Smoke-free Indoor Air Research Articles

Prevalence of Smoking Among School Students in Iraq.

Background Developing communities like Iraq are critical to building a good community environment. Many complex patterns of behaviors like smoking among adolescents have been exacerbated rapidly in the current era which led to changes in the Iraqi community's perspectives and life expectancy. This study aims to find out the prevalence of smoking among secondary school students in Iraq and their perceived contributing factors. Methods A cross-sectional study design was used with a representative sample of Iraqi school students recruited through a multistage cluster randomization from the Nineveh Governorate's intermediate and secondary schools to ensure the representation of the general public strata. A total of 330 students were randomly selected from eight schools distributed all over Mosul city (the center of Nineveh Governorate) and its boundaries semi-rural areas. Data collection utilized a standardized, anonymous questionnaire based on the Global Youth Tobacco Survey (GYTS) administered within classrooms with the researcher's presence. The questionnaire included questions related to sociodemographic characteristics of the students, smoking state, smoking types, frequency of smoking, relative smoking state, opinion on predisposing factors for initiation of smoking, and knowledge about hazards of smoking. Data analysis was done using SPSS version 26 to calculate frequency distribution with further logistic regression analysis was performed to identify statistically significant factors contributing to initiation of smoking among the student participants with p-value estimation of any compares considered significant below 0.05. Results Prevenance of all types of smoking was 24.5% from 330 students with 30% from 246 males and 7%from 84 females has been encountered. Hookah (Shisha) was the most prevalent type of smoking.About a third of the smoker sample reported smoking at least once daily. Peer pressure (OR=3.49, P< 0.001) or family smoking (OR=1.769, P=0.019) emerged as the strongest influence for initiation of smoking, besides stress (OR=2.23, P= 0.04) and personality traits like stammering and jealousy (OR=2.58, P= 0.013), (OR=2.22, P= 0.017, respectively) have also significant odds. Interestingly, media (movie star) influence played a significant role also. (OR=1.492, P= 0.045). Conclusion The prevalence of smoking among the study sample was 24.5 % out of 330 participating students. Significant influencing factors were found that raised the concern and necessitated the development of targeted interventions. Implementing evidence-based strategies, such as comprehensive school-based educational programs and smoke-free indoor air policies, can significantly improve public health outcomes.

An Association Between State Laws Limiting Local Control and Community Smoke-Free Indoor Air in the United States.

This study examines the association between state laws limiting local control (preemption laws) and local smoke-free policies. We utilized policy data from the American Nonsmokers' Rights Foundation. The primary outcome variable is the presence of a "100% smoke-free policy," across any of 4 indoor settings: workplaces, restaurants, bars, and gaming venues. We employed generalized structural equation modeling to investigate the relationship between state laws pre-empting smoke-free indoor air regulation and local adoption of policies requiring smoke-free air in any public venues, or for specific venues, adjusting for sociodemographic characteristics. Our findings reveal a significant association between state preemption laws and the presence of a local 100% smoke-free indoor policy as of 2023. In states with preemption laws, cities were less likely to have a 100% smoke-free indoor policy at any venue than cities in states without preemption laws (OR = 0.07, 95% CI = 0.05-0.10). When considering specific smoke-free venues, cities in states with preemption laws were less likely to have a 100% smoke-free indoor policy covering workplaces (OR = 0.05, 95% CI = 0.03-0.09), restaurants (OR = 0.04, 95% CI = 0.02-0.07), bars (OR = 0.04, 95% CI = 0.03-0.08), and gaming venues (OR = 0.03, 95% CI = 0.01-0.09) compared to cities in states without preemption laws. Our study suggests that state preemption laws limit local decision-making and the implementation of public health policies focused on tobacco harms.

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.

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.

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.

Comparing particulate emissions between electronic nicotine delivery devices: context for smoke-free indoor air quality

Comparing particulate emissions between electronic nicotine delivery devices: context for smoke-free indoor air quality

Control of Cardiovascular Disease in the 20th Century: Meeting the Challenge of Chronic Degenerative Disease.

