Public Smoking Research Articles

Abstract CN11-02: Models of the pathways between socioeconomic status and health

Abstract CN11-02: Models of the pathways between socioeconomic status and health

Study of secondhand smoke levels pre and post implementation of the comprehensive smoking ban in Mumbai

Objectives:This research was undertaken with the aim of assessing the indoor air quality in popular hospitality venues, as also to evaluate the effectiveness of the nationwide comprehensive public smoking ban. The analysis was split into two halves – baseline study taken up prior to implementation of the said ban on 2nd October 2008, and the follow-up study after it came into effect.Materials and Methods:Twenty-five venues including five restaurants, fourteen resto-bars, two hookah (smoking water-pipe) cafes and four pubs were selected using a mix of random, convenience and purposeful sampling. Particulate matter (PM2.5) measurements at these venues were made using TSI SidePak AM510 Personal Aerosol Monitor.Results:The average PM2.5 level in venues where smoking was permitted prior to implementation of ban was found to be 669.95 μg/m3 in the baseline study. Post ban, the average PM2.5 level in same test venues reduced to 240.8 μg/m3. The hookah cafes were an exception as the average PM2.5 levels exceeded the permissible limits before as well as post ban.Conclusion:The baseline study showed that the hospitality venues had hazardous levels of PM2.5 particles arising from second-hand smoke prior to smoking ban. These decreased by a maximum of 64% after the law took effect. A substantial improvement in air quality at these venues post implementation of the smoking ban indicated the effectiveness of the law.

Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland.

On March 1st, 2008 a smoking ban in public buildings became effective in the Canton of Graubuenden, Switzerland. The aim of our study was to investigate, whether implementation of this new regulation was followed by a decrease in the incidence of acute myocardial infarction (AMI). The Kantonsspital Graubuenden serves as a tertiary care hospital, possessing the only cardiac catheterization laboratory in the Canton of Graubuenden. Based on an excellent functioning network including all hospitals in the Canton of Graubuenden, virtually all patients experiencing an AMI in the Canton of Graubuenden are transferred to our hospital for either acute or early coronary angiography. Data of all patients with AMI undergoing coronary angiography at our hospital between March 1st, 2008 and February 28th, 2009 were collected prospectively. The data were then compared with those of the two corresponding 12-month periods preceding implementation of the public smoking ban. In the two years before adoption of smoke-free legislation, the number of patients with AMI was 229 and 242, respectively (p = ns). In the 12 months after implementation of the public smoking ban, the number of AMI patients dropped to 183 (p <0.05 vs. each of the previous 12-month periods), representing an overall 22% reduction in the AMI incidence within the first year after enactment of the new regulation. This reduction was driven by a significant decrease in the AMI incidence in men, nonsmokers, and individuals with established coronary artery disease, including those with prior AMI or prior percutaneous coronary intervention. Similar to other countries in Europe and various regions of the USA and Canada, implementation of a public smoking ban was followed by a significant early decline in the incidence of AMI in the Canton of Graubuenden, Switzerland.

One Last Puff? Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's sixteen federal states. We exploit this variation in the timing of state bans to identify the effect that smoke-free policies had on individuals' smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates also point to important heterogeneous effects. Groups that go out more often, and hence are more exposed to the constraints of public smoking bans in everyday life, did adjust their smoking behavior. Specifically, we find that young, unmarried individuals, men, and those living in urban areas are groups that are both less likely to smoke and smoke less intensively following the introduction of public smoking bans. Furthermore, effects on individual smoking habits proved stronger in states that had more strict smoking bans. Public smoking bans, therefore, have important health benefits over and above the reduction in exposure of non-smokers to second-hand smoke that is their immediate and prime objective.

Much Ado About Nothing? Smoking Bans and Germany’s Hospitality Industry

Over the last years, public smoking bans have been introduced in most European countries. Unlike elsewhere, in Germany such bans were introduced at state level at different points in time, which provides important intra-country regional variation that can be exploited to identify the effects of such bans on the hospitality industry. Using monthly data from a compulsory survey carried out by the German Federal Statistical Office, we study the short-run effects that these bans had on establishments’ sales. In contrast to the largely US-based literature, we find that smoke-free policies had a negative (yet moderate) effect on establishment sales. Closure rates of businesses in the hospitality industry.

