Public Smoking Research Articles

Incidence of acute myocardial infarction after implementation of a public smoking ban in Graubünden, Switzerland: Two year follow-up

In the first year after implementation of a public smoking ban a significant decrease in the incidence of acute myocardial infarction (AMI) was observed in Graubünden. In the present study we analyzed the incidence of AMI in the second year of the ban. In addition, we investigated the contribution of smoking ban-unrelated factors to the reduced incidence of AMI incidence observed after enactment of the ban. Data of all AMI patients who underwent coronary angiography at the Kantonsspital Graubünden, the only tertiary care hospital with a cardiac catheterization laboratory in Graubünden, between March 1st, 2009 and February 28th, 2010 were collected prospectively. Data were compared with those of the three preceding 12-month periods. We also estimated AMI incidence during the corresponding time period in Lucerne, a region with no smoke-free legislation, using data of the AMIS Plus registry. The influence of outdoor air pollution was analyzed with the help of official measurements of PM(10)- and NO(2)-concentrations in Graubünden. The prescription of lipid-lowering drugs was estimated by using sales figures in Graubünden and Lucerne. In Graubünden, the number of patients with AMI in the second year after adoption of the smoking ban was similar to that in the first year of the ban (188 vs. 183; P = ns) and significantly lower than in each of the two years preceding the ban (229 and 242, respectively; P <0.05 vs. each of the 12-month periods after the ban). Overall, the number of AMI patients in the two post-ban years was 21% lower than in the two pre-ban years. The reduction in the number of patients with AMI was most pronounced in non-smokers and individuals with known coronary artery disease. During the corresponding time period, no similar decrease in the incidence of AMI was observed in Lucerne. No association was found between the magnitude of outdoor air pollution and the incidence of AMI. During the observation period, the use of lipid-lowering drugs increased similarly in Graubünden and Lucerne. Compared with the two years preceding the implementation of a smoking ban, the incidence of AMI remained significantly reduced in the second year of the ban in Graubünden, whereas no similar reduction was seen in a comparable area without smoke-free legislation. Changes in outdoor air pollution or the use of lipid-lowering drugs did not substantially contribute to the decrease in the incidence of AMI that occurred after adoption of the ban in Graubünden.

Smoking and Predictors of Nicotine Dependence in a Homeless Population

To assess prevalence rates of tobacco use and dependence in a sample of homeless individuals and to investigate trends for demographic and clinical characteristics across different levels of nicotine dependence (nonsmokers vs. lowly dependent smokers vs. highly dependent smokers). A cross-sectional study of 489 homeless men and women in 3 Canadian cities. Each subject was assessed using structured clinical interviews and the Fagerström Test for Nicotine Dependence (FTND). Cochran-Armitage trend tests were applied to determine unadjusted trends in sociodemographic and clinical variables across levels of nicotine dependence. A generalized logit model was computed to adjust for potential confounding. The mean age was 37.9 years; 39.2% of the participants were women. About 80.8% were current smokers; the mean FTND score was 5.0. Although no significant differences were found between nonsmokers and smokers with low nicotine dependence, smokers with high nicotine dependence were only half as likely as nonsmokers to be Aboriginal, were 2.39 times more likely to have ever been incarcerated, and 2.44 times more likely to have current drug dependence. There were significant trends for the use of cocaine, opioids, and alcohol, with nonsmokers having the lowest and highly dependent smokers having the highest rates of using these substances. Available public health smoking cessation treatment opportunities should be made available within health care services for the homeless. There is also a need for developing and implementing tobacco dependence treatment programs, which are accessible and tailored to meet the needs of this specific population, accounting for polysubstance use and concurrent substance dependence and mental health disorders.

News and Notes

News and Notes

Pharmacotherapy for Smoking Cessation

Promoting smoking cessation is among the key medical interventions aimed at reducing worldwide morbidity and mortality in this century. Both behavioural counselling and pharmacotherapy have been shown to significantly increase long-term abstinence rates, and combining the two treatment modalities is recommended. This article provides an update on pharmacotherapy for smoking cessation in the general population. Current first-line agents used to support quit attempts are nicotine replacement therapy (NRT), bupropion and varenicline. Research suggests that abstinence rates can be increased by combining different forms of NRT or simultaneously administering NRT and non-nicotine medications. New treatments targeting the nicotinic acetylcholine receptor as well as other pathophysiological pathways involved in nicotine addiction are being developed, with nicotine vaccines now being tested in phase III clinical trials. Among the numerous research topics currently addressed, pharmacogenetics and tailoring therapy to specific groups of smokers look most promising. However, substantial progress is unlikely to be made unless social gradients impeding effective treatment of all smokers are overcome. In addition, public smoking bans and reimbursement of medication costs are crucial in reducing the future burden of disease caused by smoking on a global level.

