Social Acceptability Of Smoking Research Articles

A Qualitative Study of Barriers and Motivators to Prevent Secondhand Smoke Exposure Among Pregnant Women and Children in Egypt: Identifying Appropriate Approaches for Change.

The prevalence of daily secondhand smoke (SHS) exposure among pregnant nonsmoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking in the home in Egypt. Six focus group discussions with pregnant women or mothers of children residing in urban-rural areas (n = 61) were conducted. Data were managed and analyzed using the Framework Method. Sixty-one participants aged 18-49 were recruited. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women or mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke-free home or workplace were social acceptance of smoking and SHS exposure, masculinity and gender norms of accepting smoking among men as a normative behavior, fear among women of damaging a relationship with family or even divorce, women resigning themselves to SHS exposure, and doctors not being supportive of smoking cessation. The majority of interviewees' families were reported to allow smoking anywhere in the home. Others implemented some measures to prevent SHS; however, these tended to be inconsistently implemented. Changing the norm of accepting smoking among men as a normative behavior within Egyptian society and better enforcement of smoke-free policies, will help to protect pregnant women and children from SHS. This study suggests promising approaches to support the promotion of smoke-free homes and the prevention of SHS exposure among pregnant women and children in public places in Egypt. Better enforcement of smoke-free policies is needed. Healthcare professionals should support smoking cessation services in primary health centers. SHS policy, practice, and research should focus on husbands/fathers as they are the main source of SHS. There is a need for denormalization of SHS exposure in Egyptian society.

Preliminary feasibility of integrating tobacco treatment into SUD peer recovery coaching: a mixed-methods study of peer recovery coaches

BackgroundIndividuals with substance use disorder (SUD) have high prevalence of cigarette smoking and difficulty quitting. Peer recovery coaches (PRCs; individuals with lived SUD experience) facilitate SUD behavior change in recoverees but it is unknown if/how they address tobacco treatment in SUD recovery coaching. We assessed PRC’s tobacco-related practices and attitudes about tobacco treatment in SUD recovery.MethodsThe Tobacco use In Peer-recovery Study (TIPS) was a cross-sectional mixed-methods pilot survey (January–March 2022) of the 26 PRCs employed by a Massachusetts-based healthcare system’s 12 SUD treatment clinics/programs. PRCs completed a quantitative survey (n = 23/26; 88%) and a telephone-based qualitative interview (n = 20/26; 77%).ResultsOne-third of PRCs reported current smoking, 50% reported former smoking, and 18% never smoked. Among PRCs, 61% reported accompanying recoverees outdoors to smoke, 26% smoked with recoverees, 17% had provided cigarettes to recoverees, 32% used smoking to help build peer-relationships, and 74% rated smoking as socially acceptable in SUD treatment. PRCs reported regularly talking to recoverees about tobacco treatment (65%), believed they should have a role in helping recoverees quit smoking (52%), and were interested in tobacco treatment training (65%). A majority of both nonsmoking and current smoking PRCs (73% vs. 57%) regularly talked to recoverees about quitting smoking.ConclusionPRCs’ attitudes about integrating tobacco treatment into SUD recovery coaching were generally positive and PRCs reported they could have a role in helping recoverees with tobacco treatment. Barriers to integrating tobacco treatment into SUD recovery include use of cigarettes as a peer-recovery tool and high prevalence and social acceptability of smoking in SUD recovery.

Factors associated with smoking refusal self-efficacy among Finnish and Portuguese early adolescents

ABSTRACT Background Research indicates that refusal self-efficacy predicts adolescent smoking behavior and needs to be addressed in health education programs. Developing such programs requires examining the factors associated with smoking refusal self-efficacy in the target group. Thus, our study examined factors associated with smoking refusal self-efficacy among early adolescents in Finland and Portugal. Methods Self-reported data on smoking refusal self-efficacy, smoking outcome expectations, smoking-related attitudes, motives, and motivations were obtained from 295 early adolescents, and analyzed using a logistic regression and correlation calculations. Results Experiences with tobacco, smoking-related attitudes and motives, the motivation to refrain from smoking in the future, and smoking outcome expectations were associated with smoking refusal self-efficacy. Gender, and the smoking behavior of relatives and friends were independent predictors of smoking refusal self-efficacy. The findings were similar in both countries. Conclusions Our results strengthen the notion that parental smoking is not associated with smoking refusal self-efficacy of early adolescents but smoking by friends and relatives and gender favoring girls are. Thus, health education programs aiming to support early adolescent smoking refusal self-efficacy need to consider the role of peer influence and the social acceptance of smoking and place more emphasis on effectively supporting boys’ smoking refusal self-efficacy.

