Tobacco Control Activities Research Articles

Seeing the forest and the trees: Using network analysis to develop an organizational blueprint of state tobacco control systems

In the United States, tobacco control activities are organized primarily in state tobacco control programs. These programs are comprised of public and private agencies working together to reduce tobacco use. The human, financial, and informational resources that go into state tobacco control programs are documented, and the outcomes of these programs have been studied in terms of health and health behavior. However, little is known about the organizational infrastructure that transforms the human, financial, and informational resources into positive health outcomes. This study examined the inter-organizational relationships among key partner agencies in eight state tobacco control programs. The state programs varied in terms of funding level, funding stability, and region of the country. Using a network analytic approach we asked an average of 14 agencies in each state program about their contacts and partnerships with the other key tobacco control agencies in their state program. Using network visualization and statistics we determined that the state networks shared some common features such as a highly central lead agency, but also had differences in network structure in terms of density and centralization. Using blockmodeling we found that, despite differences in state and program characteristics, there was a common organizational structure among the eight state programs. Understanding the inter-organizational relationships and the common organizational structures of state programs can aid researchers and practitioners in enhancing program capacity and in developing strategies for organizing effective public health systems.

Smoking characteristics and saliva cotinine levels in Taiwanese smokers: gender differences

The present study examined the smoking characteristics and a biomarker of a community-based sample of Taiwanese individuals, seeking to determine the correlates of nicotine dependence for each gender. Nicotine dependence is a key barrier to smoking cessation. Additionally, nicotine metabolism may influence smoking behaviour and dependence. Correlates of nicotine dependence and biochemical markers of smoking for the Taiwanese population have not yet been studied. Participants were 402 men and 110 women smokers, who had recently smoked at least one cigarette every day over a recent year. All participants completed a questionnaire which included demographic data, smoking background, self-reported quantity of cigarettes per day and the Fagerstrom Test for Nicotine Dependence. The participants also provided saliva samples. Female smokers were younger, more likely to be unmarried and were on average higher educated than males. A higher percentage of females reported that family members smoked and tended to be younger at initiation and were also more likely to have attempted to quit on previous occasions. Males reported smoking significantly more cigarettes than females, however, there was no significant difference in the Fagerstrom Test for Nicotine Dependence scores between the two groups. The average saliva cotinine level was significantly higher for males than females (228.8 ng/ml vs. 94.6 ng/ml, p < 0.0001). Family and friends smoking were risk factors of nicotine dependence among both men and women smokers, but there was a stronger association of both factors on dependence levels for women. Being married is a risk factor for dependence for women but not for men. These findings support the evidence that smoking characteristics and a biochemical marker differ between the males and females. The results of the study are useful for health policymakers, assisting them in planning tobacco control activities in light of gender differences.

Does delayed measurement affect patient reports of provider performance? Implications for performance measurement of medical assistance with tobacco cessation: A Dental PBRN study

Background:We compared two methods of measuring provider performance of tobacco control activities: immediate "exit cards" versus delayed telephone follow-up surveys. Current standards, e.g. HEDIS, use delayed patient measures that may over or under-estimate overall performance.Methods:Patients completed exit cards in 60 dental practices immediately after a visit to measure whether the provider "asked" about tobacco use, and "advised" the patient to quit. One to six months later patients were asked the same questions by telephone survey. Using the exit cards as the standard, we quantified performance and calculated sensitivity (agreement of those responding yes on telephone surveys compared with exit cards) and specificity (agreement of those responding no) of the delayed measurement.Results:Among 150 patients, 21% reporting being asked about tobacco use on the exit cards and 30% reporting being asked in the delayed surveys. The sensitivity and specificity were 50% and 75%, respectively. Similarly, among 182 tobacco users, 38% reported being advised to quit on the exit cards and this increased to 51% on the delayed surveys. The sensitivity and specificity were 75% and 64%, respectively. Increasing the delay from the visit to the telephone survey resulted in increasing disagreement.Conclusion:Patient reports differed considerably in immediate versus delayed measures. These results have important implications because they suggest that our delayed measures may over-estimate performance. The immediate exit cards should be included in the armamentarium of tools for measuring providers' performance of tobacco control, and perhaps other service delivery.