After World War II, industrialized countries found themselves faced with a new epidemic of chronic disease. Stroke had long been a common cause of death, however a much more virulent form of vascular disease involving the coronary arteries was now recognized as a major public health challenge. By the late 1950s, cardiovascular diseases (CVD) accounted for almost two-thirds of deaths in the US. Within 10 years, the key causal factors underlying CVD had been fully defined, and by the mid-1960s, prevention trials, policy changes, and subsequent population-wide risk factor improvement and targeted high-risk medical therapy led to a rapid and sustained decline in both coronary heart disease (CHD) and stroke. By the turn of the century, CVD had declined over 80%, transforming health for adults and providing the main driver of lengthening life expectancy. This transformative process has now reached every country in the world. Epidemiologic, nutritional and clinical research, along with changes in social norms, public health education, smoke-free indoor air regulations, drug development, and clinical trials have led to the astounding success of the CVD control movement. The broad pattern pursued in the control of CVD provides a template for similar control efforts aimed at cancer, diabetes, renal disease, and other common chronic diseases.

Comprehensive US Statewide Smoke-Free Indoor Air Legislation and Secondhand Smoke Exposure, Asthma Prevalence, and Related Doctor Visits: 2007-2011.

We evaluated the impact of comprehensive statewide smoke-free indoor air laws on secondhand smoke (SHS) exposure, asthma prevalence, and asthma-related doctor visits. We used the 2007-2011 Behavioral Risk Factor Surveillance System data sets. We employed a paired t test to determine whether comprehensive statewide smoke-free indoor air laws reduced SHS exposure. We performed weighted logistic and Poisson regressions to obtain likelihood of reporting asthma symptoms and incidence rate ratio (IRR) of doctor visits owing to severe asthma symptoms. After such laws were enacted, people in states with comprehensive smoke-free indoor air laws had a lower level of SHS exposure (P < .01), decreased odds of reporting current asthma symptoms (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.51, 0.63), and a decreased frequency of doctor's visits owing to severe asthma symptoms (IRR = 0.80; 95% CI = 0.69, 0.92) than did their counterparts in fully adjusted models. Comprehensive statewide smoke-free indoor air laws appear to be effective in reducing SHS exposure and improving asthma outcomes. Regulations requiring smoke-free indoor environments and public areas are beneficial, and smoke-free indoor air laws should be enforced in all states.

“Anti-Smoking Data Are Exaggerated” Versus “The Data Are Clear and Indisputable”: Examining Letters to the Editor About Tobacco

Media advocacy plays a unique role in tobacco control policy development. Letters to the editor in particular are an interesting form of media advocacy because they reflect community sentiment regarding the policy agenda and provide insight into the public debate. The authors used ethnographic context analysis to examine the techniques used by writers of 262 tobacco-related letters to the editor published in 61 newspapers across Missouri over a 2-year period when tobacco tax and smoke-free indoor air initiatives were occurring across the state. The authors found that pro–tobacco control letter writers often used didactic strategies, citing numbers and reports, to convey information and presented their training or experience as a health professional (e.g., M.D., Ph.D.) to add legitimacy to their arguments. Anti–tobacco control letter writers, in contrast, used narrative strategies to support their stance, claimed authority as a smoker or small business owner to legitimize their claims by relating to the audience, and used collectivity to capture the attention of policymakers. These results present the importance of strategic media advocacy in tobacco control. Tobacco control advocates should increase their use of narrative strategies and collectivity in order to better connect with the public and policymakers.