Psychosocial Factors, Smoke-Free Restrictions, and Media Exposure in Relation to Smoking-Related Attitudes and Behaviors among Adults in Armenia and Georgia.

Background: Perceived harm, social influences, smoke-free policies, and media exposure have been understudied in relation to tobacco-related attitudes/behaviors in aggregate or in low and middle-income countries; thus, this study examined these factors collectively in relation to smoking-related outcomes among Armenian and Georgian adults. Methods: Using 2018 cross-sectional survey data (n = 1456), multivariable regression analyses examined these factors in relation to smoking status, perceived harm among nonsmokers, and readiness to quit and past-year quit attempts among smokers. Results: Significant predictors (p < 0.05) of current smoking (27.3%) included lower perceived harm, more smoking friends, and fewer home and vehicle restrictions. Among nonsmokers, more home and restaurant/bar restrictions, fewer vehicle restrictions, greater anti-tobacco media exposure, and less pro-tobacco media exposure predicted greater perceived harm. Among smokers, greater perceived social acceptability of smoking, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted readiness to quit (12.7% of smokers). More smoking friends, more home restrictions, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted past-year quit attempts (19.2%). Conclusions: Findings support the importance of smoke-free policies but were counterintuitive regarding the roles of social and media influences, underscoring the need to better understand how to address these influences, particularly in countries with high smoking rates.

Prevalence and behavior regarding cigarette and water pipe smoking among Syrian undergraduates

BackgroundThe devastating Syrian crisis has raised concern regarding the social acceptance of smoking especially with water pipe use becoming a growing epidemic. We aim to determine the prevalence of cigarette and water pipe smoking among university students, along with identifying the addictive behavior among university students. MethodsA cross-sectional study was conducted at the Syrian Private University during World No-Tobacco Day, in Damascus, Syria during the war crisis. The survey consists of 4 sections: socio-demographic information, Fagerström Test of Nicotine Dependence, attitude towards water pipes, and perspective about smoking. Data were analyzed using the Statistical Package for Sciences version 25.0 (SPSS Inc., United States.) ResultsOf the 622 participants, 429 (69%) were males with a mean age of 21.3 ± 3.1 years. The prevalence of tobacco smoking was 320 (51.4%), 208 (23.8%) for cigarettes, and 112 (18.0%) for water pipe. Smoking was significantly higher among male non-medical university students. The majority were low to moderate dependent when assessed by the Fagerström Test of Nicotine Dependence. ConclusionsThis study showed a very high prevalence of smoking indicating the need for smoking cessation programs, access to effective quitting treatments, and mass media campaigns to diminish smoking among the youth.

'I smoke and drink alcohol during pregnancy, but I'm a good enough mom': a mixed methods study

Abstract Background Smoking and alcohol consumption during pregnancy is a major public health concern. The aims of this study were: 1) to examine smoking and alcohol consumption during pregnancy and to investigate their association with maternal attitudes and socio-demographic characteristics; 2) to explore maternal attitudes regarding smoking and alcohol consumption during pregnancy among pregnant and postpartum women in Israel. Methods This mixed methods study is comprised of a self-reported questionnaire for measuring attitudes and behaviors regarding smoking and alcohol consumption among 676 Jewish women, up to 9 months postpartum; and semi-structured interviews with 17 women who smoked cigarettes and/or consumed alcohol during their pregnancy. Results Sixty-four women (9.6%) reported drinking alcohol during pregnancy, and 30 (4.8%) reported smoking. Women with a fewer children (OR 2.25; 99% CI: 1.30, 3.92) and those whose attitudes supported alcohol avoidance (OR 0.52; 99.9% CI: 0.36, 0.74) consumed less alcohol while pregnant. Educated women (OR 0.31; 99% CI: 0.14- 0.71) and women with anti-smoking attitudes (OR 0.50; 99% CI: 0.30, 0.82) were more likely to avoid smoking during pregnancy. Qualitative analyses reveals three major themes: 1) 'A good enough mom': The mothers presented risk-management practices in line with the conflict between their perception of ideal motherhood and that of being an independent person; 2) 'Social acceptance of smoking and alcohol consumption during pregnancy': Social attitudes of spouses, family and friends; 3) 'Lack of reliable information' from healthcare professionals. Conclusions Women's attitudes have a significant impact on their decision to drink alcohol and/or smoke during pregnancy. These attitudes may be a result of their risk management practices and the social acceptance of risk behaviors during pregnancy, and information provided (or not) by healthcare professionals. Key messages The results highlight the importance of creating a supportive environment and shaping health promoting attitudes among pregnant women. Reliable information given by healthcare professionals regarding risk behaviors during pregnancy is needed.