Activities and perceptions of pharmacists providing tobacco control services in community pharmacy in Thailand

Community pharmacists' involvement in tobacco control and their perceived role and barriers were assessed. In part I, a self-administered questionnaire was mailed to 164 community pharmacists who applied for community pharmacy accreditation from the Thai Pharmacy Council in 2003. In part II, an in-depth interview was conducted among 13 community pharmacists who participated in the 1-day smoking cessation services training. Main outcome measures were tobacco control-related activities, perceived tobacco control role, and perceived barriers. The questionnaire response rate was 51% (83/164 pharmacists), with half of the respondents (42/83, 51%) reporting active tobacco control activities. Of these pharmacists, seven (7/42, 17%) reported participating in public or policy advocacy by campaigning against smoking in the community. Thirty-four (34/42, 81%) and thirty-six (36/42, 86%) reported engaging in activities in their own pharmacies by providing educational materials and smoking cessation services, respectively. Even though the perceived roles in tobacco control of these pharmacists were high, they also reported several barriers, especially in five categories: lack of client demand, lack of educational materials, lack of smoking cessation products, lack of knowledge and skill, and lack of follow-up visits. On the other hand, lack of time and lack of reimbursement were not indicated as important barriers. Data from in-depth interviews confirmed these findings. This study revealed that Thai community pharmacists were engaged in various levels of tobacco control-related activities. Most of them perceived the significance of tobacco control activities. However, several barriers were also reported and need to be addressed further.

Grapefruit Compound Battles Hepatitis C

and middle-income countries, and the moneygeneratedfromtaxescouldbeused toimplementandenforcetobaccocontrol efforts.Butgovernmentsaroundtheworld currently collect 500 times more money intobaccotaxeseachyearthantheyspend on antitobacco efforts. The WHO report outlines a strategy to reduce tobacco use across the globe, a program called MPOWER (http://www .who.int/tobacco/mpower/facts_findings /en/index.html). “While efforts to combat tobacco are gaining momentum, virtually every country needs to do more. These six strategies are within the reach of every country, rich or poor and, when combined as a package, they offer us the best chance of reversing this growing epidemic,” said Margaret Chan, MD, the WHO’s director-general, in a statement at the time of the report’s release. The6strategiesofMPOWERaremonitoring tobacco use and prevention policies; protecting people from tobacco smoke;offeringhelp toquit tobaccouse; warningaboutthedangersoftobacco;enforcingbansontobaccoadvertising,promotion,andsponsorship;andraisingtaxes on tobacco. “This package will create an enablingenvironment tohelpcurrent tobacco users quit, protect people from second-handsmoke, andpreventyoung people from taking up the habit,” said DouglasBettcher,MPH,MD,PhD,directorof theWHO’sTobaccoFreeInitiative. AccordingtoMcKay,widedissemination of the report is needed so that it gets intothehandsofpolicymakersandpolicy influencers in as many countries as possible.Advocatesoftobaccocontrolefforts are urging unanimous ratification of the FrameworkConventiononTobaccoControl, a tobacco control treaty adopted by member countries of the WHO (http: //www.who.int/tobacco/framework /en/). In addition, “governments should act now, especially on taxation,” said McKay. “Of all the recommended policies in the MPOWER package, taxation is the most effective.” WHO is scaling up its ability to help nations put the MPOWER strategies in place. Through the Bloomberg Initiative—a $125 million global tobacco control effort by New York City’s Mayor Michael Bloomberg—the WHO, the Campaign for Tobacco Free Kids, the Centers for Disease Control and Prevention, the Johns Hopkins Bloomberg School of Public Health, and the World Lung Foundation are working together to coordinate tobacco control activities and provide grants to countrylevel organizations to combat the tobacco epidemic.

