Tobacco Hazards Research Articles

台湾纸烟管理政策对需求影响之探讨

本文探讨主要烟品管理政策，如烟盒加注警示标语、烟害防制法以及课征健康捐等对国产与进口烟品需求的影响，以建议政府规划有效之烟品管理政策。研究方法采用1971~2009年之纸烟消费量及零售价格等时间序列数据以近似无关回归(SUR)估计国产与进口纸烟之需求函数。模型中并以虚拟变量量化台湾纸烟开放进口、烟盒警示标语、烟害防制法以及烟品健康捐等管理政策之推行。此外建立吸烟风险讯息指数以评估吸烟危害人体健康讯息对需求之影响。实证结果发现，样本期间国产纸烟及进口纸烟之价格弹性分别为−0.88及−0.47，所得弹性则分别为0.06及0.18；国产纸烟对进口纸烟之交叉弹性为0.40，进口纸烟对国产纸烟之交叉弹性为0.63。此外，吸烟健康风险讯息、烟盒警告标语以及烟品健康捐对国内纸烟需求具有负面影响，烟品开放进口对国产纸烟消费具负面影响；但对进口纸烟消费具正面影响。最后，烟害防制法对国产纸烟需求具负面影响；对进口烟品需求的影响并不明显。综合实证发现，本文建议以价制量是有效之纸烟管理政策，但政府应再提高烟品健康福利捐之税赋，并将烟品健康福利捐，改为从价计税，才能更有效降低国人对进口纸烟的需求。 This paper aims to analysis the comprehensive influence of regulation policy such as, Tobacco Hazards Prevention Act, Tobacco Health and Welfare Tax, on demand for cigarette inTaiwan. Annual data through 1971 to 2009 are used to estimate the demand for cigarettes by applying SUR model. The impacts of deregulation of foreign cigarettes imports, anti-smoking campaigns on cigarette case, the implementation of Tobacco Hazards Prevention Act, and levy of Tobacco Health and Welfare Tax are taken into account by using dummy variables. The empirical results indicate that the price elasticities for domestic and imported cigarettes are −0.88 and −0.47, respectively. The income elasticities are 0.06 for domestic and 0.18 for imported cigarettes and the cross-price elasticities are 0.40 for domestic and 0.63 for imported cigarettes. The regulation policies of revelation of cigarette health information, anti-smoking campaigns on cigarette case, and the Tobacco Health and Welfare Tax have significantly negative effects on both domestic and imported cigarette consumption. In addition, opening the markets to imported cigarettes has had a significantly negative effect on domestic cigarette consumption, but had a significantly positive effect on imported cigarette consumption. Finally, Tobacco Hazards Prevention Act has a significantly negative effect on domestic cigarette consumption, but had an insignificantly effect on imported cigarette consumption. In conclusions, the effects of regulation policy on domestic cigarettes are more significant than on imported cigarettes. Taiwan Government should increase the amount of the Tobacco Health and Welfare Tax, and transform it from unit tax into ad valorem tax in order to effectively reduce the demand on imported cigarettes.

Validation of the Chinese-version Self-Efficacy in Smoking Cessation Service Scale (SE-SCS) for clinical psychiatric professionals

Smoking cessation has been an important issue of concern for Taiwan's psychiatric nurses since promulgation of the Tobacco Hazards Prevention Act. However, Taiwan has lacked a qualified tool to evaluate the self-efficacy of nurses in providing smoking cessation services. The purpose of this study was to validate the Chinese version of the Self- Efficacy in Smoking Cessation Service Scale (SE-SCS). A back translation approach was used to develop the SE-SCS Chinese version. We enrolled 193 psychiatric nurses from two psychiatric centers in central and southern Taiwan to assess the reliability and validity of the Chinese version scale using internal consistency, test-retest, factor analysis, and concurrent criteria validity. The reliability of the SE-SCS Chinese version was assessed as good (Cronbach's α = .85) and the Pearson correlation for total test-retest score was acceptable (r = .65, p = .004). Explanatory factor analysis revealed that one factor explained 63.4% of total variance. As to the criteria validity, frequency of smoking cessation service provision was the main criterion, with a correlation of 0.25-0.26. We identified a low, but significant correlation (p < .001). The SE-SCS Chinese version appears to be a valid measure for assessing psychiatric nurse self-efficacy in providing smoking cessation services.

