Smoking Restrictions Research Articles

Individual, Social and Psychological Characteristics of Smoking Cessation Behaviors: A Systematic Review

About two thirds of active smokers want to quit smoking, yet not many people finally succeed in smoking cessation. Smoking cessation involve complex behaviors associated with individual, social and psychological characteristics as the key factors. Our objective is to review the studies about smoking cessation behavior correlated issues in order to find effective interventions of smoking cessation program. Terms and keywords pertinent to individual, social and psychological characteristics of smoking cessation behavior were used in a search of the electronic databases. Searches were limited to English language, included papers were: a) had clearly report the predictor variables related to smoking cessation behaviors, b) exclusively represent nation/s of study population, c) the time frame for the analysis was limited from 1998 to 2018. A result of 116 individual studies were retrieved at first and reviewed. After further inspection of references from the collected studies, 9 studies were approximately selected that met all inclusion criteria. The final studies consisted of five cross-sectional study and four cohort studies, conducted from different countries. There were several characteristics related to smoking cessation behavior including on levels of nicotine dependence, self-efficacy, smoking restriction and involve other smokers environment, motivation and educational background. Adjusted interventions due to those specific behaviors are needed in order to make more effective smoking cessation programs. Therefore, this study may provide new perspective for encouraged to decrease the amount of smokers worldwide through smoking cessation program.

Did Slowdown on Taxes and Program Impact California's Smoking Decline?

Author(s): Pierce, John P; Shi, Yuyan; Hendrickson, Erik; White, Martha; Noble, Madison; Kealey, Sheila; Strong, David | Abstract: Objective: In this paper, we examine whether a slowdown in implementing tobacco control policies in California after 2000 influenced trends in smoking behavior. Methods: We assessed the strength of state tobacco control policies using excise tax data (1990-2014), tobacco control expenditures per capita, and workplace and home smoking restrictions (from the Tobacco Use Supplement of the Current Population Survey, 1992-2015). Smoking prevalence was assessed with the National Health Interview Survey, 1985-2015. We compared trends between California and the rest of the US using split regression models with a knot at 2000. Results: Throughout the 1990s, compared to the rest of the US, California had higher cigarette excise taxes, higher expenditures on tobacco control, more smoke-free workplaces, and more smokers with smoke-free homes. Except for smoke-free homes, these differences disappeared after 2000. During the 1990s, smoking prevalence declined much faster in California than in the rest of the US, but the decline slowed significantly after 2000. Conclusions: Smoking prevalence is sensitive to continued implementation of tobacco control policies.

Educational attainment & quitting smoking: A structural equation model approach

In the United States, disparities in smoking prevalence and cessation by socioeconomic status are well documented, but there is limited research on reasons why and none conducted in a national sample assessing multiple potential mechanisms. We identified smoking and cessation-related behavioral and environmental variables associated with both educational attainment and quitting success. We used a structural equation model of cross-sectional data from respondents ≥25 years from the United States 2010–2011 Tobacco Use Supplement-Current Population Survey. Quitting success was defined as former (n = 2607) versus continuing smokers (n = 7636); categories of educational attainment were ≤high school degree, some college/college degree, and advanced degree. Results indicated that using nicotine replacement therapy (NRT) >1 month and having a home smoking restriction were associated with both educational attainment and quitting success. Those with lower educational attainment versus those with an advanced degree were less likely to report using NRT >1 month (≤high school: β = −0.50, p < 0.001; college: β = −0.24, p = 0.019). Use of NRT >1 month, in turn, was positively associated with quitting success (β = 0.25, p < 0.001). Those with lower educational attainment were also less likely to report a home smoking restriction (≤high school: β = −0.42, p < 0.001; college: β = −0.21, p = 0.009). Having a home smoking restriction was positively associated with quitting success (β = 0.50, p < 0.001). Results were similar with income substituted for education. Using NRT >1 month and having a home smoking restriction are two strategies that may explain the association between low education and lower cessation success; these strategies should be further tested for their potential ability to mitigate this association.