Prävalenz des Rauchens vor und während der Schwangerschaft - populationsbasierte Daten

Population-based data on smoking behavior in Germany of women before or during pregnancy have been lacking. Smoking rates of these women have now been recorded over a period of 3 years against the background of growing tobacco control activities in Germany. The study was conducted between 4/2003 and 3/2006 in the context of a prospective population-based survey about perinatal morbidity and mortality (Survey of Neonates in Pomerania - SNiP). This survey registers all newborns and their mothers in one defined region. Of the women eligible for the study 2 297 (68.1%) participated after delivery by giving data about their smoking behavior before and during pregnancy. 61.2% of the women had smoked at some time, 46.6% had smoked before, 24.2% into the 4. month and 20.5% into the last 4 weeks of pregnancy. Smoking rates remained unchanged over the 3 years that were studied. The rates of smokers who had quit by the time of delivery varied according to the length of school education: (<10 years: 30%; 10 y: 59%; >10 y: 84%) and age (<24 years: 45%; 25-30 y: 65%; >30 y: 77%). This study for the first time provides population-based data about the prevalence of smoking before and during pregnancy among women in Germany. The data show extremely high numbers of smokers, especially younger women and women of only 10 years or less of school education. Despite growing tobacco control activities no changes in smoking rates were observed over three years. These findings underline the need to develop effective interventions to prevent smoking of women before and during pregnancy.

Susceptibility to smoking and its association with physical activity, BMI, and weight concerns among youth

Research has yet to examine how physical activity, body mass index (BMI) and concerns about weight among youth populations are associated with susceptibility to smoking among never smokers. The Physical Activity Module of the School Health Action, Planning and Evaluation System (SHAPES) was completed by 25,060 students in grades 9 to 12 within 76 secondary schools in Ontario (Canada) to examine how being overweight, weight concerns, and physical activity are associated with susceptibility to smoking in a large sample of youth. Among the 14,795 students who were never smokers, 3,809 (25.8%) were classified as susceptible to future smoking and 10,986 (74.2%) were classified as non-susceptible to future smoking. Smoking susceptibility was negatively associated with being highly active or at risk of overweight and positively associated with perceptions of being slightly overweight or slightly underweight. Students who report 1 or more hours of screen or phone time per day were also more likely to be susceptible. This is the first study to identify that susceptibility to future smoking among never smokers is associated with physical activity, overweight and concerns about weight. This is valuable new insight for tailoring and targeting future school-based tobacco control and/or physical activity programming to youth populations.

Smoking behavior and attitudes toward smoking cessation among members of the Japanese Cancer Association in 2004 and 2006

We analyzed the postal surveys conducted by Japanese Cancer Association (JCA) in 2004 and 2006. This survey aimed to assess JCA members' behavior and their attitudes toward patients who are smokers, smoking cessation, and their responsibilities. In the 2006 version, questions were added about hope for various approaches related to smoking and health and the attitudes as medical experts when treating patients. JCA members' smoking rate was 5.9% in 2004 and 9.0% in 2006. Current smokers were significantly more likely than never or former smokers to disagree or have no opinion with most activities about smoking control such as 'raising the price of tobacco' and 'labeling health warnings describing the harmful effects of tobacco in large letters with clarity for easier reading', while most members including smokers agree to ban smoking while walking, to educate general people about tobacco and health, to provide an environment where children cannot get tobacco and the information about tobacco and health. Smoking rate among JCA members were less than that of general populations, and most of them are in favor of promoting tobacco control activities.

Can population-based tobacco-control policies change smoking behaviors of adolescents from all socio-economic groups? Findings from Australia: 1987–2005

To examine whether socio-economic status (SES) was associated with changes in smoking prevalence among Australian adolescents during three phases of tobacco-control activity between 1987 and 2005. Triennial cross-sectional national studies of representative random samples of secondary students aged 12-17 years have been conducted since 1987. Numbers range from 19,203 in 1987 to 29,853 in 1996. Self-report anonymous surveys assessed cigarette use in the past month, week (current), and on at least three of the previous seven days (committed). Students' residential postcode was collected and the Index of Relative Socio-Economic Disadvantage (IRSD) associated with each postcode determined SES quartiles. Between 1987 and 2005, smoking prevalence decreased in all SES groups. Tobacco-control activity level was associated with changes in smoking prevalence and whether changes were consistent across SES groups. In a period of low tobacco-control funding (1992-1996) and activity, smoking prevalence increased among 12- to 15-year-olds, the increase being greatest among low SES students. In a period of high tobacco-control activity (1997-2005) smoking decreased and reductions were generally consistent across SES groups. Well-funded, population-based tobacco-control programs can be effective in reducing smoking among students from all SES groups.