Cost Effectiveness of Tobacco Control Policies in Vietnam

Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. <GDP per capita). Graphic warning labels on cigarette packs was the most cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector. All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

Effects of household, workplace, and public place smoking restrictions on smoking cessation

The aim of this study was to evaluate the association between environmental smoking restrictions, distinguished by site, and smoking cessation by Chinese urban residents. Recruited through multi-stage quota-sampling, residents in six Chinese cities were surveyed. Data were both individual-level and city-level. Among 4735 respondents, 715 were identified as successful quitters and 405 as unsuccessful. Multilevel logistic regression analysis showed smoking cessation to be associated with city-level public place and workplace restrictions and individual-level workplace and household restrictions. Results offer justification for decision-makers to implement environmental tobacco control policies and related public health interventions aimed at markedly diminishing the high smoking prevalence in China.

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.

Abstract 1883: Smoking and lung cancer in the United States: Geographic variations by state over time

Abstract Introduction: Years of research have confirmed a causal association between lung cancer and chronic exposure to tobacco products. It is estimated that active smoking is responsible for approximately 90 % of lung cancer cases. In 2009, lung cancer accounted for approximately 28% of all cancer deaths. However, there have been significant improvements in controlling population exposures to these carcinogens. Our research reviewed the implementation of smoking bans across the United States and correlated prevalence and incidence rates of lung cancers across states over the last six years. Methods: Lung cancer data were obtained from the Cancer in North America (CINA) database. Prevalence and incidence of current smokers by state, race, and gender were obtained from the CDC's morbidity and mortality weekly report (MMWR) for the years 2004, 2006 and 2008 as well as other websites. Current smokers were defined as individuals who smoked more than 100 cigarettes in their lifetime and currently smoke every day or some days. ArcGIS 9.3 was used to spatially display tobacco and lung cancer rates by state. Visual representation of data included map series for comparisons across multiple years and graphical chart illustrations embedded in maps to show race/ethnic comparisons by state. All geographical data was analyzed at the state level. Results: Tobacco initiation was delayed among women, and country wide data demonstrated an increase in lung cancer among women and a decrease among men between 2004 and 2006. Despite a decline in incidence among men, the age-adjusted death rate for lung cancer was higher for men (67.0 per 100,000 persons) than for women (40.0 per 100,000 persons). In 2006, Kentucky (a state with a thriving tobacco industry where the only smoking related state laws prohibit smoking in government offices, universities, and the state capitol, except in designated smoking areas) had the highest age-adjusted lung cancer incidence rates in both men (124.8 per 100,000) and women (76.6 per 100,000) while Utah had the lowest age-adjusted cancer incidence rates in both men and women (32.0 per 100,000 and 24.7 per 100,000 respectively). Conclusion: The states with the lowest smoking rates are those that have implemented smoking bans in workplaces, restaurants, and bars. The decrease in smoking rates has not been evenly distributed across all sectors of society; there are notable gender and racial disparities in the number of smokers and in the number of people enrolled in smoking cessation programs. Increasing bans on public smoking, increased cost of cigarettes, and improved access to smoking cessation programs are apparently linked to decreased sales and use of tobacco products as observed at the state level. In the long term this should lead a decrease in the number of lung cancer cases associated with tobacco products. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1883. doi:10.1158/1538-7445.AM2011-1883

Adolescents' Support for Smoke-Free Public Settings: The Roles of Social Norms and Beliefs About Exposure to Secondhand Smoke

To assess support for smoke-free policies in public settings among adolescent smokers and nonsmokers in a pro-smoking culture. A total of 1,924 Greek secondary school students (mean age = 14 years, standard deviation = 1.00, 50% female) from nine schools in the urban area of Thessaloniki, Greece, participated in the study. The main outcome measures were supportiveness of smoke-free policies in public settings. Smoker adolescents were less supportive of smoke-free policies, compared with nonsmokers. Regression analysis showed that policy support was predicted by smoking status and motivation to smoke, social norms, and beliefs about the effects of smoking and exposure to secondhand smoke. A significant interaction between smoking status and social norms was also observed, as smoker adolescents who often encountered others smoking in public places reported less support for smoke-free public settings. Three important processes underlying adolescents' support for smoke-free policies not mentioned in previous research were identified. First, social norms of the immediate social environment play a pivotal role in shaping policy support of young people. Second, the effects of smoking status on policy support are significantly moderated by exposure to public smoking. Finally, beliefs about the effects of exposure to secondhand smoke significantly predict young people's support for smoke-free public settings.