Implementation of smoke-free law in Denpasar Bali: Between compliance and social norms of smoking.

Background: Since 2013, City of Denpasar government has adopted a smoke-free law. Implementation of the law faces several obstacles, partly due to the high social acceptability of smoking in the city, where cigarette and smoking has been deeply engrained within social life and become part of hospitality. This study aims to assess the smoke-free law compliance and to explore the social norms that may affect the compliance.Design and Methods: The study was a mix of cross-sectional compliance survey and qualitative exploration conducted in Denpasar in 2019. Survey included 538 samples, which were selected using stratified random sampling and a walking protocol. The qualitative data was collected through in-depth interviews and Focus Group Discussion (FGD) in four sub-districts of Denpasar.Results: Of the 538 venues, 32.9% complied with the seven compliance indicators. The university has the highest compliance (83.3%), while public places including worship places have a low compliance. The three most common violations were the absence of no-smoking signage (58.6%), provision of ashtray (17.5%), and smell of tobacco smoke (15.8%). The poor compliance was related to the lack of awareness of the regulation, and the fact that smoking is highly acceptable and part of the culture. The informants highlighted the essential role of public figures and potency of local policy as social disapproval of smoking.Conclusions: Compliance to the smoke-free law in Denpasar remains low, continuous education, socialization and improved supervision are crucial. Meanwhile, social and cultural acceptance of smoking is considered as an essential factor that hampers the implementation of the smoke free law.Significance for public healthThe tobacco epidemic is one of the major challenges for public health across the world. Smoke-free law is recommended by WHO which aim to protect nonsmokers from cigarette smoke exposure. However, this policy will be more effective for public health if the society comply. Hence, the compliance appears as a big challenge in implementing smoke-free law. Numerous studies showed various strategies to improve the compliance. Nevertheless, there were few strategies based on local norms or culture, which are important particularly in developing countries where smoking behavior is reinforced by cultural and religious aspects. Through our study, we would like to find out the extent to which improvements in compliance have been made using conventional strategies and identify the potential of local wisdom among the society, which affect their smoking behavior. Ultimately, this study is expected to recommend also a culture-sensitive strategy to improve and sustain the compliance with the smoke-free law.

Electronic Cigarette Advertising Impacts Adversely on Smoking Behaviour Within a London Student Cohort: A Cross-Sectional Structured Survey

IntroductionIn contrast to tobacco smoking, electronic cigarette (“vaping”) advertisement had been approved in the United Kingdom (UK) in January 2013. Currently, there are an estimated 3.2 million UK e-cigarette users. The impact of e-cigarette advertisement on tobacco use has not been studied in detail. We hypothesised that e-cigarette advertisement impacts on conventional smoking behaviour.MethodsA cross-sectional structured survey assessed the impact of e-cigarette advertising on the perceived social acceptability of cigarette and e-cigarette smoking and on using either cigarettes or e-cigarettes (on a scale of 1 to 5/‘not at all’ to ‘a lot’). The survey was administered between January to March 2015 to London university students, before and after viewing 5 UK adverts including a TV commercial.ResultsData were collected from 106 participants (22 ± 2 years, 66% male), comprising cigarette smokers (32%), non-smokers (54%) and ex-smokers (14%). This included vapers (16%), non-vapers (77%) and ex-vapers (7%). After viewing the adverts, smokers (2.6 ± 1.0 vs. 3.8 ± 1.1, p = 0.001) and non-smokers (3.2 ± 0.7 vs. 3.7 ± 0.8, p = 0.007) felt smoking was more socially acceptable, compared to before viewing them. Participants were more likely to try both e-cigarettes (1.90 ± 1.03 to 3.09 ± 1.11, p < 0.001) and conventional cigarettes (1.73 ± 0.83 to 2.27 ± 1.13, p < 0.001) after viewing the adverts compared to before. Vapers were less likely to smoke both an e-cigarette, and a conventional cigarette after viewing the adverts.ConclusionE-cigarette advertising encourages both e-cigarette and conventional cigarette use in young smokers and non-smokers. The adverts increase the social acceptability of smoking without regarding the importance of public health campaigns that champion smoking cessation.

