Survey Tobacco Use Research Articles

Educational Disparities in Home Smoking Bans Among Households With Underage Children in the United States: Can Tobacco Control Policies Help to Narrow the Gap?

The prevalence of home smoking bans in the United States has increased overtime, but educational disparities have persisted. Little research has explored potential associations between tobacco control policies and disparities by socioeconomic status in home smoking bans. We examined educational disparities in home smoking bans in the United States from 1995 to 2007 and investigated the association between these disparities and statewide tobacco control policies, including cigarette taxes, smoke-free air laws, and media campaigns. We used data from the 1995-1996, 1998-1999, 2001-2002, and 2006-2007 Current Population Survey's Tobacco Use Supplement surveys (TUS-CPS) and data on state-level tobacco control policies. Disparities by level of education were calculated, and logistic regressions were estimated to explore the association between statewide tobacco control policies and educational disparities in the adoption of complete home smoking bans. Between 1995 and 2007, average absolute educational disparities in complete home smoking bans between those with and without a college degree were 8.5 percentage points (pp) and 17.1 pp among nonsmoker and smoker households, respectively. The adjusted odds ratio for education increased among nonsmoker households over time (p < .01) but remained stable among households with smokers. Households with less than college were generally more responsive to antitobacco policies. Antitobacco media campaigns at the state level were associated with reduced disparities by education among households with smokers (p < .05). More vigorous tobacco control policies at the state level may help promote the adoption of home smoking bans and reduce educational disparities in these protective behaviors.

Long-Term Effects of Laws Governing Youth Access to Tobacco

We sought to examine the association between policies governing access to tobacco during adolescence and subsequent adult smoking. We analyzed adult smoking data from the 1998 through 2006-2007 administrations of the US Current Population Survey Tobacco Use Supplement by employing a quasi experimental approach. Participants (n = 105,519) were adults, aged 18 to 34 years at the time of the survey. Smoking outcomes included having ever smoked 100 cigarettes, smoking at the time of the survey, and having smoked 10 or more cigarettes a day conditioned on being an ever smoker. These were predicted from exposure to state youth access policies at age 17 years. Four of the 9 policies exhibited significant associations with reduced prevalence of 1 or more smoking outcomes, primarily among women. Lesser effects for other policies could not be ruled out. Restrictions on youth access to tobacco might lead to reduction in smoking prevalence later in adulthood. The effect might be limited to women; we estimate that having all policies in place could be associated with a 14% reduction in lifetime smoking prevalence for women, and an additional 29% reduction in heavy smoking among ever smokers.

DO HIGHER TOBACCO TAXES REDUCE ADULT SMOKING? NEW EVIDENCE OF THE EFFECT OF RECENT CIGARETTE TAX INCREASES ON ADULT SMOKING

There is a general consensus among policymakers that raising tobacco taxes reduces cigarette consumption. However, evidence that tobacco taxes reduce adult smoking is relatively sparse. In this paper, we extend the literature in two ways: using data from the Current Population Survey Tobacco Use Supplements we focus on recent, large tax changes, which provide the best opportunity to empirically observe a response in cigarette consumption, and employ a novel paired difference‐in‐differences technique to estimate the association between tax increases and cigarette consumption. Estimates indicate that, for adults, the association between cigarette taxes and either smoking participation or smoking intensity is negative, small, and not usually statistically significant. Our evidence suggests that increases in cigarette taxes are associated with small decreases in cigarette consumption and that it will take sizable tax increases, on the order of 100%, to decrease smoking by as much as 5%. (JEL I18, I12)

The Economics of Tobacco Use in Jordan

We conducted an independent survey of tobacco use in Jordan following the methods and template of the Global Adult Tobacco Survey. Using data collected on cigarette use and cigarette prices, we estimated the price elasticity of cigarette demand in Jordan. We used a 2-part model of cigarette demand. In the first part, we estimate the impact of prices on the decision to smoke while controlling for individual demographic and environmental characteristics. Conditional on smoking, we then estimate the effect of price on the number of cigarettes smoked. The total price elasticity of cigarette demand in Jordan was estimated to be -0.6. Smoking among women was found to be relatively unresponsive to price (elasticity of -0.01), whereas smoking among men was much more responsive to price (elasticity of -0.81). The price elasticity estimates suggest that significant increases in tobacco taxes are likely to be effective in reducing smoking in Jordan, particularly smoking among men.