Exploring the barriers and incentive architecture for modifying smoke exposures among asthmatics

Background: The socio-structural barriers for reducing secondhand smoke exposure (SHSe) among children with asthma may be insurmountable for low-income caregivers. Health promoting financial incentives (HPFIs) are increasingly being used in the adult population to motivate and sustain tobacco-reduction behaviors. We assessed barriers to SHSe reduction and means to overcome them through the design of an HPFI-based, caregiver-targeted SHSe reduction study. Methods: Using a mixed-methods design, we conducted semi-structured in-depth interviews among low-income primary caregivers of children with asthma residing in Baltimore City. Quantitative data using an online survey were used to augment interview findings. Results: Home smoking restrictions were a frequently referenced strategy for decreasing SHSe, but interviewees (n = 22) described the complex social pressures that undermine reduction efforts. Caregivers redirected conversations from broadly implemented smoking bans towards targeted reduction strategies among mothers and members of their social network who are active smokers. Participants converged on the notion that sustainable SHSe reduction strategies are realizable only for mothers who are active smokers, possess high self-efficacy and social structures that promote cessation. Survey data (n = 56) clarified the multiple contexts that underlie pediatric SHSe and preferred HPFI architecture that included fixed, recurrent payments contingent on reduced nicotine biomarkers and completion of basic asthma education classes. Conclusions: Based on the combined analyses, we envision testing a HPFI-based study design whose optimal target population included low-income caregivers and members of their social network where incentives are tied to pediatric biomarkers and asthma education—an integrated approach that has not yet been used in pediatric tobacco studies.

Developing Smoke-Free Policies in Public Housing: Perspectives From Early Adopters in 2 Southern States.

Purpose and ObjectivesIn 2016, the US Department of Housing and Urban Development (HUD) issued a new rule requiring smoke-free policies in conventional public housing by July 2018 (HUD, 2016). This process evaluation describes the policy development experiences of conventional and nonconventional public housing authorities (PHAs) in North Carolina and Georgia that had established smoke-free policies before the HUD rule.Intervention ApproachHUD began to issue guidance that encouraged smoke-free policies in public housing in 2009, and most early adopters were outside of the Southeast. Documenting the process early adopters in the Southeast used to develop their policies provides useful lessons for conventional PHAs and those with properties not covered by the rule.Evaluation MethodsSemi-structured interviews were conducted with PHA representatives from 23 PHAs with some level of smoking restriction, along with residents from 14 of these PHAs, from January to August 2016.ResultsOrganizational leaders and board members were usually the primary players in making the decision to adopt a policy, with approval processes consistent with any type of policy adoption. Common reasons for establishing the policy included costs of turning a unit; health of children, nonsmokers, and staff; HUD guidance; and concerns or experience with fire caused by cigarettes. Levels of restriction were influenced by layout of the property, perceptions of compliance and enforcement challenges, concerns about smokers congregating, resident mobility, weather concerns, consistency with HUD guidance, and availability of funds for designated smoking areas. Resident input was obtained through general meetings, resident advisory boards or councils, surveys, and formal comment periods.Implications for Public HealthUnderstanding the process of policy development and adoption enables public health practitioners to be more effective partners in advising on the flexible components of the HUD smoke-free rule and accelerating the adoption of comprehensive policies within nonconventional PHAs.

Smoking ban and health at birth: Evidence from Hungary

In 2012, smoking restrictions were extended to hospitality venues in Hungary. Women working in bars and restaurants were primarily affected by the intervention. In this research, we analyze the effect of this smoking ban on the outcomes of their pregnancies. Using individual live birth, fetal loss, and infant mortality registry data, we examine the probability of live birth, indicators of health at birth, and the probability of death in the first year of life. We apply a difference-in-differences framework and show that the smoking ban has improved health at birth. We observed birth weight to increase by 56 g (95% CI: 4.2 to 106.8) and gestation length by 0.19 weeks (95% CI: 0.02 to 0.36). Due to the ban, the probability of being born with very low and low birth weight has decreased by 1.2 and 2.2 percentage points, respectively (95% CI: −0.2 to −2.2 and 0.06 to −4.4), and we see a 0.9 percentage points reduction in the chance of being born very preterm (95% CI: −0.03 to −1.9). We also observe a decrease in the probability of being born with a low Ponderal index (decrease of 4.1 percentage points, 95% CI: −0.7 to −7.5). Performing a series of robustness and placebo tests, we provide evidence that supports the causal interpretation of our results. We also show that the ban was more beneficial for newborns of parents with low educational attainment and at the bottom of the fetal health endowment distribution.