Moving from Overwhelming to Actionable Complexity in Population Health Policy: Can ALife help?

In this issue, we highlight a call to arms to the Artificial Life community to join the effort to address complex, whole-systems problems in health care. Many problems that society wishes to address in population health are clearly problems of managing complex adaptive systems. They involve making interventions in systems with multiple interacting causal connections, which span domains from physiological to economic. Additionally, of course, the individuals whose health we ultimately wish to improve adapt and change their behavior in response to medical or policy interventions.But how do we do it? In complex adaptive systems, as the following article reminds us, individual-level interventions are often not the most effective. Rather we might wish to change the conditions or structures of interaction in which individual behaviors play out. Taking a whole-systems view of the problem can allow us to identify higher-level levers that may allow us to reach broader swathes of the population simultaneously. We might be able to change what emerges or is stable in the system, without relying on the limited agency of individuals in a constrained and tangled context. Systems-based and complexity methods can help decision makers to understand their system at a level that makes such interventions possible to envisage and design.However, as Silverman rightly points out, producing effective and actionable policies [1] should be the goal that we aim to assist. Complexity approaches, however, run the risk of exposing policy makers to overwhelming complexity—situations in which revealing the reality of the situation paralyzes action. A case in point is the obesity systems map commissioned by the Foresight program of the UK Government Office for Science in 2007 [2]. This qualitative causal map attempted to systemically represent the full range of factors that affect individual obesity and their causal interconnections. The systems map produced had 108 factors organized in ten domains. Of these factors, only a very few concern individual physiology or calorie intake and energy expenditure. The rest span a large range of domains and phenomena such as social psychology, economics, the food production industry, transport infrastructure, urban design, and more, including long-term social changes such as more women in the workplace, the move away from manual labour, longer working hours, and a decrease in the social acceptability of smoking. It neatly shows the systemic nature of the health problem and the need for diverse and innovative policy interventions above the individual level.The map should be a powerful tool for enhancing understanding and communicating complexity and offers a means to identify levers, feedback loops, and causal cascades that could help to design complexity-appropriate policy interventions that exploit system structure. Interestingly, however, it is commonly referred to by policy professionals as “the horrendogram” and seems to have made people feel powerless in the face of the realities of the issue’s complexity.This perhaps highlights, more than anything else, that without guidance, models that demonstrate complexity may simply be intimidating. Without a domain expert to facilitate model exploration and translation, one has no idea how to start to unpick the complexity that has suddenly been revealed, let alone how to go about acting on it. Working in policy or public domains therefore requires much more than building models. It requires us to be on hand throughout a process of transforming overwhelming complexity into actionable complexity.This ultimately requires capacity building on complexity-appropriate methods and approaches within policy-making contexts themselves. For now, it entails a commitment to stay with the modeling and interpretation process as long as it is supported, a willingness to work in a way that can meet policy makers’ needs, and the provision of clear methods for stakeholders to investigate and interact with models. We must be clear, and illustrate with action and insights, that complex adaptive systems approaches are not silver bullets, but will pay dividends if committed to over time.Simulations in population health fall outside of what might be considered the traditional concerns of the artificial life community; however, the skills that ALife researchers might bring to the domain are clearly urgently required and, as Silverman reports, are being actively sought. It is heartening to find that genuine recognition of societal challenges as complex adaptive systems problems is spreading, despite the many entrenched interests and institutional constraints that lead to reductive thinking. For many decision makers, however, that nagging feeling that things need to be done differently continues to grow and grow. We must continue to build the groundwork, communicate, and actively seek out opportunities to make a difference. The appetite for change in policy design and evaluation is real, and the more support we can offer, the greater will be the chance that a groundswell of complex adaptive systems thinking can bring real change.