Erratum: Single Mothers’ Time Preference, Smoking, and Enriching Childcare: Evidence from Time Diaries

Previous research has shown that time preference affects individuals’ market time allocation and own human capital investments. This paper uses data from the Current Population Survey-Tobacco Use Supplements, the American Time Use Survey, and the Panel Study of Income Dynamics-Child Development Supplement to examine how time preference, as measured by smoking behavior, affects mothers’ time investments in their children under age 13 and children's future test scores. The results indicate that single mothers who smoke spend significantly less time with their children in educational activities, such as reading and homework, and sharing meals with their children than non-smokers. Their children also have lower reading test scores.

Validity and Reliability of Survey Items and Pictograms for Use in a National Household Survey of Tobacco Use in Cambodia

The validity of survey measures of smoked and smokeless tobacco use in the Western Pacific Region is often unknown. We conducted a validation study (n = 201) in a random sample of rural adults in Cambodia. A comparison with salivary cotinine indicated (1) that survey items and pictograms of current tobacco use had an 87% (95% confidence interval [CI] = 78%-93%) sensitivity, 94% specificity (95% CI = 87%-98%), and 93% (95% CI = 85%-97%) positive predictive value in detecting cotinine levels >10 ng/mL; (2) a positive correlation with number of cigarettes smoked (R = 0.34; P = .01); and (3) a positive correlation with the amount of tobacco chewed (R = 0.44; P = .02). The validity of the index for the amount of smokeless tobacco used was enhanced by adding to the index the data from pictograms that were utilized to help participants estimate the amount of loose tobacco used per session. These tobacco items and pictograms were found to have excellent reliability (κ = 0.80-1) over 2 to 3 weeks. Interviewer-administered survey items and pictograms can provide an accurate, quantitative measure of smoked and smokeless tobacco use in rural Cambodia.

Single Mothers’ Time Preference, Smoking, and Enriching Childcare: Evidence from Time Diaries

Previous research has shown that time preference affects individuals’ market time allocation and own human capital investments. This paper uses data from the Current Population Survey-Tobacco Use Supplements, the American Time Use Survey, and the Panel Study of Income Dynamics-Child Development Supplement to examine how time preference, as measured by smoking behavior, affects mothers’ time investments in their children under age 13 and children's future test scores. The results indicate that single mothers who smoke spend significantly less time with their children in educational activities, such as reading and homework, and sharing meals with their children than non-smokers. Their children also have lower reading test scores.

How Turkey Meets MPOWER Criteria?

In 2003 World Health Assembly adopted an international treaty on tobacco control; FCTC, Framework Convention on Tobacco Control. Five year later World Health Organization (WHO) declared the six effective approach for tobacco control, under the name of MPOWER. In the following years, WHO evaluated the level of implementation of MPOWER criteria in the countries. In this article, how Turkey implemented these six criteria will be discussed. Monitor tobacco use and prevention policies: Monitoring of tobacco use prevalence has been successfully monitored in Turkey through Global Adult Tobacco Survey, Global Youth Tobacco Survey and Health Professionals Tobacco Use Survey. Nevertheless, monitoring of tobacco industry activities was not successfully implemented. Protect people from tobacco smoke: Smoking was banned in most of the indoor public places in Turkey since 1996, and Turkey became a complete smoke-free country by the exposion of smoke-free places including the hospitality workplaces in 2008. Offer help to quit tobacco use: Although smoking cessation services has been a bit late in Turkey, availability of smoking cessation drugs and the establishment of free quitline services made Turkey successful in this regard. Warn about the dangers of tobacco: Since 1996, all TV channels have a duty of broadcasting programs on harms of tobacco use, not less than 90 minutes in a month and it has been implemented successfully. Additionally written messages indicating harms of tobacco has been printed on the packs since 1988 and pictures was added in 2010. But since the average surface area covered by the messages in less than 50% of the total surface of the pack, Turkey was not regarded as to meet the requirement. Enforce bans on tobacco advertising, promotion and sponsorship: All kinds of tobacco advertisement and promotion was banned by the Law in 1996. But the tobacco products was not in closed boxes at the sales points. Turkey was not found as successful in this regard. Raise taxes on tobacco: Total tax on the tobacco products is more than 75% level which was recommended by WHO, Turkey meets this criteria. In conclusion, Turkey was regarded as meeting all the MPOWER criteria except the warning about the dangers of tobacco and enforcement of the advertisement ban. In conclusion, Turkey was regarded as meeting all the MPOWER criteria except the warning about the dangers of tobacco and enforcement of the advertisement ban.