Cognitive status of Beijing suburban residents in tobacco harm and the study of intervention strategy

Through random sampling,a total of 300 residents of Beijing Changping Ming Tombs Town were selected for home-based questionnaires.The smoking rate of interviewed residents was 21.4％ (53/248).The rate in men (42/125,33.6％ ) was bigber than that in women ( 11/123,8.9％ ).The rate in those with higher education was lower than that in those with lower educational level ( x2 =27.12,P ＜ 0.05 ).The population awareness of tobacco hazards was 80.6％ (200/248).Awareness in smokers was lower than the average awareness of ex-smokers and nonsmokers ( x2 =5.07,P ＜ 0.05 ).The higher the education level,the higher the awareness of tobacco health hazards ( x2 ≈ 19.72,P ＜ 0.05 ).There were differences in awareness among different age groups (x2 =13.37,P ＜ 0.05 ). Key words: Tobacco use disorder; Questionnaires

Promoting Life Skills and Preventing Tobacco Use among Low-Income Mumbai Youth: Effects of Salaam Bombay Foundation Intervention

BackgroundIn response to India's growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use.Methods/FindingsUsing a quasi-experimental design, we assessed program effectiveness by comparing 8th and 9th grade students in intervention schools to 8th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days.Findings indicate that 4.1% of 8th grade intervention students (OR = 0.51) and 3.6% of 9th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report.ConclusionsThis program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate.

Knowledge of the New Tobacco Hazards Prevention Act Is Associated With Smokers’ Behavior of Seeking Help in Smoking Cessation in Taiwan

Evidence that smoking area restrictions and raising cigarette taxes affect smokers' behavior of seeking help in cessation is limited. The authors conducted a case-control study of 200 participants in Taipei City, Taiwan, from December 2008 to June 2009 to evaluate the association between knowledge on legislation and the behavior of seeking help in smoking cessation. They compared smokers who sought assistance in clinics/classes and smokers who did not, matching for age, gender, and recruitment time. In a univariate model, both banning smoking and increasing prices had positive effects on smokers' behavior, but the effect size of the latter was larger (P = .021). A better knowledge of the regulations was associated with cessation effort (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.44-5.23), as were being more influenced by increased prices (OR = 2.44; 95% CI = 1.38-4.34) and by smoking bans (OR = 2.32; 95% CI = 1.29-4.16). Increased knowledge of the regulations is associated with seeking help for smoking.

Household secondhand smoke exposure of elementary schoolchildren in Southern Taiwan and factors associated with their confidence in avoiding exposure: a cross-sectional study

BackgroundExposure to household Secondhand Smoke (SHS) poses a major health threat to children after an indoor smoking ban was imposed in Taiwan. This study aimed to assess the household SHS exposure in elementary school children in southern Taiwan and the factors associated with their avoidance of SHS exposure before and after the implementation of Taiwan's new Tobacco Hazards Prevention Act in 2009.MethodsIn this cross-sectional school-based study, data on household SHS exposure, avoidance of SHS and related variables was obtained from the 2008 and 2009 Control of School-aged Children Smoking Study Survey. A random sample of 52 elementary schools was included. A total of 4450 3-6 graders (aged 8-13) completed the questionnaire. Regression models analyzed factors of children's self-confidence to avoid household SHS exposure.ResultsOver 50% of children were found to have lived with a family member who smoked in front of them after the new law enacted, and 35% of them were exposed to household SHS more than 4 days a week. Having a positive attitude toward smoking (β = -0.05 to -0.06) and high household SHS exposure (β = -0.34 to -0.47) were significantly associated with a lower avoidance of SHS exposure. Comparing to girls, boys had lower scores in their knowledge of tobacco hazards; and this factor was significantly related to their SHS avoidance (β = 0.13-0.14).ConclusionsThe intervention program should enhance school children do actively avoid exposure to SHS in home settings, and more importantly, provide tobacco hazard knowledge to male students to avoid exposure to household SHS for themselves. The results also provide further evidence that Tobacco Hazards Prevention Act should perhaps be extended to the family environment in order to protect children from the hazards of household SHS exposure.