The Relationship Between Quality of Life and Psychological and Behavioral Factors in Patients With Heart Failure Following Cardiac Resynchronization Therapy

While cardiac resynchronization therapy improves the quality of life of patients with heart failure, some psychological and behavioral factors still affect the quality of life of these patients. However, information on the factors that affect the quality of life of these patients is limited. To describe the quality of life and investigate the relationship between quality of life and behavioral and psychological factors such as depression, smoking, drinking, water and sodium restrictions, exercise, and adherence in patients with chronic heart failure following cardiac resynchronization therapy. This cross-sectional study was conducted using the Morisky Medication Adherence Scale, Minnesota Living With Heart Failure Questionnaire, and Cardiac Depression Scale. A convenience sample of 141 patients with heart failure following cardiac resynchronization therapy were recruited from a tertiary academic hospital in Chengdu. The mean overall score of the Minnesota Living With Heart Failure Questionnaire was 30.89 (out of a total possible score of 105). Water restrictions, sodium restrictions, depression, and exercise were all shown to significantly predict quality of life among the participants. This paper describes the quality of life and defines the behavioral factors that affect the quality of life of patients with heart failure following cardiac resynchronization therapy. The findings suggest that nurses should manage and conduct health education for patients in order to improve their quality of life.

Prison Staff and Prisoner Views on a Prison Smoking Ban: Evidence From the Tobacco in Prisons Study.

IntroductionIn jurisdictions permitting prisoner smoking, rates are high (c75%), with smoking embedded in prison culture, leading to secondhand smoke exposures among staff and prisoners and challenges for smoking cessation. Momentum is building to ban smoking in prisons, but research on staff and prisoner views is lacking. We address this gap, providing evidence on staff and prisoner views throughout all Scottish prisons.MethodsData were collected prior to the announcement of a (November 2018) prison smoking ban throughout Scotland. Mixed methods were used: surveys of staff (online, N = 1271, ~27%) and prisoners (questionnaire, N = 2512, ~34%); 17 focus groups and two paired interviews with staff in 14 prisons.ResultsStaff were more positive than prisoners about bans and increased smoking restrictions, although prisoner views were more favorable should e-cigarettes be permitted. Nonsmokers were more positive than smokers. Whilst 74% staff and 22% prisoners agreed bans were a good idea, both groups acknowledged implementation and enforcement challenges. Staff views were influenced by beliefs about: acceptability of the policy in principle and whether/how bans could be achieved. Although some voiced doubts about smoke-free policies, staff likened a ban to other operational challenges. Staff raised concerns around needs for appropriate measures, resources and support, adequate lead-in time, and effective communication prior to a ban.ConclusionWe recommend that regular and open opportunities for dialogue within and between different stakeholder groups are created when preparing for prison smoking bans and that specific measures to address staff and prisoner concerns are incorporated into plans to create and maintain smoke-free environments.ImplicationsTo our knowledge, this study is the first to research staff and prisoner views across a whole prison system prior to implementation of smoke-free policies. The results highlight potential challenges and suggest measures, which might help to maximize the success of bans. Our results are relevant for prison service managers responsible for the forthcoming introduction of a ban in Scottish prisons (November 2018) and for other prison systems and comparable institutions planning smoke-free initiatives. Given that prison smoking bans may be contentious, we recommend creating regular and open opportunities for dialogue between stakeholders when preparing for and maintaining smoke-free environments.

ED visits for AMI, Stroke, ACS &amp; COPD after the Statewide Smoking Ban in Cook Co., IL

