Smoke-free Air Laws Research Articles

Advancing the science of policy implementation: a call to action for the implementation science field.

Public policies have been essential in addressing many of the most pressing public health problems in the USA and around the world. A large and convincing body of multidisciplinary research has established the impacts or effectiveness of public policies, such as smoke-free air laws and nutrition standards, on improving health outcomes and behaviors. Most of this research assumes that because an evidence-based policy is adopted or takes effect, it is implemented as intended. This assumption, however, is often incorrect. Like with clinical guidelines and other interventions, implementation science has an important role to play in promoting the uptake and implementation of evidence-based public policies that promote public health. To realize this potential, there remains a critical need to first establish a common understanding of what public policy is, the role of specific policies in the context of implementation (i.e., is it the evidence-based intervention or the implementation strategy?), and to establish an appropriate methodological foundation for the field of policy implementation science. We recommend that the field must evolve to (i) include policy experts and actors on policy implementation science study teams; (ii) identify theories, models, and frameworks that are suitable for policy implementation science; (iii) identify policy implementation strategies; (iv) adapt and/or identify study designs best suited for policy implementation science research; and (v) identify appropriate policy implementation outcome measures.

Potential short-term effects of tobacco control scheme under various application scenarios of tobacco control measures across the globe: a Meta-analysis

Objective: based on summarizing the simulation and prediction of tobacco control measures across the globe and sorting out the various scenarios of tobacco control measures, the potential short-term effects of seven tobacco control measures in different scenarios were systematically analyzed. Methods: Until April 2022, PubMed, Embase, EconLit, PsychINFO, and CINAHL databases were used to retrieve literature about tobacco control measures simulation and prediction models across the globe. Inclusion and exclusion criteria were strictly followed. Meta-analysis for the potential short-term effects of seven tobacco control measures in different scenarios was performed using the R software. Results: A total of 22 papers covering 16 countries were selected. Five studies were conducted in the United States, three in Mexico, and two in Italy. There were all papers with the measures to tax increases, smoke-free air laws, and mass media campaigns, 21 papers with youth access restrictions, 20 with marketing restrictions, and 19 with cessation treatment programs and health warnings. The tax increases had diverse influences on the price elasticity of different age groups. The price elasticity in the age group 15-17 years was the highest, which was 0.044 (95%CI: 0.038-0.051). The potential short-term effects of smoke-free air laws in workplaces were higher than in restaurants and other indoor public places. The effects of youth access restrictions were greater in the age group <16 years than in the age group 16-17. The stronger the implementation of other measures, the greater the potential short-term effects. A comparison of seven tobacco control measures showed that the cessation treatment programs increase in cessation rate was the highest, 0.404 (95%CI: 0.357-0.456). The reduction in smoking rate and reduction in initiation rate of youth access restrictions strongly enforced and publicized was the highest in the age group <16 years, 0.292 (95%CI: 0.269-0.315), and 0.292 (95%CI: 0.270-0.316). Conclusions: The potential short-term effects of seven tobacco control measures in different scenarios were evaluated more accurately and objectively through Meta-analysis. In the short term, cessation treatment programs will substantially increase smoking cessation rates, and strong youth access enforcement will sharply reduce smoking and initiation rates among adolescents under 16. These results also offer strong data-related support for the simulation and prediction of tobacco control measures in China and other countries.

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Socio-temporal contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study