One Last Puff? - Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's federal states. We exploit this variation to identify the effect that smoke-free policies had on individuals’ smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates point to important heterogeneous effects. Individuals who go out more often to bars and restaurants did adjust their smoking behavior. Following the ban, they became less likely to smoke and also smoked less.

One Last Puff? Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's sixteen federal states. We exploit this variation in the timing of state bans to identify the effect that smoke-free policies had on individuals' smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates also point to important heterogeneous effects. Groups that go out more often, and hence are more exposed to the constraints of public smoking bans in everyday life, did adjust their smoking behavior. Specifically, we find that young, unmarried individuals, men, and those living in urban areas are groups that are both less likely to smoke and smoke less intensively following the introduction of public smoking bans. Furthermore, effects on individual smoking habits proved stronger in states that had more strict smoking bans. Public smoking bans, therefore, have important health benefits over and above the reduction in exposure of non-smokers to second-hand smoke that is their immediate and prime objective.

Smoking Cessation: It Is Never Too Late

Public health and smoking are old enemies because smoking is among the 10 leading causes of ill health on a global scale and is also possible to prevent, as repeatedly reported (1). In both developed and developing countries, smoking takes its heavy toll of lives every year, both directly and indirectly, through exposure to passively inhaled tobacco smoke (2) or via feto-placental effects. Much research efforts have been devoted to finding news ways to help the individual smoker quit the harmful habit, not only based on individual (3) or group-based support activities (4), as supported by the whole health care team, but also on ways of prescribing both older and newer drugs to support smoking cessation. Even if nicotine replacement therapy (5) in its various forms has been around for almost 3 decades and the atypical antidepressant bupropion (6) for ∼10 years, new target drugs are constantly being developed to support the addicted smoker in quitting permanently. Such drugs may be useful for very large groups of addicted smokers who have tried the other ways to quit in vain. One example is varenicline, a partial nicotine receptor agonist that has been proven successful in randomized controlled trials, both for smoking cessation and for relapse prevention (7–10). The effect is more pronounced than recorded by use of nicotine replacement therapy or bupropion. Other ways might also exist to achieve smoking cessation, such as the use of acupuncture, hypnosis, or psychopharmacological approaches, but these remedies are less well proven and therefore not truly evidence based. However, older drug preparations are developing. New faster delivery nicotine replacement drug delivery systems (11) bear the promise of addressing a broader list of indications, including treatment of nicotine withdrawal during …

Legislating tolerance: Spain's national public smoking law

While Spain's national tobacco control legislation prohibits smoking in many indoor public places, the law provides for an exception to the prohibition of smoking by allowing separate seating sections and ventilation options in certain public places such as bars and restaurants, hotels and airports. Accordingly, Spain's law is not aligned with Article 8 Guidelines of the World Health Organization's Framework Convention on Tobacco Control, which requires parties to ensure universal protection against secondhand smoke exposure in all enclosed public places, workplaces and on all means of public transport. Spain's law is currently being promoted by the tobacco companies in other countries as a model for smoke-free legislation. In order to prevent weakening of smoke-free laws in other countries through industry-supported exceptions, we investigated the tactics used by the tobacco companies before the implementation of the new law and assessed the consequences of these actions in the hospitality sector. Internal tobacco industry documents made public through US litigation settlements dating back to the 1980s were searched in 2008-9. Documents show that tobacco companies sought to protect hospitality venues from smoking restrictions by promoting separate seating for smokers and ineffective ventilation technologies, supporting an unenforceable voluntary agreement between the Madrid local government and the hospitality industry, influencing ventilation standards setting and manipulating Spanish media. The Spanish National Assembly should adopt comprehensive smoke-free legislation that does not accommodate the interests of the tobacco industry. In doing so, Spain's smoke-free public places law would be better aligned with the Framework Convention on Tobacco Control.

Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors

The lack of scientific evidence on the constituents, properties, and health effects of second-hand waterpipe smoke has fueled controversy over whether public smoking bans should include the waterpipe. The purpose of this study was to investigate and compare emissions of ultrafine particles (UFP, <100 nm), carcinogenic polyaromatic hydrocarbons (PAH), volatile aldehydes, and carbon monoxide (CO) for cigarettes and narghile (shisha, hookah) waterpipes. These smoke constituents are associated with a variety of cancers, and heart and pulmonary diseases, and span the volatility range found in tobacco smoke. Sidestream cigarette and waterpipe smoke was captured and aged in a 1 m 3 Teflon-coated chamber operating at 1.5 air changes per hour (ACH). The chamber was characterized for particle mass and number surface deposition rates. UFP and CO concentrations were measured online using a fast particle spectrometer (TSI 3090 Engine Exhaust Particle Sizer), and an indoor air quality monitor. Particulate PAH and gaseous volatile aldehydes were captured on glass fiber filters and DNPH-coated SPE cartridges, respectively, and analyzed off-line using GC–MS and HPLC–MS. PAH compounds quantified were the 5- and 6-ring compounds of the EPA priority list. Measured aldehydes consisted of formaldehyde, acetaldehyde, acrolein, methacrolein, and propionaldehyde. We found that a single waterpipe use session emits in the sidestream smoke approximately four times the carcinogenic PAH, four times the volatile aldehydes, and 30 times the CO of a single cigarette. Accounting for exhaled mainstream smoke, and given a habitual smoker smoking rate of 2 cigarettes per hour, during a typical one-hour waterpipe use session a waterpipe smoker likely generates ambient carcinogens and toxicants equivalent to 2–10 cigarette smokers, depending on the compound in question. There is therefore good reason to include waterpipe tobacco smoking in public smoking bans.

Public Smoking Bans Tied to 17% Cut in MIs

Public Smoking Bans Tied to 17% Cut in MIs

Perfil de fumantes atendidos em serviço público para tratamento do tabagismo

To evaluate the characteristics of smokers seeking treatment in a public smoking cessation program. This was a retrospective evaluation of data collected during the interview for enrollment in the smoking cessation program of the Smoking Outpatient Clinic of the Paulista State University School of Medicine in the city of Botucatu, Brazil, between April of 2003 and April of 2007. Demographic variables; previous use of the behavioral approach, medications or alternative treatments for smoking cessation; degree of nicotine dependence; and history of comorbidities were evaluated in 387 smokers. In our sample, 63% of the smokers were female. The mean age of the subjects was 50 + or - 25 years. More than half of the subjects (61%) had up to eight years of schooling, and 66% had a monthly income of less than twice the national minimum wage. The degree of nicotine dependence was high/very high in 59%, medium in 17% and low/very low in 24% of the subjects. Although 95% of the patients presented comorbidities, only 35% had been referred to the program by a physician. More than half of the subjects (68%) had made at least one smoking-cessation attempt, 83% of whom did so without the help of a structured program. Smokers seeking assistance for smoking cessation were socially disadvantaged, presented a high degree of nicotine dependence and had previously made smoking-cessation attempts without the benefit of a structured program. Therefore, in order to be effective, smoking control interventions should take into consideration the general characteristics of the smokers treated via the public health care system.

Cardiovascular Effect of Bans on Smoking in Public Places: A Systematic Review and Meta-Analysis

A systematic review and a meta-analysis were performed to determine the association between public smoking bans and risk for hospital admission for acute myocardial infarction (AMI). Secondhand smoke (SHS) is associated with a 30% increase in risk of AMI, which might be reduced by prohibiting smoking in work and public places. PubMed, EMBASE, and Google Scholar databases plus bibliographies of relevant studies and reviews were searched for peer-reviewed original articles published from January 1, 2004, through April 30, 2009, using the search terms "smoking ban" and "heart" or "myocardial infarct." Investigators supplied additional data. All published peer-reviewed original studies identified were included. Incidence rates of AMI per 100,000 person-years before and after implementation of the smoking bans and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. Random effects meta-analyses estimated the overall effect of the smoking bans. Funnel plot and meta-regression assessed heterogeneity among studies. Using 11 reports from 10 study locations, AMI risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation. Smoking bans in public places and workplaces are significantly associated with a reduction in AMI incidence, particularly if enforced over several years.