ObjectiveTo utilize ED chief complaint data obtained from syndromic surveillance to quantify the effect of the Illinois smoking ban on acute myocardial infarction (AMI), acute coronary syndrome (ACS), stroke, and chronic obstructive pulmonary disease (COPD) related ED visits in adults in Cook County, IL.IntroductionTobacco use is the leading global cause of preventable death, killing more than five million people per year [1]. In addition, exposure to secondhand smoke is estimated to kill an additional 600,000 people globally each year [1]. In 1986, the US Surgeon General’s Report declared secondhand smoke to be a cause of lung cancer in healthy nonsmokers [2].The first law restricting smoking in public places was enacted in 1973 in Arizona that followed the 1972 Surgeon General’s Report providing awareness of the negative health effects associated with the exposure to air pollution from tobacco smoke [3]. Smoke-free laws were slowly enacted after this time point with most occurring after the year 2000 [4].In July 2007, the Smoke Free Illinois Act (SB0500, Public Act 095-0017) was passed in IL [5]. The ban went into effect on Jan 1, 2008 and Illinois joined 22 other states in prohibiting smoking in virtually all public places and workplaces including offices, theaters, museums, libraries, schools, commercial establishments, retail stores, bars, private clubs, and gaming facilities [5-6].While many studies have examined the effect of smoking bans on hospitalizations, this study would be the first to examine the effect of the comprehensive smoking ban in IL on ED visits by utilizing chronic disease categories created with ED chief complaint data captured by syndromic surveillance [7]. The author hypothesizes that the comprehensive smoking ban in IL significantly reduced the ED visits associated with AMI, ACS, stroke, and COPD in adults in Cook County, IL.MethodsED visits with chief complaints consistent with categories for AMI, ACS, stroke and COPD captured by the Cook Co. Dept. of Public Health local instance of ESSENCE from Jan 1, 2006 – Dec 31, 2013 were included in the analysis. Proc Genmod with a log link and negative binomial distribution was utilized for the analysis. All data was aggregated at the monthly level. The total number of ED visits of the health effect of interest was the dependent variable. The total ED visits during the same period of time, was used as the offset variable, sub-grouped by age and gender where appropriate. A binary variable was utilized to capture the effect of the time period after the implementation of the statewide smoking ban; 0 for before the ban and 1 for after the ban. When examining the effect of the statewide ban, Cook Co. as an entirety was examined as well as ED visits stratified by zip codes that already had a smoking ban in place at that time point and those that did not, and stratifying by urban (Chicago) vs. suburban Cook Co. Seasonality was addressed by including month, month squared and month cubed in the model. Influenza was addressed by including a binary variable to indicate when influenza was occurring in the area based on percent influenza-like-illness ED visits that were occurring above the threshold for the area during that time period. Age and gender were also evaluated as confounders and effect modifiers. SAS 9.4 was utilized to perform the analyses.ResultsResults are presented in Table 1. Reductions of ED visits after the smoking ban implementation were seen in AMI and ACS disease categories for the overall adjusted model, at 3% and 3.5% respectively. Stroke associated ED visits were not affected by the smoking ban. COPD associated ED visits were not reduced immediately by the smoking ban, but did have a significant reduction 6 months after implementation of the ban at 3.6%. Stronger effects were seen in individuals 70 years and older, females, the urban population, and zip codes without a prior ban for AMI, ACS, and COPD.ConclusionsAn immediate, significant reduction in ED visits associated with AMI and ACS was associated with the IL statewide smoking ban in Cook Co., IL. COPD associated ED visits were significantly reduced 6 months after the ban implementation. The effect was greater in individuals 70 years and older, females, the urban population, and zip codes without a prior ban.

Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study

BackgroundThe evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders’ views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data.MethodsAn interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team’s contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders’ views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review.ResultsNinety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [− 0.09, 0.89]).ConclusionsThe intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.

Exposure to workplace smoking bans and continuity of daily smoking patterns on workdays and weekends

IntroductionIndividuals may compensate for workplace smoking bans by smoking more before or after work, or escaping bans to smoke, but no studies have conducted a detailed, quantitative analysis of such compensatory behaviors using real-time data. Methods124 daily smokers documented smoking occasions over 3weeks using ecological momentary assessment (EMA), and provided information on real-world exposure to smoking restrictions and type of workplace smoking policy (full, partial, or no bans). Mixed modeling and generalized estimating equations assessed effects of time of day, weekday (vs weekend), and workplace policy on mean cigarettes per hour (CPH) and reports of changing location to smoke. ResultsIndividuals were most likely to change locations to smoke during business hours, regardless of work policy, and frequency of EMA reports of restrictions at work was associated with increased likelihood of changing locations to smoke (OR=1.11, 95% CI 1.05–1.16; p<0.0001). Workplace smoking policy, time block, and weekday/weekend interacted to predict CPH (p<0.01), such that individuals with partial work bans –but not those with full bans - smoked more at night (9pm – bed) on weekdays compared to weekends. ConclusionsThere was little evidence that full bans interfered with subjects' smoking during business hours across weekdays and weekends. Smokers largely compensate for exposure to workplace smoking bans by escaping restrictions during business hours. Better understanding the effects of smoking bans on smoking behavior may help to improve their effectiveness and yield insights into determinants of smoking in more restrictive environments.