BackgroundAdolescents who dual use ENDS with tobacco cigarettes are more likely to have an increased risk of developing dependence. Yet, little is understood about the factors driving dual use among adolescents. The current study sought to reveal the day-to-day socio-temporal contextual and community factors associated with adolescents’ use of electronic nicotine delivery systems (ENDS), and how these factors predict dual use with tobacco cigarettes.MethodsWe collected ecological momentary assessments (EMA) from a sample of 50 adolescent past two-week vapers (ages 14–17 years old) over 14 days. Daily EMA data were collected on ENDS and tobacco cigarette use, as well as a range of contextual (i.e., motivations to vape, location of vaping, who with when vaping) and community factors (i.e., exposure to peers vaping, to adults vaping, to ENDS advertising, to ENDS warning messages). Our primary analyses were multilevel regressions, accounting for daily observations nested within individuals (N = 700 observations).ResultsParticipants used ENDS exclusively on 44% of days and dual used ENDS and tobacco cigarettes on 8% of the days. Dual use days (versus exclusive ENDS use days) were associated with “vaping because tobacco use was prohibited” (OR = 34.65, p < .05). Also, dual use days (versus no use days) were associated with greater exposure to adults vaping (OR = 5.59, p < .05), peers vaping (OR = 7.48, p < .05), and (c) ENDS advertisements or promotions (OR = 2.12, p < .01), whereas exclusive use days (versus no use days) were only associated with greater exposure to peers vaping (OR = 2.58, p < .01).ConclusionsResults showed that exposure to peers and adults vaping and exposure to ENDS marketing were associated with same day dual use behaviors. And, that adolescents who dual used were motivated to use ENDS because they were easy to conceal. Findings support stricter regulation of ENDS marketing and for smoke-free air laws that include ENDS. In addition, these findings support prioritizing family- and school-based prevention programming that effectively communicates risk associated with ENDS use, including heightened risk of dual use and dependence. Such efforts can reduce the number of adolescents who use ENDS as well as the number who transition to tobacco cigarette use.

Housing type and secondhand tobacco smoke exposure among non-smoking New York City adults, 2004 and 2013–14

Secondhand tobacco smoke (SHS) exposure has declined due to smoking reductions, expanding workplace and public smoke-free air laws, and smoke-free housing policy promotion. Population-based studies examining objective SHS exposure biomarkers have documented reductions over time, however non-smoking urban adults are more likely to have elevated cotinine (a metabolite of nicotine) compared with national averages. Evidence suggests residential housing type may impact urban SHS exposure risk. Direct associations between multiunit housing (MUH) and elevated cotinine have been identified among children but not yet examined among adults. We used data from the cross-sectional 2004 and 2013/14 New York City Health and Nutrition Examination Surveys to investigate associations between MUH (single-family versus 2; 3–99; and 100 + units) and likelihood of elevated serum cotinine among nonsmoking adults (2004: n = 1324; 2013/14: n = 946), adjusting for socio-demographics (sex, age, race/ethnicity, education, income) and self-reported SHS exposure variables. Combined and single-year adjusted multivariable regressions were conducted. Elevated cotinine was defined as a serum level of ≥ 0.05 ng/ml. Combined year adjusted multivariable regression analyses found no difference in elevated cotinine by housing type among non-smoking adults. By survey year, elevated cotinine did not vary by housing type in 2004, while non-smoking adults in 3–99 unit buildings were twice as likely to have elevated cotinine compared with single family residents in 2013/14 (adjusted Odds Ratio = 2.55 (1.13, 5.79)). While SHS exposure has declined, relative burden may be increasing among MUH residents. In urban settings with extensive MUH, attention to housing-based policies and programmatic interventions is critical to reducing SHS exposure.

Online Tobacco Advertising and Current Chew, Dip, Snuff and Snus Use among Youth and Young Adults, 2018-2019.

Objective: To understand the relationship between exposure to online tobacco advertising and current smokeless tobacco use in the context of tobacco control policies. Methods: Three waves of a national probability-based sample of (n = 15,985) youth and young adults were used. Analysis consisted of GEE logistic models controlling for social media use, demographics, tobacco use, average price of smokeless tobacco inclusive of taxes, smoke-free indoor air laws (SFIA) and state tobacco control expenditures. Results: Frequent exposure to tobacco advertising on social media is associated with greater odds of current smokeless use (aOR: 2.05, 95% CI: 1.62, 2.60). Higher prices and SFIA coverage were associated with reduced current smokeless use when examined separately from other tobacco policy variables (aOR: 0.79, CI: 0.73, 0.85; aOR: 0.44, CI: 0.28, 0.70). Conclusions: Greater exposure to tobacco advertising online is associated with greater odds of smokeless use among surveyed youth and young adults. This effect of social media marketing exposure on smokeless use outweighs the mitigating impact of existing tobacco control policies. The findings underscore the need for strong advertising regulation of evolving tobacco products, including smokeless products, on social media and surveillance of digital marketing tactics to young people.