Tobacco industry attempts to frame smoking as a 'disability' under the 1990 Americans with Disabilities Act.

Using the Truth Tobacco Industry Documents Library and Congressional records, we examined the tobacco industry’s involvement with the 1990 Americans with Disabilities Act (ADA). During legislative drafting of the ADA (1989–1990), the Tobacco Institute, the tobacco industry’s lobbying and public relations arm at the time, worked with industry lawyers and civil rights groups to include smoking in the ADA’s definition of “disability.” Focus was on smoking as a perceived rather than actual disability so that tobacco companies could maintain that smoking is not addictive. Language that would have explicitly excluded smoking from ADA coverage was weakened or omitted. Tobacco Institute lawyers did not think the argument that smokers are “disabled” would convince the courts, so in the two years after the ADA was signed into law, the Tobacco Institute paid a lawyer to conduct media tours, seminars, and write articles to convince employers that hiring only non-smokers would violate the ADA. The ultimate goal of these activities was to deter employers from promoting a healthy, tobacco-free workforce and, more broadly, to promote the social acceptability of smoking. Employers and policy makers need to be aware that tobacco use is not protected by the ADA and should not be misled by tobacco industry efforts to insinuate otherwise.

Physicians\u2019 views on the role of smoking in smoking-related diseases: findings from cross-sectional studies from 1982\u20132014 in Estonia

BackgroundPrevious reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases.MethodsCross-sectional postal surveys were sent to all practising physicians in Estonia in 1982, 2002 and 2014 providing data from 3504, 2694, and 2865 physicians respectively. Data analysis involved calculation of the prevalence of smoking with 95% confidence intervals and calculation of the prevalence of agreement with a causal role of smoking in ischaemic heart disease (IHD), lung cancer and chronic bronchitis. Logistic regression was used to analyse associations between agreement with the statements that smoking is a cause of IHD, lung cancer, chronic bronchitis and study year, smoking status, age group and ethnicity. Fully adjusted odds ratios with 95% confidence intervals were calculated.ResultsThe age-standardized prevalence of current smoking among men decreased from 39.6% in 1982 to 14.2% in 2014, and among women from 12.4 to 5.1%, respectively. Compared with 1982, the proportion of physicians agreeing with statements that smoking is a major cause or one of the causes of IHD, lung cancer, or chronic bronchitis was significantly higher in 2002 and 2014. Past and never smokers were more likely to admit a causal role of smoking in lung cancer than smokers. Agreement with a causal role of smoking in IHD and chronic bronchitis was significantly higher among never and past smoking women only. Compared with non-Estonians, the odds ratio indicating agreement with all three statements was significantly higher among Estonians.ConclusionFrom 1982 to 2014, physicians’ attitudes towards the health risks of smoking improved in Estonia. However, their assessment of a causal role of smoking in smoking-related diseases was related to their own smoking habits and ethnicity.A further decline in smoking among Estonian physicians would require special efforts targeted at physicians. Societal pressure from a national policy could support a further decline in the social acceptability of smoking in Estonia and developments in medical education could provide continuing evidence-based information about the health effects of smoking to Estonian physicians.

Preventing tobacco epidemic in LMICs with low tobacco use — Using Nigeria GATS to review WHO MPOWER tobacco indicators and prevention strategies

IntroductionTobacco is a major preventable cause of disease and death globally and increasingly shifting its burden to low and middle-income countries (LMICs) including African countries. We use Nigeria Global Adult Tobacco Survey data to examine indications of a potential tobacco epidemic in a LMIC setting and provide potential interventions to prevent the epidemic. MethodologyGlobal Adult Tobacco Survey data from Nigeria (2012; sample=9765) were analyzed to examine key tobacco indicators. Estimates and confidence intervals for each indicator were computed using SPSS software version 21 for complex samples. Results5.5% of adult Nigerians use any tobacco and exposure to secondhand smoke was mainly high in bars (80.0%) and restaurants (29.3%). Two-thirds of smokers (66.3%) are interested in quitting. Among those who attempted to quit, 15.0% used counseling/advice and 5.2% pharmacotherapy. Awareness was high that tobacco use causes serious illnesses (82.4%), heart attack (76.8%) and lung cancer (73.0%) but only 51.4% for stroke. Awareness that secondhand smoke can cause serious illness was also high (74.5%). Overall 88.5% support tobacco products tax increase. ConclusionAlthough tobacco use is relatively low in Nigeria as in other African countries, high smoking rate among men compared to women might indicate potential increase in prevalence. Challenges to preventing increasing smoking rate include limited use of evidence-based cessation methods among quit attempters, social acceptability of smoking particularly in bars and restaurants, and gap in knowledge on tobacco-related diseases. However, ratification of WHO FCTC and signing into law of the Tobacco Control law provide the impetus to implement evidence-based interventions.