American Heart Association and Nonprofit Advocacy: Past, Present, and Future

Influencing public policy through advocacy is an essential strategy used by the American Heart Association/American Stroke Association (AHA/ASA) to achieve its health impact goals and programmatic objectives, which include helping all Americans lead healthier lives and reducing the incidence and consequences of cardiovascular disease and stroke. This advocacy work involves and engages the association's national officers, researchers, volunteer advocates, staff, and the general public and is a core strategy and key work process of the AHA/ASA. The organization's strategic approach to influencing public policy and leveraging its science and evidence base is not well known. This article provides the historical context of AHA advocacy, the organizational and legal structure under which these activities are carried out, the process used to develop the association's public policy positions and goals, the approaches used to achieve these goals, and the methods that have been developed to evaluate progress. This statement also examines the various tools and tactics that advocacy organizations use to influence public policy and specifically how the AHA/ASA conducts policy research, legislative and regulatory lobbying, coalition building and grassroots mobilization, and media advocacy. Finally, the ways that AHA/ASA evaluates the impact of its advocacy efforts are discussed, highlighting specific case studies and a brief summary of the association's 2010 to 2013 public policy agenda. The AHA's efforts to translate the science of cardiovascular disease and stroke into meaningful public policy began in earnest in the early 1980s. The association established a full-time office in Washington, DC, in early 1981 that was initially focused on increasing federal research funding administered by the National Institutes of Health.1 Other early policy priorities included tobacco control and support for programs that increased access to automated external defibrillators (AEDs), new clinical preventive benefits in the Medicare program, and nutrition policy. The commitment and involvement of …

Reaching Healthy People 2010 by 2013: A SimSmoke Simulation

Healthy People (HP2010) set as a goal to reduce adult smoking prevalence to 12% by 2010. This paper uses simulation modeling to examine the effects of three tobacco control policies and cessation treatment policies-alone and in conjunction-on population smoking prevalence. Building on previous versions of the SimSmoke model, the effects of a defined set of policies on quit attempts, treatment use, and treatment effectiveness are estimated as potential levers to reduce smoking prevalence. The analysis considers the effects of (1) price increases through cigarette tax increases, (2) smokefree indoor air laws, (3) mass media/educational policies, and (4) evidence-based and promising cessation treatment policies. Evidence-based cessation treatment policies have the strongest effect, boosting the population quit rate by 78.8% in relative terms. Treatment policies are followed by cigarette tax increases (65.9%); smokefree air laws (31.8%); and mass media/educational policies (18.2%). Relative to the status quo in 2020, the model projects that smoking prevalence is reduced by 14.3% through a nationwide tax increase of $2.00, by 7.2% through smokefree laws, by 4.7% through mass media/educational policies, and by 16.5% through cessation treatment policies alone. Implementing all of the above policies at the same time would increase the quit rate by 296%, such that the HP2010 smoking prevalence goal of 12% is reached by 2013. The impact of a combination of policies led to some surprisingly positive possible futures in lowering smoking prevalence to 12% within just several years. Simulation models can be a useful tool for evaluating complex scenarios in which policies are implemented simultaneously, and for which there are limited data.

Evaluation of the Immediate Impact of the Washington, D.C., Smoke-Free Indoor Air Policy on Bar Employee Environmental Tobacco Smoke Exposure

On January 2, 2007, thw Washington, D. C., City Council banned smoking in restaurants and bars. We sought to determine the immediate impact of the ban on cotinine-confirmed environmental tobacco smoke (ETS) levels and respiratory symptom reports of a random sample of bar employees. We conducted an assessment of 66 employees from 41 randomly selected bars in December 2006, a month before the ban went into effect. After analyses of baseline data, 52 employees were eligible and 49 of them (94%) had a post-ban assessment in February 2007. Three participants were excluded due to high cotinine levels at the post-ban assessment, yielding a final sample size of 46 bar employees. ETS exposure levels were documented using saliva cotinine analyses by tandem liquid chromatography and mass spectrometry. Employee respiratory and sensory symptoms reports were assessed by a standardized, validated form: the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire. Employee ETS exposure reports at work were eliminated after the ban. Sensory symptoms reports (at < or = 4 weeks) declined significantly by 70% to 100% (p = 0.0016); respiratory symptoms results were inconclusive due to a lack of data. Saliva cotinine medians declined significantly by 70% (p < 0.0001), from a pre-ban mean of 2.11 nanograms per millileter (ng/mL) to a post-ban mean of 0.29 ng/mL, confirming reports of no ETS exposure at work. We concluded that the indoor air law was effective, eliminating employee ETS exposure reports, dramatically reducing their cotinine levels, and almost eliminating reports of sensory symptoms.