Is there an impact of public smoking bans on self-reported smoking status and exposure to secondhand smoke?

BackgroundImplementation of smoke free policies has potentially substantial effects on health by reducing secondhand smoke exposure. However little is known about whether the introduction of anti-smoking legislation translates into decreased secondhand smoke exposure. We examined whether smoking bans impact rates of secondhand smoke exposure in public places and rates of complete workplace smoking restriction.MethodsCanadian Community Health Survey was used to obtain secondhand smoking exposure rates in 15 Ontario municipalities. Data analysis included descriptive summaries and 95% confidence intervals were calculated and compared across groupsResultsAcross all studied municipalities, secondhand smoke exposure in public places decreased by 4.7% and workplace exposure decreased by 2.3% between the 2003 and 2005 survey years. The only jurisdiction to implement a full ban from no previous ban was also the only setting that experienced significant decreases in both individual exposure to secondhand smoke in a public place (-17.3%, 95% CI -22.8, -11.8) and workplace exposure (-18.1%, 95% CI -24.9, -11.3). Exposures in vehicles and homes declined in almost all settings over time.ConclusionsImplementation of a full smoking ban was associated with the largest decreases in secondhand smoke exposure while partial bans and changes in existing bans had inconsistent effects. In addition to decreasing exposure in public places as would be expected from legislation, bans may have additional benefits by decreasing rates of current smokers and decreasing exposures to secondhand smoke in private settings.

Public crack cocaine smoking and willingness to use a supervised inhalation facility: implications for street disorder

BackgroundThe health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility.MethodsData for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility.ResultsAmong our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police.ConclusionWe found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police.

Enquête sur le tabagisme passif chez l’enfant à Agadir

The aim of the study was to assess children's exposure to tobacco smoke at home, at school and in public places, to study its risks and to educate parents about the dangers of passive smoking. This is a survey conducted in October2007 among children enrolled in pre-school and primary school in the city of Agadir, Morocco. The data was gathered by a written questionnaire completed by parents at home. The survey covered 776children. The response rate to the questionnaires was 88%. The father was a smoker in 28.9% of cases, against 0.7% for the mother. The prevalence of childhood exposure to tobacco was 34.1% at home, 36.4% in public places and 30.1% in schools. Concerning pregnant women, passive smoking and/or active was associated with a significantly increased risk of respiratory distress in newborn babies and hospitalisations in the neonatology department. In infant and child, involuntary inhalation of tobacco smoke involved an increased risk of sudden infant death syndrome and recurrent respiratory symptoms. However, its noxious effects were not found in the case of child asthma and tumour. Passive smoking is a real public health problem and smoking is a dangerous but also a preventable source of pollution.

Tobacco use and exposure in rural areas: Findings from the Behavioral Risk Factor Surveillance System

Evidence suggests that those residing in rural areas may be disproportionately affected by the health burden of tobacco use. The present study examined tobacco use, self-reported exposure to tobacco smoke, and policies regarding public smoking according to area of residence using data from the 2006 and 2008 Behavioral Risk Factor Surveillance System. Results indicated that, relative to those from suburban and urban locations, adults residing in rural areas were significantly more likely to smoke cigarettes (22.2% versus 17.3% (suburban) and 18.1% (urban), p<.001) and to use smokeless tobacco (p<.001). Rural residents were also more likely than those living in suburban and urban areas to report that someone had smoked in their presence during the past seven days both at home (p<.001) and at work (p<.001). Finally, rural participants reported policies that afforded less protection from tobacco smoke both at home and in the workplace. These findings suggest that those living in rural areas are at increased risk for tobacco-related illness due to both their own tobacco use and exposure to others' cigarette smoke.

The Impact of Public Smoking Ban on the Incidence of Myocardial Infarction Hospitalizations

Smoking is a well-established risk factor for cardiovascular disease (CVD) and acute myocardial infarction (AMI). Exposure to tobacco smoke is associated with an estimated 35,000 cardiovascular deaths per year in nonsmokers. In addition, the risk of CVD decreases with the cessation of exposure to smoking. Association of smoking with CVD has been well known for years; however, association of secondhand smoke with CVD has been a topic of great interest, especially for the past 2 decades. Multiple studies and articles have evaluated the impact of smoking ban on the incidence of AMI-related hospitalizations. In this article, we discuss the effect of smoking ban on the economy and on human health in general, as well as its potential effects on the prevalence of smoking.