The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries

BackgroundSmoking prevalence differs significantly across Europe. In addition, there are considerable differences in tobacco control activities across European countries. The relationship between prevalence and policy is under-researched. The present analysis examines the motivation to change smoking behaviour across 5 different European countries that differ considerably in their tobacco control activities.MethodsA population-based, representative survey of 1750 smokers, aged 16–59, from 5 different European countries (Germany, Greece, Poland, Sweden, UK) was used. Demographic variables, smoking status and the motivation to stop smoking were assessed. Motivation was assessed as, first, intending to quit (using the stages of change plus a modified stage for Precontemplation), and second, the desire to quit.ResultsThe majority of smokers want to stop smoking (73.5%), while only 35.0% want to stop definitely. Across countries, 10.2% definitely do not want to stop.Most of the smokers can be categorised in the Precontemplation stage (between 62.6% and 77.7% depending on the country), one of the stages of change categories. The relationship between the stages of change and the country under examination is statistically significant (chi-square = 43.466, p < 0.001). In countries with a high level of tobacco control, the proportion of people in Precontemplation is lower than in countries with low tobacco control activity.ConclusionThere are differences in the stages of change between the countries under examination. However, the categorisation of the countries into low, medium and high tobacco control activity used in this analysis does not explain these differences. Most smokers want to stop smoking, but a high proportion cannot indicate a time-frame when this is going to happen. Tobacco control efforts or other kinds of support might encourage these smokers to actually try to stop. Longitudinal studies at the population level are needed to assess, relate or monitor tobacco control activities and the intention to stop.

The historical decline of tobacco smoking among Australian physicians: 1964-1997.

BackgroundPhysicians occupy an important position as tobacco control exemplars and their own smoking habits are known to influence how effective they may be in such a role.MethodsA comprehensive review of all published manuscripts describing tobacco usage rates and tobacco control activities in the Australian medical profession between 1964 and 1997.ResultsSome of the earliest surveys revealed that around one-quarter of Australian physicians were smoking in the mid twentieth century, a rate which rapidly declined in the 1970s and 1980s, with reductions beyond that achieved by the general population.ConclusionOverall, our review suggests that not only do contemporary Australian physicians smoke at very low rates when compared internationally, but that an active professional community can also make a real difference to the lifestyle choices of its own members.

Tobacco Smoking by Occupation in Australia and the United States: A Review of National Surveys Conducted between 1970 and 2005

Tobacco use represents a key issue in workplace health, and much can be learned from countries where occupational smoking data has been regularly collected on a national basis. This article reviews national smoking surveys previously conducted in Australia and the United States between 1970 and 2005, and examines their relevance to the field of occupational tobacco control. When the first preliminary research was undertaken over 35 years ago, tobacco smoking was a regular feature in the general population of both countries, albeit with higher rates often documented among blue collar workers. Recent national investigations however, suggest that certain historical differences in smoking prevalence rates by occupation are persisting as we enter the 21st century. Detailed examination also indicates that employee sub-groups, such as cleaners and construction workers, are now bearing much of the occupational smoking burden in Australia and the United States. As such, there is an urgent need for more aggressive and finely targeted tobacco control activities in the workplace, as well as increased cooperation between tobacco control organizations, labor unions and other stakeholders, so that they may more effectively combat this ongoing threat to workers' health.

Impact of the 1976 Tobacco Control Act in Finland on the proportion of ever daily smokers by socioeconomic status

Objective. To assess the impact of the 1976 Tobacco Control Act (TCA) on smoking initiation across socioeconomic groups. Methods. Nationwide data from independent annual cross-sectional postal surveys in 1978–2002 in Finland. Subjects were 25–64-year-old men and women born 1926–1975 ( n = 68 071). Socioeconomic status was derived individually from population census data. Logistic regression was applied to assess the impact of the 1976 TCA on the prevalence of ever daily smoking in birth cohorts and socioeconomic groups. Results. Clear socioeconomic differences in ever daily smoking among men and women were found. In all socioeconomic groups a declining cohort trend was observed among men whereas women showed an increasing trend in early cohorts and a declining one thereafter. A statistically significant decline in the proportion of ever daily smokers compatible with the impact of the TCA was found in all socioeconomic groups except farmers. Among women the decline was roughly similar in each socioeconomic group, while among men it varied and was most pronounced among white collar employees. Conclusions. The impact of the 1976 TCA was less pronounced among male lower socioeconomic groups. In spite of the even impact of the TCA on female smoking across socioeconomic groups, large socioeconomic disparities remain. Tobacco control policy measures specifically directed at lower socioeconomic groups are needed.