Willingness to quit tobacco smoking and its correlates among Indian smokers - Findings from Global Adult Tobacco Survey India, 2009-2010.

Background:In the stages of change model for smoking cessation, “willingness to quit” forms the starting point.Objective:To determine the prevalence and correlates of willingness to quit among smokers in India from Global Adult Tobacco Survey (GATS), 2009–2010.Methods:Secondary data analysis of GATS, 2009–10, was done to find the correlates of willingness to quit among smokers. All the sociodemographic variables, smoking-related factors such as frequency, previous attempt to quit, and also effect of antitobacco messages delivered to various media were tested for association using multivariable analysis.Results:Of 9627 current smokers analyzed, 50.9% [95% confidence interval (CI): 49.9–51.9] were willing to quit smoking. Multivariable analysis showed that younger age groups [prevalence ratio (PR): 1.31, 95% CI: 1.05–1.65], individuals who have their first smoke after 60 min of wakeup (PR: 1.19, 95% CI: 1.05–1.36), those living in a house with smoking restriction (PR: 1.29, 95% CI: 1.17–1.42), those who received advice to quit from doctor, those who attempted to quit in the past 12 months (PR: 1.28, 95% CI: 1.03–1.60), having knowledge about illness caused due to smoking, and those who have noticed antismoking messages in billboards/hoardings were willing to quit smoking compared to their counterparts (PR: 1.13, 95% CI: 1.04–1.23).Conclusion:Enforcing social restrictions like smoking restriction at house and also brief advice by doctors to quit smoking during any contact with the tobacco user could improve quit rate especially in young tobacco users and those who have attempted to quit before.

Adult Attitudes and Practices Regarding Smoking Restrictions and Child Tobacco Smoke Exposure: 2000 to 2015.

Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure. Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed. The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P < .05). Car smoking prohibitions increased from 68.3% to 81.8% (P < .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues. Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.

Prevalence of Home Smoking Bans and its Determinants in Families with Infants

Background Exposure to cigarette smoke has numerous health risks for infants and children. Home smoking ban is a simple way to reduce the detrimental impacts of cigarette smoke. This study aimed to determine the prevalence of cigarette smoking bans in homes as well as associated factors in families with infants in Tehran, Iran. Materials and Methods This study was a population-based cross-sectional survey on 1,112 families with infants, selected through stratified-cluster sampling. In this study, a researcher made questionnaire including four parts: sociodemographic characteristics, smoking status, smoking restrictions, and parental awareness and belief, was completed. The multivariable logistic regression was used to investigate the relationship between smoking bans in homes and associated factors. Results Complete smoking ban in homes was 37.3%. In the multivariable logistic regression, cigarette smoking ban in homes was significantly higher for employed mothers (odds ratio [OR] = 3.03, 95% confidence interval [CI]: 1.2-7.2, P<0.001), for those who did not have any smoker friends or relatives (OR = 2.3, 95% CI: 1.3-4.4, P<0.001), for those smoking a smaller number of cigarettes (OR = 2.7, 95% CI: 1.4-5.3, P=0.003), and for parents who concurred with the impacts of thirdhand cigarette smoke on infant health (OR = 4.7, 95% CI: 1.4-14.9, P<0.001). Conclusion This study indicates that complete smoking ban is not established in many households with infants in Iran. Furthermore, it is necessary to perform health interventions for reducing infant exposure to cigarette smoke, while considering the factors associated with smoking ban. Keywords

Public Opinion, Public Policy, and Smoking: The Transformation of American Attitudes and Cigarette Use, 1890–2016 by Thomas R. Marshall