Association between Inclusion of E-Cigarettes in Statewide Comprehensive Smoke-Free Indoor Air Laws and Vaping Behaviors: Results from a Longitudinal Population Study

Background Several states have included e-cigarettes in their comprehensive smoke-free indoor air laws (i.e., aerosol-free policies), prohibiting the use of e-cigarettes––in addition to combustible tobacco products––in workplaces, restaurants, and bars. However, whether these policies contribute to reductions in e-cigarette use remains largely unknown. Objective This study utilized a nationally representative longitudinal sample to examine the association between the implementation of statewide aerosol-free policies and e-cigarette use behaviors. Methods: This longitudinal retrospective study implemented a quasi-experimental design. Waves 1–4 (2013–2018) restricted-use data from adult participants (weighted N = 22,838,787; unweighted N = 8,663) in the Population Assessment of Tobacco and Health (PATH) study were analyzed. The generalized difference-in-difference approach along with weighted hurdle and multinomial logistic regressions were conducted to examine the associations between aerosol-free policies and three measures of e-cigarette use (past 30-day e-cigarette abstinence status and number of use days, and past-12-month use frequency) pre- and post-policy implementation. Results Results indicated there were not statistically significant differences in e-cigarette use behaviors between participants living in states with and without the aerosol-free policies (ps ranged from 0.301 to 0.831), considering pre- and post-policy implementation. Conclusions Findings indicated that the effectiveness of the aerosol-free policies on e-cigarette use behaviors was not supported by longitudinal national data. States that have implemented aerosol-free policies should make pertinent efforts to enhance the awareness of these policies and to strengthen their enforcement. Future investigation into e-cigarette use in places where it is prohibited and implications with regard to effectiveness of aerosol-free policies is warranted.

The Impact of Smoke-Free Air Laws and Conventional Cigarette Taxes on Cardiovascular Hospitalizations.

Smoke-free air legislation and conventional cigarette taxes have long been used to reduce smoking initiation, prevalence, and conventional cigarette consumption. However, the extent to which these policies affect population health across a range of diagnoses and age groups remains less well understood. Analyses use 2005-2014 hospital inpatient discharge data from up to 40 US states to estimate the effects of smoke-free air laws and conventional cigarette taxes on cardiovascular hospitalizations among working age and older adults. An increase in the percent of a county's population covered by smoke-free air laws yielded a significant decline of 2.4% (Relative risk [RR]: 0.976, 95% confidence interval [95% CI]: 0.954, 0.997) in acute cerebrovascular disease hospitalizations among older adults. Moreover, significant declines of 2.0% (RR: 0.980, 95% CI: 0.967, 0.994) and 2.8% (RR: 0.972, 95% CI: 0.949, 0.996) in acute cerebrovascular disease were observed among older adults in the first year and subsequent years after smoke-free air legislation was implemented, respectively. Conventional cigarette taxes did not yield a significant change in acute cerebrovascular disease hospitalizations, nor did either tobacco control policy lead to a significant decline in acute myocardial infarction hospitalizations. Smoke-free air laws play an important role in reducing adult cardiovascular hospitalizations. These findings confirm existing research on acute cerebrovascular disease outcomes, as well as the modest effects on acute myocardial infarction hospitalizations observed in state- and national-level analyses. Current research at the local level finds smoke-free air laws yield 40% declines in acute myocardial infarction hospitalizations and 29% declines in acute cerebrovascular disease. State- and national-level analyses find smaller effects of smoke-free air laws, and largely omit analyses of working age adults. Existing research likely suffers from omitted variable bias, including state-level tobacco control funding and local-level conventional cigarette taxes. Using adult hospitalization data from up to 40 states, this study confirms existing evidence at the national and state level, and provides new evidence that smoke-free air laws significantly reduce acute cerebrovascular disease hospitalizations among older adults.