A framework convention on obesity control?

In your Aug 27 Editorial,1 you ask who will take the lead in creating a framework convention for obesity control. We agree that international law has an untapped potential to substantially improve global health. Yet this potential must be applied not only to obesity, tobacco, or other single health hazards, but also to global health as a whole, to respond, in a coordinated manner, to the health deprivations and inequities that stain our world.2

Tobacco advertising and press coverage of smoking and health in 10 years of Argentinean newspapers

To describe the extent and content of tobacco-related images, advertising and articles published in the largest Argentinean newspapers before and after a voluntary advertising ban implemented in 2001. Issues from four months of each year of the four main national newspapers were examined from 1995 to 2004. We recorded the number of tobacco images (advertisement or not), tobacco-focused articles, space used, and placement within the newspaper. Regression analyses evaluated time trends. We identified 1800 images and articles from 4828 different issues. Non-advertisement images were the most frequent (71.2%), followed by articles (20%) and advertisement images (8.8%). Advertisements only appeared in the two best selling newspapers with a majority (57%) in the Sunday magazine and 21% in the sports sections. Non-advertisement images were published in the sports and entertainment sections (55%) and showed a public figure in 88%. Of 336 articles, 39% focused on health topics and 55% emphasized the negative effects of tobacco on health. Regression models showed that prior to 2001 there were significant time-related decreases in ad images and articles and significant increases in non-ad images. The trend of each outcome changed direction beginning in 2001 and the magnitude of the change in trend was significant for ad images and non-ad images. The number of non-ad images dropped significantly in 2001 from a model-predicted value of 178 per year to 103 non-ad images and remained constant thereafter. Tobacco images exceeded information about tobacco hazards in Argentinean newspapers over this period. Advertisement increased from 2001 to 2005, following the voluntary advertisements ban. Partial advertisement bans are ineffective and a total ban is imperative.

Changes in smoking behavior among college students following implementation of a strict campus smoking policy in Taiwan

To understand the perception and responses among college students to a strict campus smoking policy which was in accordance with a national law requiring complete prohibition indoors and permission to smoke in designated outdoor smoking areas only. This study was conducted in the third to sixth month after the implementation of the revised Tobacco Hazard Prevention Act in Taiwan. In-depth interviews were conducted with 22 smokers who were second and third year students of a college in Taiwan. Thematic analysis was used to categorize ideas into concept themes. In interviews, most smokers revealed some modification in their smoking behavior and attitude: they sensed that smoking was unwelcome, reduced smoking in campus, thought about quitting, and tried to avoid exposing roommates in the dormitory. The reasons cited by the students for behavior change were grouped into four major themes: a changed smoking experience, change in social norm, the respect for law, and concern for others' health. Implementation of a strict smoking policy in college prompted smokers to markedly reduce smoking in campus.

Prevalence, risk factors, attitude on tobacco use and knowledge on hazards among adolescents in Karnataka, India

Background: Tobacco consumption remains the single largest leading cause of preventable deaths & diseases. Tobacco consumption is a major risk factor for more than 25 diseases like coronary heart diseases, carcinomas, Bronchitis etc, and also causes economic& social deterioration. Adolescents are the most vulnerable population to initiate tobacco use. It is important to understand various factors that influence and encourage young teenagers to start smoking or to use other tobacco products.Objectives:To know the prevalence, initiating factors, behavioural patterns and determinants of tobacco use.Materials and Methods: A cross sectional study, data collected by personal interview of 1536 adolescents between the ages of 10-19 year.Results: Prevalence of tobacco use in this adolescent sample was 11.13% (171 out of 1536 subjects); 20.41% among males and 0.42% among females. The prevalence increased over the adolescent period – from 14.81% in the age group of 14 – 15 years to 68.42% among the age group of 18 – 19 years. The prevalence was 51.61% in illiterates compared to 7.58% in literates. Prevalence was higher among illiterate parents (8.87%) in comparison to those educated parents. Majority opined (50.29%) that the main reason for starting tobacco use was influence of their parents and relatives, followed by friends (45.03%). Other attributions were Show off (36.84%), curiosity (32.75%),movies (31.58%) and advertisements (5.26%).Conclusion: Tobacco use is present in a sizeable proportion of the adolescent population. Most started the abuse early and were aware of the hazards of tobacco. The adolescents perceive that their parents, relatives and friends as important factors for their tobacco use.