Smoking Bans, Health and Science: A Comparative Study of Policy Networks and Smoking Policies in England, Germany and Denmark

After long trailing the American development on tobacco control, Europe has seen a big wave of public place smoking bans in the past five years, beginning when Ireland took the plunge and banned all smoking in workplaces in 2004. Inspired by the Irish development, most European countries have now introduced their own smoke-free legislation and in most cases, the main topic of debate is the question of banning smoking in bars and restaurants to protect employees and other customers against second hand smoking.The simultaneous timing of European smoke-free legislation and the general consensus on conclusive evidence against second hand smoking hide interesting comparative differences between countries, however. What may seem like petty differences between partial smoking bans on one hand and Irish-style comprehensive smoking bans with no loopholes or dedicated smoking rooms on the other, the impact on the ground level is significant. For example, while practically no bars are entirely smoke-free in Berlin, all pubs in London are. The question is what can explain these policy differences and what this tells us about the balancing of health concerns, scientific knowledge, economy and individual rights in the formation of public health policy.The paper compares England, Germany and Denmark who all adopted legislation on second hand smoking in public places in 2007, but where the English ban is as comprehensive as the Irish, the German is a minimal one with Denmark somewhere in the middle. The paper suggests these differences can be explained by looking at the formation of policy networks around tobacco control in each country and how these networks privilege health arguments differently, in particular by granting different roles for the impact of scientific knowledge on policy. The empirical argument is backed by research interviews with policymakers, anti-tobacco advocacy groups and scientists involved in the public debate about smoking in addition to material on the policy process in each country. Altogether, this analysis should help to explain the different policy paths as well as extend our understanding of the relationship between scientific knowledge and public health policy.

DOUBLE PROTECTION: Reaching Accord on the Ethical Conduct of Child Observational Research

From Bernardino Ramazzini’s visits to seventeenth-century craftsmen’s worksites—where he made observations that earned him the title of “father of occupational medicine”—to modern-day research leading to bans on public smoking, observational studies have improved and enhanced environmental health. Such studies involve observing people’s everyday lives, defining the characteristics of their environments, and determining whether any risks arise from activities within the context of those environments. Modern environmental observational studies, including the recently launched National Children’s Study, also measure environmental compounds and their metabolites in people’s bodies while assessing sources and routes of exposure so that the appropriate agencies can initiate reduction strategies if high exposures are seen. Generally, an observational study is conducted without the observer intervening with research subjects to avoid undermining research goals. However, strict adherence to this practice could create significant ethical concerns, particularly when a vulnerable subject such as a child is at risk for harm. Misunderstandings and disagreements about how those concerns should be addressed in children’s observational exposure studies have forced researchers and policy makers to more precisely—and now possibly successfully—define what constitutes a scientifically rigorous and ethical study.

Rauchverbote in öffentlichen Räumen: Aktuelle epidemiologische Evidenz für kardiovaskuläre Gesundheitseffekte auf Bevölkerungsebene

During the past years smoking bans in public places including hospitality venues have been introduced in several countries. Up to now, eight ecological studies on hospital admission rates due to acute myocardial infarction or coronary events after introduction of a smoking ban in the United States, Canada, and Italy have been published. This article reviews these studies and discusses their significance and potential sources of error from an epidemiological point of view. The chronological order of reduction in acute myocardial infarction rates following the smoking ban, the consistency of this association in several countries, and the biological plausibility because of the known acute cardiovascular effects of secondhand smoke suggest a causal association. Thus, if this turns out to be true public smoking bans will be a very effective public health measure.