Epidemiological study of alcohol and tobacco consumption in people above 15 years of age in rural area of Nagpur, Maharashtra, India

Background: The World Health Organization predicts that tobacco deaths in India may exceed 1.5 million annually by 2020.Very few community-based studies have been conducted on the prevalence of alcohol use in India. Alcohol consumption has a U- shaped relation with ischemic heart disease and is as well a strong frisk factor for hepatic cirrhosis and many other type of injury. Methods: It was a cross-sectional study, carried out in three villages of a PHC. A total of 3771 study subjects aged 15 years and above were included in the study. It was conducted from July 2007 to December 2009. General information and socio-economic details of study subjects were obtained. Details were recorded about personal habits like smoking, consumption of smokeless tobacco, alcohol. General and systemic examination was carried out and findings were recorded. Results: In the present study, the prevalence of current smokers was 20.5% among males and none among females. In the present study the prevalence of smokeless tobacco use was 48.3% and the prevalence of current consumer of alcohol was 37.7% among males while there were none among the female. Conclusions: we found a low prevalence of smoking tobacco and non-consumption of alcohol among females which can be attributed to the less social acceptability of smoking in this rural part of Nagpur, Maharashtra, India.

Evaluating the validity of self-reported smoking in Mexican adolescents

ObjectivesWe aimed to evaluate the validity of the self-reported smoking indicator used in the Global Youth Tobacco Survey (GYTS).Setting43 middle and high-school classrooms from 26 schools were selected from Mexico...

Clearing the air: improving smoke-free policy compliance at the national oncology hospital in Armenia.

BackgroundSmoke-free policies shown to reduce population exposure to secondhand smoke (SHS) are the norm in hospitals in many countries around the world. Armenia, a transition economy in the South Caucasus, has one of the highest male smoking rates in the European region. Although smoking in healthcare facilities has been banned since 2005, compliance with this ban has been poor due to lack of implementation and enforcement mechanisms and social acceptability of smoking. The study aimed to develop and test a model intervention to address the lack of compliance with the de jure smoking ban. The national oncology hospital was chosen as the intervention site.MethodsThis study used employee surveys and objective measurements of respirable particles (PM2.5) and air nicotine as markers of indoor air pollution before and after the intervention. The intervention developed in partnership with the hospital staff included an awareness campaign on SHS hazards, creation of no-smoking environment and building institutional capacity through training of nursing personnel on basics of tobacco control. The survey analysis included paired t-test and McNemar’s test. The log-transformed air nicotine and PM2.5 data were analyzed using paired t-test.ResultsThe survey showed significant improvement in the perceived quality of indoor air, reduced worksite exposure to SHS and increased employees’ awareness of the smoke-free policy. The number of employees reporting compliance with the hospital smoke-free policy increased from 36.0% to 71.9% (p < 0.001). The overall indoor PM2.5 concentration decreased from 222 μg/m3 GM (95% CI = 216-229) to 112 μg/m3 GM (95% CI = 99-127). The overall air nicotine level reduced from 0.59 μg/ m3 GM (95% CI = 0.38-0.91) to 0.48 μg/ m3 GM (95% CI = 0.25-0.93).ConclusionsThe three-faceted intervention developed and implemented in partnership with the hospital administration and staff was effective in reducing worksite SHS exposure in the hospital. This model can facilitate a tangible improvement in compliance with smoke-free policies as the first step toward a smoke-free hospital and serve as a model for similar settings in transition countries such Armenia that have failed to implement the adopted smoke-free policies.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-943) contains supplementary material, which is available to authorized users.