Patterns of Alcohol and Tobacco Use in Cambodia

Few studies have considered whether the habitual use of tobacco in Southeast Asia is part of an established pattern of addiction that includes regular alcohol use. As part of a national survey of adult tobacco use in Cambodia (n = 13 988), we found that men who smoked were 2 times more likely to have drank alcohol in the past week (odds ratio = 2.53, 95% confidence interval = 2.10-3.03). By age 18 to 25 years, 47% of male smokers drank alcohol, and this pattern of alcohol and tobacco use increased to >55% through the fifth decade. Women using smokeless tobacco with betel quid were more likely to be alcohol drinkers (odds ratio = 1.49, 95% confidence interval = 1.12-1.98). Past week's drinking declined by late middle age and was associated with lower education and being currently married; the behavior was lower in some ethnic groups (ie, Cham). Our findings indicate an important association between alcohol and tobacco use, and raise the possibility that reducing alcohol consumption can be an important component of tobacco control.

Betel quid use in relation to infectious disease outcomes in Cambodia

The habitual chewing of betel quid (areca nut, betel leaf, tobacco) is estimated to occur among 600 million persons in Asia and the Asia-Pacific Region. Emerging data from rural Asia indicate that the betel quid is part of traditional medicine practices that promote its use for a wide range of ailments, including infectious disease. In the present study, we examined the association between betel quid, traditional medicine, and infectious disease outcomes. For the purpose of a nationwide, interviewer-administered, cross-sectional survey of tobacco use (including betel quid), we conducted a stratified three-stage cluster sampling of 13988 adults aged 18 years and older from all provinces of Cambodia. We found an association between the intensity of betel quid use and HIV/AIDS (odds ratio (OR) 2.06, 95% CI 1.09-3.89), dengue fever (OR 2.40, 95% CI 1.55-2.72), tuberculosis (OR 1.50, 95% CI 0.96-2.36), and typhoid (OR 1.48, 95% CI 0.95-2.30). These associations were even stronger in women - the primary users of betel quid in Cambodia. Multivariable analyses that controlled for age, gender, income, education, urban versus rural dwelling, receiving care from traditional medicine practitioners, and cigarette smoking did not alter the betel quid-infectious disease association. Our findings raise the possibility of a role of betel quid use in the transmission of infectious disease through pathways such as immunosuppression, oral route of entry for a pathogen (i.e., through injury to the oral mucosa), and contamination (i.e., fecal-oral) of the betel quid ingredients.

Home Smoking Bans Among U.S. Households with Children and Smokers: Opportunities for Intervention

Public health campaigns have reduced the exposure of U.S. children to secondhand smoke at home; however, these may not have been equally effective across subgroups. To examine prevalence of home smoking bans among U.S. households with both children and smokers, over time and by demographic subgroups. The Tobacco Use Supplement to the Current Population Survey (TUS-CPS) is a nationally representative household survey of tobacco use. The 1992/1993 and 2006/2007 TUS-CPS interviewed 22,746 households from a major racial/ethnic group with both children and adult smokers. Predictors of complete home smoking bans among demographic subgroups were identified using multivariate logistic regression. Analyses were conducted in 2010-2011. Complete home smoking bans among U.S. households with children and smokers (smoking families) more than tripled, from 14.1% in 1992/1993 to 50.0% in 2006/2007. However, non-Hispanic white and African-American smoking families lagged behind Asian/Pacific Islanders and Hispanics. In 2006/2007, 67.2% of African-American smoking families allowed smoking in the home, as did 59.2% of smoking families with all children aged ≥14 years. Bans were more likely among more-educated households and in states with lower adult smoking prevalence; however, these differences were attenuated in some racial/ethnic groups. As of 2006/2007, only half of U.S. households with both children and smokers had complete home smoking bans. Home bans were less common among smoking families with older children, in African-American households, and in Hispanic or non-Hispanic white households in states with high smoking prevalence. Interventions are needed to promote smoke-free homes among these groups.

Occupation and Workplace Policies Predict Smoking Behaviors

Describe differences in smoking behaviors associated with occupation, workplace rules against smoking, and workplace smoking cessation programs. We analyzed data from the Current Population Survey-Tobacco Use Supplement surveys from 1992 through 2007. After adjusting for demographic factors, blue-collar workers were at higher risk than white-collar workers for ever smoking, current smoking, and persistent smoking (current smoking among ever smokers). Construction workers were more likely to be current daily smokers than other blue-collar workers. Among ever smokers, current daily smoking was more common in the absence of both workplace rules against smoking and workplace smoking cessation programs. Social or cultural effects related to occupation are important determinants of smoking. More aggressive promotion of smoking cessation programs and workplace rules prohibiting smoking could have a significant public health impact.

