounced (5.11 times, 3.52 times, and 4.31 times, respectively, more) in the intervention group than the control group. Post intervention, it was also observed that there was a significant increase in the average quit attempt.Conclusion:The community-based intervention was very effective in reducing the consumption of tobacco in urban slums in any form. As per the study findings, there is a wide possibility for the integration of tobacco cessation activity into the health program.

Developing A Community-Based Tobacco Control Intervention to Reduce Secondhand Smoke Exposure Among Children and Promote Smoking Cessation Among Household Members in Rural China: a Qualitative Studyecondhand Smoke Exposure Among

Developing A Community-Based Tobacco Control Intervention to Reduce Secondhand Smoke Exposure Among Children and Promote Smoking Cessation Among Household Members in Rural China: a Qualitative Studyecondhand Smoke Exposure Among

Psychological, Normative, and Environmental Barriers to Tobacco Cessation that Disproportionally Affect Sexual Minority Tobacco Users

Sexual minority populations-particularly gay/lesbian and bisexual women-use tobacco at higher rates than their heterosexual peers. Evidence-based biopsychosocial interventions for tobacco cessation are available; however, research is lacking on the specific barriers to tobacco cessation in these populations. The purpose of this study is to describe the psychological, normative, and environmental barriers to cessation that disproportionally affect sexual minority tobacco users. Data from wave 1 of the Population Assessment of Tobacco and Health were used to explore differences by sexual identity across psychosocial barriers and facilitators of tobacco cessation. The analytic sample consisted of current tobacco users (including cigarettes, e-cigarettes, cigars, cigarillos, pipes, hookah, dissolvable snus, and smokeless products). Psychosocial barriers/facilitators were modeled using logistic regression analyses, controlling for age, race/ethnicity, poverty, education, census region, and urbanicity and were stratified by sex. Models accounted for the complex study design and nonresponse. Substance use and internalizing/externalizing behavioral problems were more common among gay/bisexual men. Bisexual, but not gay/lesbian, women also had higher odds of these behavioral problems. Bisexual men and women reported less normative pressure to quit than their heterosexual peers (no differences in gay/lesbian tobacco users). Gay men had more environmental barriers to quit, being more likely to receive tobacco promotion materials, and live with another tobacco user. Several barriers to tobacco cessation were identified as disproportionally affecting sexual minority groups in this study; however, there were considerable differences between sexual minority men and women, as well as between gay and bisexual participants. Several important psychological, normative, and environmental barriers to tobacco cessation were identified that disproportionally affect sexual minorities. There was considerable heterogeneity in the prevalence and relative difference of these barriers across sexual minority subgroups, suggesting that community-based tobacco cessation programs should be responsive to differences in gay and bisexual men and women.

Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities

ABSTRACT Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 – December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2–3 (51%) were best for screening, while days 3–4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas. Abbreviations CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board

Cost-Effectiveness of Community-Based Tobacco Dependence Treatment Interventions: Initial Findings of a Systematic Review.

IntroductionScientific literature evaluating the cost-effectiveness of tobacco dependence treatment programs delivered in community-based settings is scant, which limits evidence-based tobacco control decisions. The aim of this review was to systematically assess the cost-effectiveness and quality of the economic evaluations of community-based tobacco dependence treatment interventions conducted as randomized controlled trials in the United States.MethodsWe searched 8 electronic databases and gray literature from their beginning to February 2018. Inclusion criteria were economic evaluations of community-based tobacco dependence treatments conducted as randomized controlled trials in the United States. Two independent researchers extracted data on study design and outcomes. Study quality was assessed by using Drummond and Jefferson’s economic evaluations checklist. Nine of 3,840 publications were eligible for inclusion. Heterogeneity precluded formal meta-analyses. We synthesized a qualitative narrative of outcomes.ResultsAll 9 studies used cost-effectiveness analysis and a payer/provider/program perspective, but several study components, such as abstinence measures, were heterogeneous. Study participants were predominantly English speaking, middle aged, white, motivated to quit, and highly nicotine dependent. Overall, the economic evaluations met most of Drummond and Jefferson’s recommendations; however, some studies provided limited details. All studies had a cost per quit at or below $2,040 or an incremental cost-effectiveness ratio (ICER) at or below $3,781. When we considered biochemical verification, sensitivity analysis, and subgroups, the costs per quit were less than $2,050 or the ICERs were less than $6,800.ConclusionAll community-based interventions included in this review were cost-effective. When economic evaluation results are extrapolated to future savings, the low cost per quit or ICER indicates that the cost-effectiveness of community-based tobacco dependence treatments is similar to the cost-effectiveness of clinic-based programs and that community-based interventions are a valuable approach to tobacco control. Additional research that more fully characterizes the cost-effectiveness of community-based tobacco dependence treatments is needed to inform future decisions in tobacco control policy.