Factors Associated With Taiwanese Junior High School Personnel Advising Students to Quit Smoking

Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.

Self-reported tobacco use, knowledge on tobacco legislation and tobacco hazards among adolescents in rural Kerala State

Tobacco consumption initiated during the adolescent period is a major contributor to the pathogenesis of fatal diseases in adulthood. Information on tobacco use and awareness regarding tobacco legislation and hazards among adolescents in rural Kerala is limited. To assess the prevalence of tobacco use among adolescent students in a rural district in Kerala state and to understand the extent of awareness about the prominent legislative measures against tobacco and tobacco hazards. Data on awareness regarding health hazards due to tobacco use and legislation against tobacco consumption were collected from students of 15 randomly selected high schools in an educational sub-district in Kerala, using a cross-sectional study design. Chi-square and Fisher's exact test statistics were used for statistical analysis. A total of 1473 students participated in the study, of which 79% were males (mean age 15.4 years, SD 1.5). The overall prevalence of 'current tobacco users' was 8%. A significant association between age and tobacco use was noted among tobacco habitués (P<0.05). Awareness regarding legislation against smoking in public places was more in the higher age-groups (P<0.05). Females were more aware of the 'smoking ban' than males (P<0.05). Our survey of the awareness regarding the hazards associated with tobacco use revealed that 41.5% of the students knew about the link between oral cancer and tobacco, with the awareness being greater among females than among males (64.3% vs 35.4%). The finding that tobacco consumption increases with age is a matter of concern. In addition to their clinical work, dental professionals should also educate the public on the hazards of tobacco and conduct tobacco cessation programmes for adolescent groups to control the tobacco epidemic.

Awareness of Tobacco-Related Health Hazards among Adults in China

To determine the level of awareness of the hazards of tobacco smoking and secondhand smoke inhalation among adults in China. Household surveys were conducted with a total of 13,354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. The findings revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively. Awareness regarding smoking-related hazards across all participants was significantly associated with several factors, including gender, smoking status, urban/rural residency, education level and exposure to tobacco control publicity in the last 30 days. Awareness regarding tobacco-related hazards in smokers was significantly associated with urban/rural residency, education level, exposure to tobacco control publicity in the last 30 days, and physician's advice. Awareness relating to the hazards of inhaling secondhand smoke was associated with smoking status, urban/rural residency, age, education level, and exposure to tobacco control publicity in the last 30 days. Medical professionals were found to know more about the health hazards of tobacco compared with people in other types of employment. Overall awareness of the health hazards of tobacco has improved in the last 15 years in China, but is still relatively poor. Improved means of communicating information and more effective warning labels on cigarette packaging are necessary for increasing public awareness of tobacco hazards, particularly among rural residents and people with less education.

A Behavioral Economics Perspective on Tobacco Taxation

Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco's hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country's circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.

A study on prevalence of chewing form of tobacco and existing quitting patterns in urban population of Jamnagar, Gujarat