POLICY: Smoking Bans Yield Long-Term Benefits

When it comes to linking cigarette smoke to heart attacks, one might assume that such a link would apply only as long as one is smoking or being exposed to secondhand smoke. That’s not necessarily true, however, at least according to a follow-up study of people living in and around Pueblo, Colorado. In the 2 January 2009 issue of Morbidity and Mortality Weekly Report (MMWR), researchers reported that hospitalizations in Pueblo for acute myocardial infarction (AMI) showed a steady, continuous decline three years after the city introduced a smoking ban in all public buildings. In November 2005, researchers first began to report that a smoking ban in all public buildings in Pueblo was associated with a significant reduction in the number of hospitalizations for AMI [see EHP 114:A154 (2006)]. In the 18 months after the ban came into force, the number of such hospitalizations fell 27%, from 257 to 187 per 100,000 person-years. Only a small reduction was seen for the population living outside the city limits, and no reduction was seen in neighboring El Paso County—areas unaffected by the ban. The new figures published in MMWR examine the three years since the smoking ban began and show that the number of hospitalizations for AMI has continued to decline to 152 per 100,000 person-years, says Robert Alsever, medical director for health information at the Parkview Medical Center in Pueblo and first author of the update report. That’s a 19% reduction over the figure for the first 18 months after the ban began and a total 41% reduction since the ban started, he says. The point at which these improvements will level off remains to be seen. In a review published in the February 2009 issue of Preventive Medicine, Lorenzo Richiardi and colleagues noted that at least 10 studies in the United States and Europe had reported a reduction in the number of hospital admissions for AMI in the months following the introduction of regulations banning smoking in public places. The decreases observed ranged from 8% in New York State to 40% in Helena, Montana. Specifically, the Helena study found a 40% decline in hospital admissions for AMI during a 6-month smoking ordinance within Helena city limits; however, this was a relatively small population study. An editorial note that accompanies the MMWR report observes that a meta-analysis of seven other studies and one unpublished study yielded a pooled estimate of a 19% reduction in AMI hospitalization rates after implementation of public smoking bans. Three studies suggested these reductions were more pronounced among non smokers than among smokers. The Pueblo study, however, did not assess what portion of the observed decrease in hospitalizations could be attributed to reduced secondhand smoke exposure among nonsmokers or to quitting among smokers. Even though the prevalence of smoking dropped in Pueblo County as a whole, the difference over time was not statistically significant. As the editorial note explains, “the ecologic nature of this study precludes definite conclusions about the extent to which the observed decline in AMI hospitalizations in the city of Pueblo was attributable to the smoke-free ordinance.” One concept that may begin making its way into tobacco control policies and programs is that of “thirdhand smoke,” which refers to the chemicals in cigarette smoke that settle on the surfaces inside a home. Jonathan Winickoff, a pediatrician at the Dana-Farber/Harvard Cancer Center, is one of a growing number who believe these deposited chemicals pose a hazard to occupants’ health days after a cigarette is stubbed out. “Children are particularly likely to come into contact with this third-hand smoke,’” explains Winickoff. “The chemicals in smoke may stick to objects for many days and are gradually released back into the air, so infants and children breathe in and ingest tobacco toxins as they crawl over, mouth, and play on contaminated surfaces.” In a survey published in the January 2009 issue of Pediatrics, Winickoff’s team asked U.S. adults to describe their beliefs about the health effects of second- and thirdhand cigarette smoke. Many people reported believing that thirdhand smoke is far less of a health concern for children than secondhand smoke. Those who did report believing thirdhand smoke poses a hazard to children were more likely to enact strict smoking bans inside their homes. Says Winickoff, “These findings suggest that if more people understood the dangers of thirdhand smoking, especially to their children, we might see more nonsmoking policies adopted in the home.”

Effectiveness of Public Health Center Smoking Cessation Counseling Program using the Transtheoretical Model

The purpose of this study was to identify the effectiveness of public health center smoking cessation counseling program using the transtheoretical model on the process of change, smoking temptation, decisional balance and stage change transition. A nonequivalent control group non-synchronized design was used for this study. The study population was 115 adult smokers. The counseling program was administered to the experimental group and a smoking cessation program from the Korean Ministry of Health & Welfare was administered to the control group. Descriptive analysis, chi(2)-test, t-test, and ANCOVA were used with the SPSS 12.0 program to analyze the data. After treatment with this program, the experimental group showed significantly higher scores for process of change (t=4.148, p<.001), smoking temptation (t=-2.988, p=.003), and stage change transition (chi(2)=5.871, p=.031) compared to the control group. Experimental group members also showed significantly lower score for Pros of smoking (t=-3.151, p=.002). The findings indicate that this program could have positive effect on process of change, smoking temptation, decisional balance and stage transition for adult smokers. Based on these findings, the authors suggest additional counseling program focusing on smokers in specific stages.

Will the Doctor Stop Smoking?!