An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder.

Tobacco use is prevalent among people living with bipolar disorder. We examined tobacco use, attempts to quit, and tobacco-related attitudes and intentions among 685 individuals with bipolar disorder who smoked ≥ 100 cigarettes in their lifetime. Data were collected online through the website of the Depression and Bipolar Support Alliance, a mood disorder peer-support network. The sample was 67% female, 67% aged 26 to 50, and 89% Caucasian; 87% were current smokers; 92% of current smokers smoked daily, averaging 19 cigarettes/day (SD=11). The sample began smoking at a mean age of 17 years (SD=6) and smoked a median of 7 years prior to bipolar disorder diagnosis. Among current smokers, 74% expressed a desire to quit; intent to quit smoking was unrelated to current mental health symptoms [χ(2) (3)=5.50, p=0.139]. Only 33% were advised to quit smoking by a mental health provider, 48% reported smoking to treat their mental illness, and 96% believed being mentally healthy was important for quitting. Ex-smokers (13% of sample) had not smoked for a median of 2.7 years; 48% quit 'cold turkey.' Most ex-smokers (64%) were in poor or fair mental health when they quit smoking. At the time of the survey, however, more ex-smokers described their mental health as in recovery than current smokers [57% versus 40%; χ(2) (3)=11.12, p=0.011]. Most smokers living with bipolar disorder are interested in quitting. The Internet may be a useful cessation tool for recruiting and potentially treating smokers with bipolar disorder who face special challenges when trying to quit and rarely receive cessation treatment from their mental health providers.

Sociodemographic and geographic variability in smoking in the U.S.: A multilevel analysis of the 2006–2007 Current Population Survey, Tobacco Use Supplement

Because smoking is a pervasive risk factor for numerous health outcomes, it is essential to understand smoking patterns in different populations and places. Previous studies have described sociodemographic and geographic variation in smoking across the U.S., providing insight to public health scientists aiming to identify high-risk populations and places in the absence of local data. This study extends previous research by considering the influence of a combination of covariates at the U.S. state, core-based statistical area (CBSA), and individual levels, focusing on a time period when smoking prevalence has decreased significantly but disparities remain. We applied multilevel regression to the 2006–2007 Current Population Survey–Tobacco Use Supplement. We conducted a four-level logistic regression model and evaluated fixed and random effects to quantify the contribution of sociodemographic characteristics at the individual level, area poverty at the CBSA level, and indoor smoking legislation and cigarette taxes at the state level, to the probability of smoking at the individual level and the variance in smoking at the state and CBSA levels. Sociodemographic covariates were significant predictors of smoking and explained 67% of variance at the CBSA level alone but only 41% at the state level. Contextual covariates alone, such as indoor smoking legislation and cigarette taxes at the state level and area poverty at the CBSA level, explained a larger proportion of state variance (82%) but individually had modest statistical significance. Our findings emphasize the continued disparities in smoking patterns in the U.S. despite the decrease of smoking prevalence in the past decade; as well as the ongoing necessity to consider associations with both compositional and contextual factors. Patterns of residual variance emphasize the continued need to identify and evaluate appropriate contextual covariates, with more refined geographic resolution than that available from national surveys at present.

Menthol: putting the pieces together

ObjectiveTo integrate information on cigarette companies' understanding and use of menthol as summarised in published research based on previously internal tobacco industry documents with results from large population-based surveys of...

Cutting through the smoke: separating the effect of price on smoking initiation, relapse and cessation

I employ a large national representative dataset (Current Population Survey-Tobacco Use Supplements) to investigate how cigarette prices affect smoking decisions. A standard econometric approach is to estimate the relationship between cigarette prices and smoking participation at a point in time. I extend this approach to model past-year decisions to start, resume or quit smoking. Considering reverse causality, I apply an instrumental variable (excise taxes) for cigarette prices. I include an index of state-level anti-smoking sentiment to control for omitted variable bias. After estimating separate models for smoking initiation, relapse and cessation and for different age groups, I find no evidence that increasing taxes on cigarettes can prevent the onset of youth smoking. Neither does it effectively induce young smokers to quit. However, cigarette prices do play an important role to prevent relapse and encourage quitting at older ages.