Background:Awareness towards tobacco hazards has increased with time but its role alone towards cessation is questionable. With widespread menace of tobacco in developing countries like India, not much tobacco chewing prevalence and their quitting patterns data are available in urban Saurashtra region.Objectives:1. To find out prevalence of various forms of chewing tobacco and quitting attitudes in urban Jamnagar. 2. To study quitting patterns in relation with age of habit initiation, family background and habit duration.Materials and Methods:It was a cross-sectional study involving 2513 individuals as study population by 30-cluster sampling method. The study was carried out between June 2007 and March 2008. Pre-set, pre-tested questionnaire was used for interview purpose and the statistical analysis was done on proportion basis.Results:About 37.2% of study population was ever-tobacco-chewers; 32.9% of them were current-chewers and 4.3% were quitters. Approximately 28.4% of current-consumers were willing to quit. Mawa-masala (63.7%) and Gutka (57.6%) were preferred forms of chewing tobacco and 57.5% of the current-chewers chewed tobacco six to eight times a day. Tobacco initiation age between 20 and 30 years was commoner among quitters (84.2%), while a little younger in current-consumers (76.5%). About 58.3% quitters and 74.0% chewers showing willingness to quit had not consumed tobacco for more than five years, 63.8% of current-chewers had a family member consuming tobacco. With initiation of health problems, 72.2% subjects quit and 55.5% of them already knew about health hazards.Conclusions:Every 4 out of 10 residents was found to be exposed to chewing tobacco. With Mawa-masala and Gutka being the predominant forms, habit onset in late adolescence, years of consumption and family exposure seem to be hampering quitting. Awareness about tobacco hazards alone does not appear to be resulting in successful quitting.

Call centre employees and tobacco dependence: Making a difference

India is known as the Business Process Outsourcing (BPO) capital of the world. Safeguarding health of millions of youngsters employed in this new growing economy is an occupational health challenge. This study was initiated in June 2007 in India with the objectives to assess the prevalence of tobacco use and study the factors responsible for initiating and continuing its use. The main aim, however, was to assess the effect of different tobacco cessation intervention strategies, thus identifying effective methods to assist these employees to quit tobacco. This is a 4-arm cluster randomized trial of 18 months duration among 646 BPO employees, working in 4 different BPO units. The employees were invited to participate in interviews following which tobacco users of each BPO were offered specific tobacco cessation interventions to assist them to quit tobacco use. The prevalence of tobacco dependence is 41%, mainly cigarette smoking. The tobacco quit rate is similar (nearly 20%) in the 3 intervention arms. Significantly higher reduction in tobacco consumption of 45% is seen in Arm 4 with the use of pharmacotherapy. BPO employees change jobs frequently, hence follow-up remains a major challenge. Inaccessibility of pharmacotherapy in the developing countries should not deter tobacco cessation efforts as good tobacco quit rates can be achieved with health education and behavioral therapy. Tobacco cessation should be an integral activity in all BPOs, so that the employees receive this service continuously and millions of our youths are protected from the hazards of tobacco.