The Mexico SimSmoke tobacco control policy model: Development of a simulation model of daily and nondaily cigarette smoking.

BackgroundNondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico.MethodsA previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels.ResultsBetween 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15–44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending.ConclusionsAlthough Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.

Adding vaping restrictions to smoke-free air laws: associations with conventional and electronic cigarette use.

In the United States, some states and localities have added vaping restrictions to established smoke-free indoor air laws in order to reduce electronic cigarette use. Yet, if smokers use e-cigarettes to quit, such restrictions could have the unintended effect of attenuating the original smoke-free air policy's effects on smoking. This study estimated changes in current smoking, past-year smoking cessation, and recent vaping following the introduction of smoke- and vape-free air laws. Observational study of nationally representative data from the 2014-2018 National Health Interview Survey. United States. 87 334 participants, 18-54years of age. Multivariable linear regressions estimated the association between increased exposure to smoke- and vape-free worksite and restaurant laws and self-reported current smoking and recent vaping among emerging adults (ages 18-25), as well as past-12-month smoking cessation among prime age adults (ages 26-54). All regressions adjusted for respondent sociodemographic and other tobacco control policies, along with state and year fixed effects. Smoke-free worksite laws were associated with significant reductions in the likelihood of current smoking ( =-0.050, 95% CI: -0.098, -0.002, P=0.038) and recent vaping ( =-0.040, 95% CI: -0.072, -0.007, P=0.013), as well as increases in the likelihood of smoking cessation ( =0.026, 95% CI: 0.000, 0.052, P=0.046). Adding vaping restrictions to smoke-free worksite laws did not yield further reductions in recent vaping ( =0.008, 95% CI: -0.021, 0.036, P=0.568) and counteracted over half of the estimated association with current smoking relative to smoke-free policies alone ( =0.030, 95% CI: -0.028, 0.088, P=0.301). From 2014 to 2018, increased adoption of smoke-free worksite laws in the United States was associated with reductions in both current smoking and recent vaping, as well as increases in smoking cessation. Adding vaping restrictions to smoke-free worksite laws, however, was not associated with a reduction in recent vaping among emerging adults and may have attenuated the smoke-free policy's impact on current smoking in this age group.

Testing effects of awareness of statewide smoke-free air law and risk perception on smoking behaviors

PurposeTo reduce the smoking rates and alleviate societal problems associated with smoking, health administrators and policy makers have attempted to promote and implement statewide smoking free policy. The present study examined how adults' awareness of and attitude toward the smoke-free air law, their perceived risks of secondhand smoke and current smoking status were associated with smoking attitude and behaviors.Design/methodology/approachAs part of the Indiana Adult Tobacco Survey, 2,027 respondents participated in cross-sectional telephone surveys. A series of independent sample t-test and binary logistic regression analyses were performed.FindingsAwareness of the state law was inversely related to negative attitude toward smoking behaviors. Individuals who reported favorable attitude toward the state smoke-free air law and higher risk perceptions of secondhand smoke showed negative attitude toward smoking behaviors. Non-smokers and former smokers were significantly different from current smokers with regard to attitude toward smoking. Negative attitude was significantly related to intention to quit smoking. Awareness of the state law, perceived risk and current smoking status were key determinants for anti-smoking attitude and behavior.Originality/valueFindings highlight the importance of effective dissemination of the state law and recommend a strategic intervention design that invokes risk perceptions of secondhand smoke.

The impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California.