Disparities in Children's Exposure to Environmental Tobacco Smoke in the United States, 2007

This study examined racial/ethnic, socioeconomic, and geographic disparities in children's exposure to environmental tobacco smoke (ETS) or secondhand smoke in the home. The 2007 National Survey of Children's Health (N = 90,853) was used to calculate the prevalence of children's exposure to ETS. State-level data on home smoking ban from the 2006-2007 Current Population Survey-Tobacco Use Supplement were used to supplement analyses. Logistic regression was used to estimate adjusted odds of exposure. In 2007, 7.6% of US children, or 5.5 million children, lived in households where someone smoked inside the home. The prevalence varied from a low of 1.1% for Utah and 1.9% for California to a high of 17.9% for West Virginia and 17.6% in Kentucky. After adjustment for sociodemographic factors, children in Ohio, West Virginia, Kentucky, and Pennsylvania had 12 times higher odds and those in Wisconsin, Missouri, Delaware, and the District of Columbia had 10 times higher odds of being exposed to ETS than children in Utah. Compared with children from higher socioeconomic backgrounds, Hispanic ethnicity, and non-English-speaking households, children from lower socioeconomic backgrounds had 7.3 to 10.6 times higher adjusted odds; non-Hispanic white, black, American Indian, and mixed-race children had 2.0 to 2.6 times higher odds; and children from English-speaking households had 4.1 times higher odds of ETS exposure. Considerable disparities exist in children's exposure to ETS, with geographic pattern strongly related to home smoking ban. Greater exposure to ETS among children in several states and disadvantaged socioeconomic groups is likely to exacerbate existing health disparities.

Survey of Alcohol, Tobacco, and Cannabis Use in the French Army

ABSTRACT The aim of the current study is to describe the consumption rate of alcohol, tobacco, and cannabis in the French Army. A cross-sectional two strata randomized survey was performed between October 2006 and March 2007 using self-report questionnaires (n = 990) to collect individual characteristics, consumption, and addictive behaviors with urinal tests for cannabis (n = 985). The surveyed sample comprised 59% privates, 26% non-commissioned officers, and 6% officers, was predominantly male (89%) and young (median age: 29 years), and had a low level of education (60% attended secondary school). The consumption rate was high: 54.1% were active tobacco smokers, 56.0% were heavy drinkers, 20.5% declared drunkenness more than once per month, 52.6% at least experienced cannabis while 12.3% were occasional users, 8.2% were regular users, and 15.0% displayed multi-risk behaviors. Consumption was higher in the younger age (18 to 25 years) and lower educational group, leading to a high prevalence among privates and suggesting an “army effect.” However, large scale behavioral social studies may help distinguish between personal and peer effect among the targeted population.

Support for Smoke-Free Policies: A Nationwide Analysis of Immigrants, US-Born, and Other Demographic Groups, 1995–2002

We examined whether support for tobacco control policies varies by demographic group, including nativity status (i.e., immigrant versus US born). We analyzed 1995 to 2002 data from the Current Population Survey Tobacco Use Supplement (n=543,951). The outcome was a summary attitudinal measure assessing support of smoking bans in 4 of 6 venues. US-born respondents, smokers, male respondents, Native Americans, Whites, and those who were unmarried, of lower socioeconomic status, and whose workplaces and homes were not smoke free were less likely to support smoking bans. Immigrants exhibited stronger support for banning smoking in every venue, with a generation-specific gradient in which support eroded with increasing assimilation to the United States. Levels of support were more than twice as high among immigrants as among US-born respondents (odds ratio [OR]=2.16; 95% confidence interval [CI]=2.08, 2.23). Naturalized citizens displayed higher support than US-born citizens, which may be relevant for mobilization of the electorate. Differences in population composition and contexts (e.g., smoke-free workplaces) only partially accounted for immigrants' stronger level of support. Immigrants and their children may be valuable tobacco control allies given their supportive attitudes toward smoke-free policies.

Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey

BackgroundThe Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.MethodsA survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures of sensitivity, specificity and predictive values were calculated. Concordance between the tests was also established (Cohen's kappa).ResultsCohen's kappa showed good agreement between measures (Kappa = 0.7); specificity values were also high (Sp = 96.2%). Sensitivity analysis in females (Se = 62.3%) did not show good agreement.ConclusionsThe HSI can be used as a reasonably good screening test in order to identify daily smokers with high nicotine dependence. Nevertheless, for populations or subpopulations having low nicotine dependence, such as women, the FTND is more reliable.