Fundamentals of cancer epidemiology – 2nd edition

Recognizing the increasing cancer burden worldwide, Nasca & Pastides provide a basic understanding of cancer epidemiology, with a particular focus on cancer biology, gene–environment associations in the cancer etiology and major risk factors for cancer. The intended readers are students in public health schools and related medical and para-medical fields as well as those working in cancer control on a regional, national and international level. Since, according to the authors, there is no textbook dealing with cancer epidemiology for first-time students, this book aims to be such a textbook for those with basic knowledge in epidemiology. Nasca & Pastides begin by emphasizing the importance of describing the cancer burden and trends using appropriate measures. Then they explain what cancer is and how it can be diagnosed and categorized using different cancer classification schemes (e.g staging, coding). Chapters 3–7 contribute to the methodological and technical knowledge on cell biology and on study types, which are of particular relevance for investigating carcinogenicity, biomarkers and genetic risk factors. Among them are experimental studies, molecular–epidemiological studies, studies on gene–environment interactions and genetic epidemiology studies. The subsequent chapters (8–16) describe risk factors for cancer in a detailed and comprehensive way. Not only are classic lifestyle and well known risk factors such as tobacco, alcohol, diet and occupational hazards considered but also genetic factors, ionization and radiation, infections, immunological factors and hormones. Possible dose–response relationships are addressed and figures and illustrations help to understand the etiology and terminology. The chapters on risk factors are internally structured in different ways, some by cancer sites, others by the particular factors associated with the increased risks, taking into account the different study types that address these associations. One whole chapter is dedicated to the risk factors for and occurrence of childhood cancers and points out the need for the life–course perspective in cancer research. This chapter was newly added into this second edition. The last section gives an introduction to cancer screening as a method for early detection using certain cancers as examples to demonstrate different screening concepts. Although the chapter on infectious agents and occupational carcinogens addresses the disproportionate geographical burden between high- and low-income countries, not much information in general is provided on geographical differences in cancer burden and survival. Using “descriptive epidemiology” as a chapter heading, one would expect more technical information on what this is. The book makes us aware of the need to take care in interpreting comparisons, trends and data on cancer occurrence; however, it does not state how to carefully interpret these statistics. The authors use tables and figures that aid in understanding the burden of cancer and distribution of cancer sites as well as the categorization within different cancer classification schemes. Several illustrations are used to make etiology and biology of cancer understandable also to non-medical professionals. The appendix provides a detailed glossary with a particular focus on biological and medical terminology, a feature that is usually available in reference books used by medical students. Appendix B lists web sites without indicating the kind of information they could provide to the reader. A more helpful table for major cancer web resources is available on page 3. Every chapter ends with a summary and discussion questions. However, it would be helpful to provide specific answers to these questions in the appendix, which would make an improvement to the relatively ineffectual appendices. The book is an important reference book for students, whether beginners or post-graduate students. It is written in a clear language, is well ordered and accurate. Nevertheless, several cancer epidemiology textbooks are already available from IARC (International Agency for Research on Cancer). Thus the main strength of this book is its strong biological and medical basis as well as the up-to-date reference to the continuum of genetics and biomarkers in cancer epidemiology. Although health policy-makers are not the priority audience, and few words are said on cancer control activities, an introduction in this field would significantly add to Fundamentals of cancer epidemiology. ■

Control of tobacco-related disease.

As ways of discouraging tobacco consumption, the effects of increases in price and in quantitative information may have been under-emphasized. To decrease the hazards of tobacco, switches from cigarettes to pipes, cigars or 'smokeless' tobacco may be useful, as may a reduction in cigarette tar delivery. Indeed, the spread of existing tar level reductions from capitalist to socialist countries might prevent tens of thousands of lung cancer deaths each year in the early decades of the next century, and (perhaps by attempts to engineer cigarettes so that smokers of lower tar cigarettes are less likely to 'compensate' by taking more smoke) it should eventually also be possible to change cigarettes so as also to reduce their effects on heart and lung disease. Changes in consumption and in composition of tobacco products are complementary, not competing, strategies. If both are pursued effectively, then although the life expectancy of old people may not be much improved, the proportion of adults who die before reaching old age will decrease substantially.

Are nurses prepared to curb the tobacco epidemic in China? A questionnaire survey of schools of nursing

Background Smoking prevalence among Chinese males is the highest in the world and its morbidity and mortality is growing. Previous studies suggested nurses are inadequately prepared to treat tobacco use and dependence. Objectives To examine the inclusion and organization of tobacco control content in the undergraduate nursing curriculum of Hong Kong and Mainland China; and the smoking status of faculty and students. Design Cross-sectional survey. Methods Deans of 32 nursing schools in Hong Kong and China with an undergraduate programme (representing over 12000 students) completed a self-administered questionnaire. Results Most schools included the health hazards of tobacco (56.3–100%), but few covered tobacco cessation theory (31.3–62.5%), or behavioural (9.4–56.3%) and pharmacological (3.1–34.4%) interventions in the curriculum. Most curricula covered less than 1 h of tobacco content per year of study. Nearly all schools (93.1%) reported smoking among faculty but only half reported access to smoking cessation programmes. Conclusions This is the first known study to examine the extent of tobacco control education in the nursing curriculum in China. Results suggested deficiencies in the coverage and clinical practice in smoking and smoking cessation, and recommendations were made to strengthen the curriculum.

Excess injury mortality among smokers: a neglected tobacco hazard

Objective: To assess the mortality risks from injuries for smokers and ex-smokers and to quantify the mortality burden of smoking from injury in Taiwan. Methods: Smokers’ (and ex-smokers’) mortality risks...