Smoke-free home initiative in Bantul, Indonesia: Development and preliminary evaluation.

INTRODUCTIONTobacco control policies in Indonesia are still limited. This study aims to describe the process of the implementation of the smoke-free home (SFH) program in rural areas in Indonesia and to conduct a preliminary evaluation of its implementation.METHODSThe development of SFH (or Rumah Bebas Asap Rokok) applies the theory of diffusion of innovation with the following stages: innovation, dissemination, adoption, implementation, and evaluation. The preliminary evaluation of the SFH program used an observational method combined with a cross-sectional survey. The population of this study was all houses in Karet hamlet, in Bantul district, Yogyakarta province with 378 houses as population, from which 196 houses were selected as sample using the proportional random sampling technique. Quantitative data analysis used multiple linear regression in Stata 15.1.RESULTSSFH is a community-based tobacco control innovation program that began with a community declaration. Preliminary evaluation after one-year implementation showed that 55% and 45% of respondents were smokers and non-smokers, respectively. Among smokers, 95%, 78% and 56% reported not smoking near pregnant women, children, and non-smokers, respectively. Moreover, 52% of respondents reported having a front-door ashtray, and 46% reported guests not smoking; among non-smokers, the corresponding values were 56% and 60%.CONCLUSIONSSFH implementation has an impact on the community’s smoking pattern. Awareness of smokers to protect women and children from secondhand smoke is very high. While the results are promising, more political and resource support is needed from the local and national policymakers to support SFH initiatives.

Addressing Risks Throughout the Life-cycle to Reduce Non-communicable Disease in Bangladesh (P10-085-19)

ObjectivesThe rapidly increasing burden of non-communicable diseases (NCD) constitutes a major public health challenge undermining future social and economic development. Using Bangladesh as a case study, we review gaps in health and nutrition behavior throughout the life-cycle and suggest possible policy and program solutions MethodsWe utilized a conceptual framework lightly adapted from the WHO Package of Essential Non-communicable Disease Interventions for Primary Health Care in Low Resource Settings. This framework guided the review of secondary literature using peer-reviewed articles and grey literature including reports, policy documents, and policy briefs. ResultsRisk factors identified include sub-optimal breastfeeding and complementary feeding with caregivers frequently resorting to prepackaged junk food for children, particularly in urban settings. For older children, many schools are unable to promote physical activity and do not include life-skills training. There is also high promotion of tobacco products to adolescents and adults, with little regulation, resulting in high use rates. Adults who have NCD also have poor control and knowledge of their condition, leading to inadequate care.Among infants, risks could be reduced through better enforcement of restrictions on the marketing of breastmilk substitutes and the mandated provision of six-month maternity leave for working women. For older children, additional taxes on junk foods partnered with improved communication campaigns on consumption of locally available, nutritious, and low-cost complementary foods could nudge diets into healthier patterns. Life skill training in school would improve the nutrition and health knowledge of the population, promote better diets, and discourage tobacco and substance abuse. Bangladesh has no wide-spread community-based tobacco cessation program or peer-educator program for adults suffering from NCD to learn more about their condition along with encouraging regular care-seeking. ConclusionsCurrent policies and programs need to realize the changing dimensions that influence NCDs in Bangladesh. A multisectoral life course approach is needed to address the risk factors to halt the progression of NCD. Funding SourcesThe program was funded by the Netherlands government under Netherland Fellowship program (Former NFP, currently known as OKP). The preparation of this abstract was funded by the EU.

Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?

Though persons with behavioral health conditions experience large disparities in tobacco use, questions about the efficacy of evidence-based tobacco use treatment remain understudied in community health settings. This evaluation examined outcomes from eight community-based tobacco cessation programs for participants with and without behavioral health conditions (n = 974 participants). The majority (64.8%) of participants reported one or more current behavioral health conditions, including mental illness and/or substance abuse. Participants who used cessation medication during the program and who attended more counseling sessions had an increased likelihood of being quit at 4-month follow-up. Quit rates were between 9.8% (intent-to-treat rate) and 30.6% (responder rate); behavioral health status did not negatively affect reported quit rates. Findings add to the growing literature evaluating community-based interventions within the behavioral health population.

Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale.