Cigarette smoking is frequently described as the most common preventable cause of death. According to the World Health Organization (WHO), by the end of the 21st century one billion people will die of smoking-related diseases, cancer will be the number one killer worldwide by 2010, and by 2030 tobacco smoking will be responsible for 8 million deaths per year [1]. These grim forecasts stem primarily from the widespread tobacco consumption mainly in Asia and Africa. Cigarette smoke contains thousands of toxic chemicals many of which are carcinogenic, prothrombotic, and/or atherogenic. The destructive effects of smoking harm virtually every organ-system in the body. In addition to lung cancer, smoking increases the risk of a vast array of diseases including other cancers (gastroesophageal and nasopharyngeal), respiratory tract infections, chronic obstructive pulmonary disease (COPD), stroke, coronary artery disease, aneurysm, peripheral vascular disease, psoriasis, sudden infant death syndrome (SIDS), infertility, and sexual dysfunction. In the United States the number of smokers has steadily declined over the past twenty years to <25% of the adult population. This was the result of intense public awareness programmes, higher taxes, and smoking bans in public places. These measures were fueled in part by dramatic revelations regarding the deliberate recruitment by the tobacco companies of teenagers into the ranks of nicotine addicts through targeted, misleading advertisement campaigns. However, the alarmingly high number of smokers in the developing countries particularly in China, India, and the Arab countries, either remains high or is getting higher. More surprising is the smoking prevalence among physicians in different parts of the world. A 1995 study in Greece found between 40 and 55% of physicians smoked regularly more than 20 cigarettes per day [2]. In Alexandria (Egypt), approximately 50% of physicians still smoke [3] today. In Jordan's largest tertiary care hospital, 44% of internists and 75% of the emergency department's physicians still smoke regularly; fortunately none of the pulmonologists in this hospital smokes [4]. However, in Poland approximately 10% of pulmonologist still smoke [5]. In northern Italy [6], smoking prevalence among general practitioner was found to be around 22% in 2006, and it has declined dramatically in Croatia (<20%), Turkey (<15%), and New Zealand (<15%) [7]. I am not aware of any published surveys or studies dealing with the prevalence of smoking among Libyan physicians and other healthcare workers, but anecdotal reports suggest that the habit is common in Libyan hospitals. However, some interesting data concerning smoking prevalence and attitude toward various forms of tobacco consumption among Libyan students have been recently published in a correspondence to this journal [8]. Physicians and healthcare professionals in general must play an active role in patient education and in establishing effective tobacco control policies. Smoking prevalence among physicians is an extremely important issue because there is evidence that the smoking status of physicians significantly influences their attitude toward smoking cessation and their ability to initiate and effectively pursue patient counseling on smoking [9]. Needless to say those physicians who still smoke should not rest until they have successfully kicked the habit. It is also imperative that the medical school curricula include extensive and repeated coverage of the subject, and that a national smoking cessation program be designed and implemented. The long-term rewards of such programs can not be overestimated both in terms of public health and national economy. In addition, every physician should make it a duty to follow up on initial patient consultation and make smoking cessation a topic of a brief and pointed discussion in every patient visit in order to reinforce the message and provide the moral support that patients are known to value highly. Some surveys showed that <30% of physicians believed in the utility of pharmacologic intervention in smoking cessation; this suggests that physicians have limited knowledge in this area perhaps due to insufficient exposure to the more recent literature. Patient education coupled with direct counseling and pharmacotherapy has proved effective in achieving complete nicotine independence. In the following, I summarize the major pharmacotherapeutic interventions that are often used to help smokers overcome the consequences of nicotine withdrawal (anxiety, irritability, and the inability to concentrate). It should be noted that the rate of success of pharmacotherapy is highly dependent on social/emotional support and consistent, repeated face-to-face counseling by physicians and other healthcare professionals. Weight gain is often a side effect of smoking cessation, but it can be effectively controlled through dietary changes and exercise.

Predicting Greek adolescents’ intentions to smoke: A focus on normative processes.

To examine the effects of normative influences on adolescent smoking in Greece, a country with weak social norms against smoking and relatively ineffective tobacco control policies. A cross-sectional survey methodology was employed, and a representative sample of Greek high school students was recruited (N = 1,920, M age = 14 years). Normative beliefs, attitudes, perceived behavioral control, self-esteem, and intentions to smoke. Multiple-regression and mediation analyses were conducted. The effects of public smoking on intentions to smoke were mediated by beliefs of perceived prevalence of smoking among peers, subjective norms, and situational temptations. Self-esteem significantly moderated the effects of subjective norms on intentions to smoke. Prosmoking norms in one's environment become internalized into biased normative beliefs about smoking, and increase susceptibility to smoke under social pressure. The effect of subjective norms on intentions to smoke was stronger among adolescents with low self-esteem, suggesting that self-esteem may act as a vulnerability factor in the process of smoking initiation.