Although numerous studies have examined the impact of cigarette prices on cigarette demand, research examining the impact of e-cigarette and cigarette prices on e-cigarette demand is relatively limited. This study estimated the impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California. Using the 2012-2017 Nielsen Retail Scanner Data, we constructed e-cigarette prices, cigarette prices, and per capita e-cigarette and cigarette sales by year, quarter, and Nielsen scantrack market in California. E-cigarettes were categorized as disposable or reusable. Separate fixed-effects models estimated the impact of e-cigarette and cigarette prices on per capita disposable e-cigarette, reusable e-cigarette, and cigarette sales controlling for year, quarter, market, and smoke-free air law coverage. Average prices were $5.86 per pack of 20 cigarettes, $9.80 per disposable e-cigarette, and $19.11 per reusable e-cigarette. When prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes increased by 1%, per capita sales of the products decreased by 0.37%, 0.20%, and 0.21% respectively. Cigarette prices were positively associated with per capita sales of reusable e-cigarettes, indicating reusable e-cigarettes are substitutes for cigarettes. Reusable e-cigarette prices were positively associated with per capita sales of disposable e-cigarettes, indicating disposable e-cigarettes are substitutes for reusable e-cigarettes. No statistically significant association was found between disposable/reusable e-cigarette prices and cigarette sales. Our results suggest that raising prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes such as via tobacco excise tax increases would result in reduced sales for the products. Policymakers should consider the substitution between e-cigarettes and cigarettes when designing tobacco control policies.

Community Program Activities Predict Local Tobacco Policy Adoption in Florida Counties.

The Bureau of Tobacco Free Florida's community program funds county-level grantees who promote local policy change through activities that educate the public, policy-makers, and decision-makers. There is robust literature linking tobacco control policies such as smoke-free air laws and tax increases to reductions in tobacco use. There is less evidence documenting the local activities programs conduct to achieve local policy change. In the current study, we used a quantitative model to assess the relationship between community tobacco control activities and local tobacco policy adoption. Grantee activities and policy adoption for each county are recorded in a database. To evaluate the community program, we compiled inputs and used a fixed-effects negative binomial regression to examine the relationship between grantee activities and policy adoption across all 67 community-based programs in Florida from 2010 to 2017 and analyzed the data in 2018. Measures included categories of policies (organization policies and jurisdiction policies) and community-based activities associated with tobacco control programs. Organization policy (school and business policy) and jurisdiction policy (county or city ordinances, proclamations, and resolutions) were dependent on partner meetings (incident rate ratio [IRR] = 1.03, confidence interval [CI] = 1.00-1.07 and IRR = 1.04, CI = 1.01-1.07, respectively) and local decision-maker communication (IRR = 1.01, CI = 1.00-1.03 and IRR = 1.05, CI = 1.03-1.07, respectively). Jurisdiction policy was also dependent on media advocacy (IRR = 1.07, CI = 1.02-1.12) and state policy-maker education (IRR = 1.16, CI = 1.06-1.26. Community outreach was negatively associated with jurisdiction policy (IRR = 0.97, CI = 0.94-0.99), and data collection was negatively associated with organization and jurisdiction policy (IRR = 0.97, CI = 0.95-1.00 and IRR = 0.97, CI = 0.95-1.00, respectively). Results from the study demonstrate that the type and timing of community grantee activities may influence local tobacco control policy adoption.

Effectiveness of Indiana's Statewide Smoke-Free Indoor Air Law in Reducing Prevalence of Adult Cigarette Smoking.