Psychological predictors of stage of readiness to quit among Hong Kong Chinese smokers: the role of social acceptance of smoking by family

Psychological predictors of stage of readiness to quit among Hong Kong Chinese smokers: the role of social acceptance of smoking by family

Smoking’s Shrinking Geographies

Smoking bans are the most geographical aspect of contemporary tobacco control policy, and are eliminating smoke from many of the spaces of everyday life, particularly in high-income countries. In this paper, we emphasize that the adoption of bans both reflects, and reinforces, changing social norms around smoking and exposure to environmental tobacco smoke. Specifically, as understandings of the health consequences of environmental tobacco smoke have developed, social acceptance of smoking has declined. Bans cement this norm shift by making the behaviour more difficult to perform, relocating smokers to marginal places, and contributing to stigmatization. We draw upon a diverse, multi-disciplinary scholarship examining contemporary trends in the spatial regulation of smoking. While its focus is on the formal, large-scale bans implemented by public authorities, increasing attention is now being paid to the myriad small-scale, voluntary decisions of private actors to limit smoking. As smoking is permitted in ever fewer places, the behaviour is denormalized and its social status markedly eroded.

Chronic Respiratory Illnesses in Jordan: Pulmonary Physicians' Experiences in Risk Reduction

Chronic respiratory diseases are on the rise in Jordan. However, there is limited research on the symptoms reported by patients, the triggers associated with their illnesses, and the health education efforts of pulmonary physicians. Thus, the purpose of this qualitative study was to understand these issues from physicians' perspectives. Fourteen face-to-face interviews were done with pulmonary physicians in their clinics in Amman, Jordan. Physicians indicated that cultural barriers existed such as the social acceptance of smoking, prevalence of olive trees, and cultural practices such as kissing as a form of greeting. In addition, health education materials were scarce and of poor quality. Implications for health education are discussed.

Try and try again--qualitative insights into adolescent smoking experimentation and notions of addiction.

addiction is a relatively unexplored issue in youth tobacco control. Increasingly, there is recognition of addiction experiences in regular and irregular teenage smokers. Research was undertaken on behalf of the Smarter than Smoking (STS) project to probe young people's reasons for smoking uptake, their attitudes towards the social acceptability of smoking, predictors of continued smoking after trial and understandings and perceptions of addiction. twenty focus groups were conducted to collect qualitative data from young people (n=92) aged 13 to 15 years from metropolitan and regional areas of Western Australia (WA), from a variety of socioeconomic backgrounds, including young Aboriginal and Torres Strait Islander people. of the young people spoken to, 20% smoked regularly, 40% had tried smoking and 40% had never tried. Acceptability and normalcy of trialling smoking was a recurring theme, with little perceived risk of trial leading to regular smoking or becoming addicted. Even non-smokers accepted 'just having a try' in the context of curiosity, life experiences and 'informed choice'. preventing continuation after trial of smoking among young people needs to increase in importance, given the prevailing norms around 'trying it' and individual choice.

Smoking cessation should have more emphasis within Tobacco Control? The case for

Smoking cessation is usually mentioned last in the chain of established measures to improve Tobacco Control. This seems logical, as smoking cessation is a secondary or tertiary preventative measure only. In the recently proposed Tobacco Control Scale (TCS) using 6 Tobacco Control measures pricing is considered most important, and smoking cessation least important. For current smokers secondary or tertiary preventative measures are necessary with smoking cessation being the most effective one as its impact on health is immediate. Pricing, on the other hand, is less effective in inciting current smokers to quit. Further, the vast majority of smokers would like to quit if they were able; so help in achieving this goal is welcome. Other Tobacco Control measures, on the other hand, are mostly negatively perceived by smokers because they perceive them as curtailment of their freedom. This is a psychological advantage the health professional active in this area has over other people involved in Tobacco Control and must be exploited. There is also strong evidence that smoking cessation is cost-effective, especially when comparing costs involved in addressing other important health risk factors, such as hyperlipidemia and arterial hypertension. Finally, the role of smoking cessation in helping to decrease social acceptability of smoking should not be underrated as every smoker who quits sets an example for other smokers to follow or for children not to start. In summary, smoking cessation continues to be of paramount importance among Tobacco Control measures, and should get more emphasis especially in health care settings.