Reviewed by: Public Opinion, Public Policy, and Smoking: The Transformation of American Attitudes and Cigarette Use, 1890–2016 by Thomas R. Marshall Mark Parascandola Thomas R. Marshall. Public Opinion, Public Policy, and Smoking: The Transformation of American Attitudes and Cigarette Use, 1890–2016. Lanham, Md.: Rowman & Littlefield, 2016. xiii + 209 pp. Ill. $85.00 (978-1-4985-0432-4). The rise and subsequent fall of tobacco use in the United States ranks among both history’s greatest public health disasters and its greatest victories. But how informed were Americans about the health risks of cigarette smoking? How have their awareness and attitudes changed over this time period? And how much have these attitudes been reflected in public policies to control tobacco use? [End Page 215] In Public Opinion, Public Policy, and Smoking, Thomas R. Marshall, professor of political science at the University of Texas–Arlington, draws on over half a century of public opinion polling to understand the evolution of Americans’ attitudes toward tobacco. Changing public opinion, he argues, was a key driving force in decreasing tobacco use and advancing tobacco control policies. Mass public opinion polling emerged just in time to capture the publicity over cigarette smoking and cancer in the mid-twentieth century. Since the late 1940s, American pollsters have asked over five thousand poll questions on smoking and health. The shift was gradual but persistent. The proportion of Americans who believed that smoking was a cause of lung cancer increased steadily, from 43 percent in 1954 to 62 percent in 1964, 70 percent in 1972, and 91 percent in 2013 (p. 51). “In magnitude,” Marshall suggests, “these belief changes are among the largest ever reported in modern survey research” (p. 51), comparable to changes in attitudes around racial segregation or same-sex marriage. The one event that did have an immediate, measurable impact on Americans’ beliefs (if not on their tobacco use habits) was the release of the 1964 report of the Surgeon General on “Smoking and Health.” The proportion of Americans believing smoking to be a cause of lung cancer jumped from 47 percent in 1962 to 62 percent in 1964 (p. 59). Meanwhile, the tobacco industry pursued an organized public relations campaign to sow doubt around the science of smoking and health. Marshall concludes that industry efforts appear to have had a limited impact on public opinion. For example, the industry’s 1954 “Frank Statement” questioning the link between cigarette smoking and cancer was not followed by a measurable change in beliefs. However, Marshall does not address the possibility that the industry campaign may have slowed what would have otherwise been a more rapid recognition of the health hazards of smoking. Changes in public awareness of health risks did not immediately translate into support for government intervention around tobacco use. It was not until the 1970s that grassroots efforts pushed for separate smoking sections and restrictions on smoking in public places, such as airplanes, buses, restaurants, and theaters. By 1986, 83 percent of never smokers and 73 percent of current smokers agreed that smoke from someone else’s cigarette was annoying (p. 85). Attitudes toward the tobacco industry also shifted, as Americans became more distrustful of the industry. Marshall also describes an innovative analysis to match fifty-nine federal tobacco control policy proposals with nationwide polls from the 1960s to the 2000s to assess the degree of consistency between policy and public opinion. Overall, American public opinion was out in front of federal policy making—while fewer than half of the proposals reviewed were adopted, 70 percent had majority public support. Marshall notes this is consistent with other areas of public policy, but it is more remarkable here given the well-organized and well-funded opposition from the tobacco industry to many tobacco control proposals. Marshall’s book is especially innovative in focusing on what the public knew or believed and how public opinion shifted over time. Other recent historical [End Page 216] accounts of this period have focused largely on scientific knowledge and on what scientists, health officials, and the tobacco industry knew or believed. Nevertheless, Marshall’s analysis would be strengthened by further historical context in some sections. In particular, Marshall neglects to...

Momentary smoking context as a mediator of the relationship between SES and smoking

There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposure to places where smoking is allowed. Exposure to smoking restrictions was assessed in real-time using Ecological Momentary Assessment methods. A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether a smoker's momentary context mediated the relationship between socioeconomic status (educational attainment) and cigarettes smoked per day (CPD). Momentary context was operationalized as the proportion of random assessments answered in locations where smoking was allowed versus where smoking was not allowed. Data were analysed using multilevel regression (measurements nested within participants) with a lower level mediation model (2-1-1 mediation). Although no significant direct effect of SES on CPD were observed, there was a significant indirect effect of SES on CPD via the momentary context. Compared to participants with higher education, lower educated participants were more likely to encounter places where smoking was allowed, and this in turn, was associated with a higher number of CPD. These findings suggest that SES is associated with smoking at least partially via differential exposure to smoking-friendly environments, with smokers from lower SES backgrounds accessing more places where smoking is allowed. Implications for current smoke-free legislation are discussed.