Indiana recently implemented a statewide smoke-free indoor air law that has prohibited smoking in both restaurants and non-hospitality workplaces. Evidence for the effectiveness of the recent statewide smoke-free indoor law may persuade 14 states that do not have any statewide smoke-free laws to enact such laws. We evaluated the effectiveness of Indiana's State Smoke-Free Air Law, implemented July 2012, in reducing adult smoking prevalence. We analyzed samples of U.S. adults using a nonequivalent control group design with multi-year, cross-sectional data from the 2011-2016 Behavioral Risk Factor Surveillance System ( N= 2,259,014). Four state groups with different levels of comprehensiveness in regard to statewide smoke-free indoor air laws in 2011-2016 served as the comparison groups, namely those with: (1) no law; (2) a partial law (prohibiting smoking in either one or two of these three settings, namely non-hospitality workplaces, restaurants, and bars); (3) a comprehensive law (prohibiting smoking in all non-hospitality workplaces, restaurants, and bars); and (4) those that changed from a partial to a comprehensive law. We used a difference-in-differences approach with multiple logistic regressions to assess the net effect of the policy with a secular trend removed. The decline rate of cigarette smoking in Indiana was steeper, from 21.2% in 2011-2012 to 17.8% in 2013-2016, than in states in our four comparison groups, which suggests a significant reduction in adult cigarette smoking prevalence above and beyond the downward secular trend observed. All the comparison groups showed higher odds of cigarette smoking than Indiana (adjusted odds ratios range from 1.08 to 1.16). Although a long-term effect of Indiana's State Smoke-Free Air Law has yet to be evaluated, current data indicate that such a policy appears to be effective in reducing smoking prevalence. The implementation of statewide smoke-free indoor air laws in all restaurants and non-hospitality workplaces may help reduce smoking rates in the 14 states that still do not have any statewide smoke-free indoor air laws.

Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures

California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015-2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012-2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February-June 2019. Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions' adult smoking prevalence. State law changes in 2015-2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.

PhenX: Environment measures for Tobacco Regulatory Research

ObjectiveA Working Group (WG) of tobacco regulatory science experts identified measures for the tobacco environment domain.MethodsThis article describes the methods by which measures were identified, selected, approved and placed in...

Differential Relationship between Tobacco Control Policies and U.S. Adult Current Smoking by Poverty.

The study’s purpose was to identify differences in the relationship between tobacco control policies and smoking by poverty. We matched state smoke-free air law coverage (SFALs), tobacco control funding (TCF), and cigarette taxes with individual current smoking and demographics from supplements to the Current Population Survey (1985–2015). We regressed (logistic) smoking on policy variables, poverty (<138% of poverty line versus ≥138% of poverty line), interactions of policy and poverty, and covariates, presenting beta coefficients instead of odds ratios because it is difficult to interpret interactions using odds ratios (they are ratios of odds ratios). We coded SFALs as (1) proportion of state covered by 100% workplace, restaurant and bar laws (SFAL-All) or (2) proportion of state covered by workplace laws (SFAL-WP) and proportion covered by restaurant or bar laws (SFAL-RB). In the SFAL-All model, SFAL-All (Beta coeff: −0.03, 95% CI: −0.06, −0.002), tax (Coeff: −0.06, 95% CI: −0.07, −0.05), and TCF (Coeff: −0.01, 95% CI: −0.01, −0.001) were associated with less smoking. In this model, the interaction of SFAL-All by poverty was significant (Coeff: 0.08, 95% CI: 0.02, 0.13). In the SFAL-WP/RB model, SFAL-RB (Coeff: −0.05, 95% CI: −0.08, −0.02), tax (Coeff: −0.05, 95% CI: −0.06, −0.04), and TCF (Coeff: −0.01, 95% CI: −0.01, −0.00) were significant. In the same model, SFAL-WP (Coeff: 0.09, 95% CI: 0.03, 0.15), SFAL-RB (Coeff: −0.14, 95% CI: −0.19, −0.09), and TCF (Coeff: 0.01, 95% CI: 0.00, 0.02) interacted with poverty. Tax by poverty was of borderline significance in this model (Coeff = 0.02, 95% CI: −0.00, 0.04, p = 0.050). Among adults, SFALs, TCF, and tax were associated with less current smoking, and SFALs and TCF had differential relationships with smoking by poverty.