Tobacco Industry Marketing, Population-Based Tobacco Control, and Smoking Behavior

Abstract Two of the major influences of cigarette smoking behavior are tobacco industry marketing and public health tobacco-control activities. These vie with each other to influence the proportion of each generation who initiate smoking, the intensity level reached by smokers, and the time before smokers are able to quit successfully. This article provides a brief summary of the evidence associating tobacco marketing practices (organized under the four “Ps” of marketing), with smoking behavior. The evidence for causality in this association is considered convincing. Publicly funded, comprehensive, statewide tobacco-control programs were introduced into the United States in the late 1980s, with money either from tobacco taxes or from legal settlements of states with the tobacco industry. These programs use organized statewide approaches to implement current recommendations on “best practices” to discourage tobacco use, recommendations that have changed over time. During the 1990s, “best practices” evolved to include protection against secondhand smoke, sale of cigarettes to minors, and restrictions on tobacco advertising. Evaluations have been published on four statewide tobacco-control programs (Sydney/Melbourne, California, Massachusetts, and Florida) and a national program aimed at youth (American Legacy Program). For each program, there was a positive association with reduced smoking. The evidence supporting the conclusion that tobacco-control programs reduce smoking behavior is evaluated as strong.

Adult smokers in Colombia: Who isn't giving it up?

Without ongoing surveillance systems to assess tobacco product demand and exposure levels, many low and middle income countries monitor smoking via periodic cross-sectional surveys. In this article, we seek to update estimates for the prevalence of adult smoking in Colombia and contribute additional information useful for tobacco control initiatives. Data are from the 2003 Colombian National Study of Mental Health (NSMH). A national probability sample of 4426 adults (age 18–65) was assessed via a computer-assisted interview. An estimated 49% of the adult population had smoked at least once in their lifetimes; one in three adults (31%) had smoked regularly. Nearly half of regular smokers had been able to quit (44%; 95% CI = 40–48). Several personal and smoking-related characteristics were associated with failing to quit: being a younger age, employed as compared to being a homemaker, and a history of daily use. Quitters and non-quitters were equivalent with respect to sex, educational status, and age of smoking onset. In conclusion, our findings describe the characteristics of regular smokers in Colombia and identify subgroups of non-quitters that may help guide tobacco control activities.

Tobacco control in developing countries: Tanzania, Nepal, China, and Thailand as examples

This paper illustrates case studies of four developing countries and compares them as to relative advancement in tobacco control as prescribed by the Framework Convention on Tobacco Control. Tobacco-control efforts first seem to involve assessment of tobacco use prevalence and passage of tobacco-control legislation (e.g., warning labels). Tanzania, Nepal, and China serve as examples. Eventually, an integrated tobacco-control stance that demonstrates several cycles of tobacco-control activities occurs, as is shown in Thailand. Through these case studies, one can achieve a sense of the direction of progress in tobacco control in developing countries.

Reduced lung cancer deaths attributable to decreased tobacco use in Massachusetts

Approximately 88% of the lung cancer deaths in men and 71% in women occurring in the US are attributable to cigarette smoking, with almost 3,700 annual lung cancer deaths in Massachusetts. In the state, male lung cancer death rates are showing a per year annual decline following a peak in the early 1990s. Such recent declines could be mostly attributed to tobacco control efforts over the past 40 years. This study predicts how many fewer lung cancer deaths have occurred in Massachusetts possibly attributable to tobacco control activities. The study employs the US National Cancer Institute's "Joinpoint" Regression Analysis Program (version 3.0) using statewide age-standardized (2000 US Standard Population) lung cancer death rates from 1931 to 2003 for each of the sexes. 95% confidence intervals (CI) were also calculated. Modeled male lung cancer death rates stabilized from the calendar year 1977 onwards but showed significant decline from 1992 onwards, while females showed a deceleration in rising lung cancer rates from 1993 onwards. Therefore, based on their corresponding beta-coefficients (slope) and standard error for each of the two calendar years 19,665 (95% CI: 18,655; 20,765) fewer lung cancer deaths in males and 3,855 (95% CI: 3,630; 4,055) fewer lung cancer deaths in females were estimated to have occurred from 1977 to 1993 onwards, respectively, largely because of the anti-smoking interventions in the past. Reductions in tobacco smoking are a major factor in the decrease in lung cancer mortality rates. Sustained progress in tobacco control is essential.