Public Smoking Bans, Youth Access Laws, and Cigarette Sales at Vending Machines

Tobacco control policies have proliferated in many countries in recent years, in particular youth access laws and public smoking bans. The effectiveness of youth access laws is still disputed, however, as are the costs of public smoking bans to the hospitality industry. Using a unique data set on cigarette sales at more than 100k vending machines that provides first objective evidence on the outgoing and customer behavior of smokers, we study both outcome dimensions by investigating several recent tobacco control measures in Germany. We find a large negative effect on cigarette sales of a nation-wide introduction of devices for electronic age verification in cigarette vending machines, particularly at machines placed outdoors and in localities that are strongly frequented by youths. In contrast, there is no evidence that a country-wide smoking ban in federal buildings affected cigarette sales in these premises and only weak evidence that a recent rise in the minimum legal smoking age affected cigarette purchases by youths. Finally, state-level smoking bans appear to have reduced indoor sales of cigarettes at vending machines, especially in bars. However, the magnitude of the estimated effect is rather modest, suggesting that businesses in the hospitality industry are unlikely to have been affected severely.

Smoker-Nonsmoker Conflict: Using a Social Psychological Framework to Understand a Current Social Controversy

Over the past two decades, state and federal restrictions of public smoking have become increasingly common. The resulting controversy has generally focused on the research evidence regarding the physiological effects of second-hand smoke while ignoring relevant psychological aspects of smoker-nonsmoker conflict. In this article 1 review the literature on the psychological consequences of smoker-nonsmoker interaction, interpreting these results from the framework of social psychological research on inter-group conflict. From this review I conclude that: a) smoker- nonsmoker conflict shares many characteristics of other ingroup-outgroup interactions; b) both groups are served by the legislated separation of these groups; and c) such separation can be successfully accomplished only when close attention is paid to subtle environmental cues. Finally, theoretical benefits of studying smoker-nonsmoker conflict from a social psychological perspective are discussed.

Philosophy, ethics, medicine and health care: the urgent need for critical practice

Philosophy, ethics, medicine and health care: the urgent need for critical practice

Smoking intensity before and after introduction of the public place smoking ban in Scotland

A study was performed to determine whether cigarettes were smoked more intensely outside of public venues in Scotland, compared to indoors, after introduction of the public place smoking (PPS) ban. It was conducted in three waves: before the ban, immediately after and 6months after introduction. The study included 322 regular smokers of four cigarette brand variants. Filter analysis measurements were used to estimate the human-smoked yields of tar and nicotine from cigarettes smoked predominantly inside (before the ban) or outside (after the ban) public venues. Self-reported cigarette consumption data were also collected. Numbers of cigarettes smoked indoors in public places fell dramatically after the ban. There was a corresponding rise in smoking incidence in outdoor public locations. The ban did not significantly affect the total number of cigarettes smoked by the subjects over the weekends investigated. Human-smoked yields of tar and nicotine decreased slightly after the introduction of the ban and some reductions were significant. Therefore, smoking outdoors at public venues, following the PPS ban, did not increase smoking intensity. Any changes in smoking behaviour that may have occurred had little effect on mainstream smoke exposure or cigarette consumption for those that continued to smoke.

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.

Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies

BackgroundDenmark and Sweden are considered to be countries of rather similar socio-political type, but public health policies and smoking habits differ considerably between the two neighbours. A study comparing mechanisms behind socioeconomic inequalities in tobacco smoking, could yield information regarding the impact of health policy and -promotion in the two countries.MethodsCross-sectional comparisons of socioeconomic and gender differences in smoking behaviour among 6 995 Danish and 13 604 Swedish persons aged 18-80 years.ResultsThe prevalence of smoking was higher in Denmark compared to Sweden. The total attributable fraction (TAF) of low education regarding daily smoking was 36% for Danish men and 35% for Danish women, and 32% and 46%, respectively, for Swedish men and women. TAF of low education regarding continued smoking were 16.2% and 15.8% for Danish men and women, and 11.0% and 18.8% for Swedish men and women, respectivelyThe main finding of the study was that the socioeconomic patterning of smoking, based on level of education and expressed as the relative contribution to the total burden of smoking exposure, was rather different in Sweden and Denmark. Moreover, these differences were modified by gender and age. As a general pattern, socioeconomic differences in Sweden tended to contribute more to the total burden of this habit among women, especially in the younger age groups. In men, the patterns were much more similar between the two countries. Regarding continued smoking/unsuccessful quitting, the patterns were similar for women, but somewhat different for men. Here we found that socioeconomic differences contributed more to overall continued smoking in Danish men, especially in the middle-age and older age strata.ConclusionThe results imply that Swedish anti-smoking policy and/or implemented measures have been less effective in a health equity perspective among the younger generation of women, but more effective among men, compared to Danish policy implementation. The results also raises the more general issue regarding the possible need for a trade-off principle between overall population efficacy versus equity efficacy of anti-tobacco, as well as general public health policies and intervention strategies.