The Minnesota SimSmoke Tobacco Control Policy Model of Smokeless Tobacco and Cigarette Use

A previous Minnesota SimSmoke tobacco control policy model is extended to more recent years and to include smokeless tobacco use. Using data from the 1993 Tobacco Use Supplement and information on state policies, the Minnesota SimSmoke model was updated and extended to incorporate smokeless tobacco (both exclusive and dual use) and smokeless tobacco-attributable deaths. The model was then validated against the 2002, 2006/2007, and 2014/2015 Tobacco Use Supplement and the 1999, 2007, 2014, and 2018 Minnesota Adult Tobacco Survey and used to estimate the impact of policies implemented between 1993 and 2018. Analysis was conducted in April 2019. The model validated well for cigarette and earlier smokeless tobacco use, but it predicted smokeless tobacco use less well in recent years. The model projected that male (female) smoking prevalence was 35% (36%) lower in relative terms by 2018 and 43% (44%) lower by 2040 owing to policies, with lesser reductions projected for male smokeless tobacco use. Tobacco-attributable deaths were reduced by 7,800 by 2018 and 46,900 by 2040. Price increases, primarily through taxes, were projected to have had the greatest impact on cigarette use followed by smoke-free air laws, cessation treatment policies, tobacco control campaign expenditures, and youth access enforcement. Similar effects were projected for smokeless tobacco use, except that smoke-free air laws had smaller effects. As cigarettes remain the dominant form of nicotine delivery product, cigarette-oriented policies may be an effective means of reducing the use of all nicotine delivery products. However, noncigarette-oriented policies may also play an important role.

State Tobacco Excise Taxation, Comprehensive Smoke-free Air Laws, and Tobacco Control Appropriations as Predictors of Smoking Cessation Success in the United States.

The purpose of the present study was (1) to examine demographic differences between smokers who successfully quit (n = 1809), who relapsed (n = 6548), and who did not attempt to quit (n = 11 102) within the last year, and (2) to examine state-level tobacco policies/programs as predictors of quit success. Data were utilized from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, which were paired with 2014 data on taxation, appropriations, and smoke-free air laws. As compared with smokers who relapsed, those who successfully quit were more likely to be white, married, more highly educated, of higher income, and heavier smokers. Compared with those who did not attempt to quit, those who attempted to quit, regardless of success, were younger and more likely to be Hispanic. State comprehensive smoke-free air laws and tobacco excise taxation significantly predicted quit success. Thus, expansions of these policies should be considered to promote successful quitting.

Contaminant Exposures in Indigenous Communities: Tribal Research Avenues and Health Effects

IntroAmerican Indians were stripped of traditional tobacco upon first contact with settlers, forcing them to use commercial tobacco for sacred ceremonies. Colonization and exploitation of American Indians by tobacco companies contribute to the Cheyenne River Sioux Tribe&amp;#8217;s (CRST) 51% smoking rate.MethodsTo reduce secondhand smoke exposure in indoor public places on CRST, the Canli Coalition began advocating for a tribal smoke-free air law in 2009. By 2012, 76% of tribal members supported smoke-free air in public. In 2015, the CRST became the third tribe in America to pass a comprehensive smoke-free air policy. Evidence supporting such policies will pave the way for more smoke-free policies in Indigenous territories. The CRST Mercury in the Water Study sought to find exposures to metals through fishing, smoking and land use pathways. Commercial tobacco contributes to heavy metal exposure and poor health outcomes through metal toxicants. Tobacco use and secondhand smoke exposure was collected using a survey and cotinine levels confirmed nicotine exposure. 225 adult CRST members participated from 2014-2016 (75 per year). This analysis focuses on tobacco exposure changes after the 2015 CRST Ordinance 77 was passed.ResultsThe year following Ordinance 77, the rate of smokers with high cotinine levels (&amp;gt; 15 ng/ml serum cotinine concentration) was reduced from 83% to 40%. Non-smokers with high cotinine levels reduced from 18% to 13% in the year following policy adoption. The number of cigarettes smoked among current smokers did not change significantly. However, participants with intermediate cotinine levels increased in 2016 for smokers and non-smokers. Detailed home and indoor sampling for nicotine surface deposition and toxicant exposure can be included in future Tribal research agendas to accurately depict the impact of smoke-free air policies in Indigenous communities.