Access point analysis in smoking and nonsmoking adolescents: findings from the European Smoking Prevention Framework Approach study

This study analyzed possibilities to access European adolescents for tobacco control activities in out-of-school settings as part of comprehensive tobacco control programs. Data on leisure time behaviors of secondary school students were gathered during three waves from six European Union countries as part of the European Smoking Prevention Framework Approach study. The results revealed that streets, shops, sport clubs, swimming pools and snack bars were the most popular leisure time settings for adolescents across the six countries. In addition, leisure time activities were similar across the six countries. European-wide prevention programmes can reach adolescents in similar out-of-school settings. Furthermore, smokers and nonsmokers differed in the places that they visited. Whereas smokers preferred social places such as bars, house/rave parties, discos, snack bars, streets and shops, nonsmokers preferred sport clubs and libraries. Smokers tended to visit more unsupervised and less structured places where smoking tends to be permitted, whereas nonsmokers tended to visit places with more structured activities and places under adult supervision. Over time, both smoking and nonsmoking adolescents tended to spend more of their leisure time in settings with low adult supervision. As structured activities under the supervision of adults can have a protective effect against the involvement in risky behaviours, participation in these types of activities must be promoted. Additional strategies for settings with less supervision need to be developed as they attract more smoking adolescents and older nonsmoking adolescents.

Making big tobacco give in: you lose, they win.

To better understand how the tobacco industry responds to tobacco control activists, we explored Philip Morris's response to demands that consumers in developing countries be informed about smoking risks, and analyzed the implications of negotiating with a tobacco company. We reviewed internal tobacco industry documents and related materials, constructed a case history of how Philip Morris responded to a shareholder campaign to require health warnings on cigarettes sold worldwide, and analyzed interactions between (1) socially responsible investment activists, (2) Philip Morris management, (3) institutional investors, and (4) industry competitors. After resisting for 11 years, Philip Morris unilaterally reversed direction, and proposed its own labeling initiative. While activists celebrated, Philip Morris's president detailed privately how the company would yield little and benefit disproportionately. Activists portrayed the tobacco industry as preying on the poor and uneducated and used delegitimization to drive a wedge between the industry and its financial and political allies. When Philip Morris "gave in" to their demands, it exchanged negative publicity for positive public relations and political credibility. Tobacco companies can appear to accommodate public health demands while securing strategic advantages. Negotiating with the tobacco industry can enhance its legitimacy and facilitate its ability to market deadly cigarettes without corresponding benefits to public health.

Inferring Strategies for Disseminating Physical Activity Policies, Programs, and Practices from the Successes of Tobacco Control

Abstract Efforts at reducing tobacco use in the United States and Canada over the last half century have been amazingly successful. This article examines those efforts in order to identify policies, programs, and practices found useful in tobacco control that might be usefully disseminated to world populations to improve rates of physical activity. Tobacco-control activities began with efforts to influence the individual smoker through public education and counter-advertising. Increasing awareness of the addictive properties of tobacco, industry efforts to manipulate those properties, and to target youth with aggressive advertising, fueled public outrage that supported additional policy changes to include community interventions, legal actions, and restraints against the tobacco industry. The article first examines ways to view the process of transferring knowledge from one enterprise (reducing tobacco consumption) to another (increasing physical activity). Several theories of knowledge generalization and dissemination are explored: transfer, knowledge utilization, application, diffusion, and implementation. The second section identifies the dissemination of tobacco control by means of brief health behavior-change interventions for smoking cessation that have been successfully integrated into primary clinical care. The question of whether similar strategies can be successfully disseminated to increase physical activity is examined in detail. The article then moves on to look at the success of arguably the most successful program in the world at achieving a reduction in tobacco control—the State of California. Finally, we compare and contrast some of the lessons as they have played out in another national context—Canada. In the concluding section, some lessons are identified that we believe may be successfully utilized in societal attempts to increase physical activity in world populations.