Soda Taxes as a Legal and Social Movement

In the last few years, several local governments have adopted new soda taxes. Other localities currently are considering adopting such a tax. In this Article, we consider whether soda taxes are becoming a more common local policy throughout the country — like local smoking restrictions — or whether, instead, they will remain a limited legal phenomenon. We focus on two potential obstacles to the widespread adoption of local soda taxes: (1) policy-based objections to the taxes as regressive and unduly paternalistic, which could undermine political support for their adoption at the local level; and (2) state preemption of local taxes, often achieved at the behest of the beverage industry. As we explain later, the principal risk of preemption vis-a-vis soda taxes does not come from the state courts in the form of decisions finding implied or field preemption, but rather from state statutes that expressly, unequivocally preempt such taxes. In almost all states, such express preemption would be considered lawful by the courts and would be effective in depriving localities of the power to impose taxes on soda.

Secondhand Smoke Exposure in Primary School Children: A Survey in Dhaka, Bangladesh.

IntroductionWe report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh—a country with laws against smoking in public places.MethodsA survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL.ResultsFour hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure.ConclusionsDespite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children.ImplicationsChildren bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.

Coaching to create a smoke-free home in a brief secondhand smoke intervention.

Few community interventions exist to reduce secondhand exposure to tobacco smoke in the home. This study presents the coaching process of a larger intervention to promote smoke-free homes across an efficacy and 2 effectiveness trials. It furthers assesses the coaching call's reach and participants' satisfaction with the call across three intervention sites. The sources of the data were from baseline and 3-month follow-up surveys, coaching forms or online tracking system and interviews with coaches. Reach for the coaching call across trials was fairly high from 72% to 92%. Overall, the majority of participants were highly satisfied with the intervention (M = 3.76) and found it useful in creating a smoke-free home (M = 3.63). Common goals set were changing the environment to support a home smoking ban (e.g. putting up signs, removing ashtrays) (82%) or picking a date (60%). Challenges to a smoke-free home were consistent with other literature on barriers related to household smoking restrictions, including need for assistance in quitting, outside weather and smokers who do not want to quit. Additional research is needed to explore differential reach and reactions to the coaching call as it is disseminated and the impact of coaching call on the outcome of a smoke-free home.

Direct Marketing Promotion and Electronic Cigarette Use Among US Adults, National Adult Tobacco Survey, 2013-2014.

IntroductionThe use of electronic cigarettes (e-cigarettes) among US adults has increased since 2007. The objective of this study was to investigate the prevalence of direct marketing promotion of e-cigarettes and its association with e-cigarette use among US adults.MethodsWe used using data from the 2013–2014 National Adult Tobacco Survey (NATS) to estimate prevalence of e-cigarette promotions received by mail or email. Multinomial logistic regression was used to examine the associations between e-cigarette promotions and the prevalence and frequency of e-cigarette use among US adults.ResultsIn the 2013–2014 survey period, 7.1% of adults (about 16.0 million) reported receiving mail or email e-cigarette promotions in the previous 6 months; 3.2% received mail promotions, and 5.1% received email promotions. A higher prevalence of promotions was found among men versus women, adults aged under 65 years versus those older, current e-cigarette users, current smokers, and people with no smoking restriction rules in their homes or vehicles. In the multivariable analysis, receiving mail or email e-cigarette promotions was associated with higher odds of being current e-cigarette users (adjusted odds ratio [aOR] = 2.0; P < .001) than being noncurrent e-cigarette users. Receiving promotions was also associated with higher odds of using e-cigarettes some days (aOR = 1.6; P = .006) or every day (aOR = 1.7; P = .008) than using e-cigarettes rarely.ConclusionReceipt of e-cigarette direct marketing promotions was prevalent among US adults. Receiving e-cigarette promotions was associated with increased odds of both prevalence and frequency of e-cigarette use. Future longitudinal studies are needed to measure causal effects of e-cigarette promotions on e-cigarette use among adults.