The US tobacco industry spends $8.2 billion annually on marketing at the point of sale (POS), a practice known to increase tobacco use. Evidence-based policy interventions (EBPIs) are available to reduce exposure to POS marketing, and nationwide, states are funding community-based tobacco control partnerships to promote local enactment of these EBPIs. Little is known, however, about what implementation strategies best support community partnerships' success enacting EBPI. Guided by Kingdon's theory of policy change, Counter Tools provides tools, training, and other implementation strategies to support community partnerships' performance of five core policy change processes: document local problem, formulate policy solutions, engage partners, raise awareness of problems and solutions, and persuade decision makers to enact new policy. We assessed Counter Tools' impact at 1year on (1) partnership coordinators' self-efficacy, (2) partnerships' performance of core policy change processes, (3) community progress toward EBPI enactment, and (4) salient contextual factors. Counter Tools provided implementation strategies to 30 partnerships. Data on self-efficacy were collected using a pre-post survey. Structured interviews assessed performance of core policy change processes. Data also were collected on progress toward EBPI enactment and contextual factors. Analysis included descriptive and bivariate statistics and content analysis. Following 1-year exposure to implementation strategies, coordinators' self-efficacy increased significantly. Partnerships completed the greatest proportion of activities within the "engage partners" and "document local problem" core processes. Communities made only limited progress toward policy enactment. Findings can inform delivery of implementation strategies and tests of their effects on community-level efforts to enact EBPIs.

A Descriptive Report of Electronic Cigarette Use After Participation in a Community-Based Tobacco Cessation Trial.

Smokers are using electronic cigarettes, also known as e-cigarettes, as a cessation aid, despite uncertainty about their efficacy. This report describes the association between use of e-cigarettes before and after cessation treatment and tobacco abstinence at 12 months. It also presents characteristics of e-cigarette users and reasons for use. A longitudinal observational secondary analysis of self-reported e-cigarette use was conducted among adult Appalachian smokers enrolled in a community-based tobacco dependence treatment trial (n = 217). Data were collected at baseline, 3, 6, and 12 months following treatment. The primary outcome measure was biochemically-confirmed 7-day point prevalence tobacco abstinence at 12 months post-treatment. One in five participants reported using e-cigarettes post-treatment. Baseline sociodemographic and tobacco-related characteristics did not differ by e-cigarette use. Primary reasons for e-cigarette use included help in quitting, help in cutting down on cigarettes, and not as bad for health. At the 12 month follow-up, tobacco abstinence was significantly lower among post-treatment e-cigarette users (4.7%) than nonusers (19.0%); (OR = 0.21 95% CI: 0.05-0.91, p = .021). Baseline use was not associated with 12-month abstinence. Among adult Appalachian smokers enrolled in community-based tobacco cessation treatment, use of e-cigarettes post-treatment was associated with lower abstinence rates at 12 months. This descriptive report of electronic cigarette use after participation in a community-based group randomized tobacco dependence treatment trial adds to the body of science examining e-cigarette use and cessation. Post-treatment e-cigarette use was associated with less success in achieving abstinence at 12 months, as compared to nonuse. At 3 months post-treatment, the majority of those who reported use of e-cigarettes did so to assist with cessation.

Closing the knowledge gap in secondhand smoke exposure among children: employment of a five-minute household survey in China

ObjectiveThe 2010 Global Burden of Disease study unexpectedly reports no health burden associated with secondhand smoke (SHS) exposure in children 5–17 years of age. One possible reason for this error is that children under 13 years of age are not considered in standard community surveys of SHS exposure. This study aims to use a 5-min household survey to estimate the prevalence of SHS exposure among children in urban and rural China. Study designCross-sectional survey. MethodsA multi-stage stratified sample of 1120 urban and rural households with 3073 residents from the Ningbo, China, was identified and one adult member from each household was administered a brief survey about the demographic characteristics and smoking status of all household residents. ResultsAdjusting for the sampling design and clustering within households, 63% of children less than 7 years of age, 53% of the children 7–12 years of age, and 54% of the children 13–17 years of age were living in households with daily smokers. Controlling for the number of male residents, significantly more households with daily smokers were located in rural areas (p < 0.001) and the average education level of adults in households with daily smokers was significantly lower than that among adults in households without daily smokers (p = 0.007). ConclusionThe heavy household exposure of children in China to SHS is an unrecognized public health problem that demands urgent policy and programmatic responses. The brief household survey developed for this study is an easy method for monitoring the prevalence of SHS exposure of children over time that could be useful in community-based tobacco control initiatives.