Strength of smoke-free air laws and indoor air quality

Smoke-free air laws have been implemented in many Kentucky communities to protect the public from the harmful effects of secondhand smoke exposure. The impact of different strengths of smoke-free air laws on indoor air quality was assessed. Indoor air quality in hospitality venues was assessed in seven communities before and after comprehensive smoke-free air laws and in two communities only after partial smoke-free air laws. One community was measured three times: before any smoke-free air law, after the initial partial law, and after the law was strengthened to cover all workplaces and public places with few exemptions. Real-time measurements of particulate matters with 2.5 mum aerodynamic diameter or smaller (PM(2.5)) were obtained. When comprehensive smoke-free air laws were implemented, indoor PM(2.5) concentrations decreased significantly from 161 to 20 microg/m3. In one community that implemented a comprehensive smoke-free law after initially passing a partial law, indoor PM(2.5) concentrations were 304 microg/m3 before the law, 338 microg/m3 after the partial law, and 9 microg/m3 after the comprehensive law. The study clearly demonstrated that partial smoke-free air laws do not improve indoor air quality. A significant linear trend indicated that PM(2.5) levels in the establishments decreased with fewer numbers of burning cigarettes. Only comprehensive smoke-free air laws are effective in reducing indoor air pollution from secondhand tobacco smoke.

Leyes que prohíben fumar en espacios cerrados en México

Recently Mexico passed federal and state-level laws banning smoking in indoor spaces. These actions are totally in accordance with measures proposed in the WHO-FCTCs article 8, ratified by Mexico in 2004. This essay reviews scientific evidence that secondhand smoke causes both chronic and acute diseases among non smokers, children and adults. There is no safe level of exposure to secondhand smoke, so the only effective intervention to protect Mexican people from such harmful exposure is by promoting 100% smoke free indoor air, as the two new laws do. Total banning of smoking is associated with reduction in smoking prevalence, amount of cigarette smoked per day, and an increase in cessation rates. Reductions in acute respiratory symptoms and hospitalization of acute myocardial infarction have been also reported. Well documented examples show that main tobacco industry arguments against smoke free policy: negative economic impact and lack of support from the public, are unjustified. These two laws strengthen the Mexican tobacco control program. Next steps include their implementation, evaluation, enforcement of compliance and encouragement for similar laws at state level.

Preemptive State Smoke-Free Indoor Air Laws

Preemptive State Smoke-Free Indoor Air Laws

Tobacco smoking increases dramatically air concentrations of endotoxin

We used a mass spectrometry-based assay for identifying the endotoxin (lipopolysaccharide, LPS) marker (R)-3-hydroxytetradecanoic acid in cigarette smoke particles and found that smoking involved inhalation of 17.4 pmol of endotoxin per each smoked cigarette. Indoor exposure to environmental tobacco smoke (ETS) entailed inhalation of 12.1 pmol of LPS/m3 air, an amount that was 120 times higher than the levels found in smoke-free indoor air. Endotoxin is one of the most potent inflammatory agents known, hence our results may help to explain the high prevalence of respiratory disorders among smokers, and they may also draw attention to a hitherto unknown or neglected risk factor of ETS. Endotoxin represents a largely neglected risk factor of smoking and passive smoking and this knowledge may lead to a reduced smoking.

Impact of a Smoking Ban on Restaurant and Bar Revenues

Impact of a Smoking Ban on Restaurant and Bar Revenues

“Can’t stop the boy”*: Philip Morris’ use of Healthy Buildings International to prevent workplace smoking bans in Australia

Objective: To document the relationship of the indoor air consultancy company Healthy Buildings International (HBI) with the Australian tobacco industry. Design: Systematic keyword and opportunistic website searches of tobacco industry...

Tobacco control advocacy in Australia: reflections on 30 years of progress.

Australia has one of the world's most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged and enshrined in World Health Organization policy documents yet is seldom the subject of analysis in the public health policy research literature. Australian public health advocates tend to not work in settings where evaluation and systematic planning are valued. However, their day-to-day strategies reveal considerable method and grounding in framing theory. The nature of media advocacy is explored, with differences between the conceptualization of routine "programmatic" public health interventions and the modus operandi of media advocacy highlighted. Two case studies on securing smoke-free indoor air and banning all tobacco advertising are used to illustrate advocacy strategies that have been used in Australia. Finally, the argument that advocacy should emanate from communities and be driven by them is considered.