Tobacco Control Plan Research Articles

Factors associated with attempting and succeeding in smoking cessation following a National Tobacco Control Plan: Analysis of two nationwide surveys (2010 and 2017)

IntroductionLower rates of smoking cessation among disadvantaged groups contribute to widening health-disparities. With this recognition, in 2010 free-of-charge/subsidized smoking cessation services became available to all Israeli residents through the not-for-profit health plans. MethodsBased on two cross-sectional National Social Surveys, data on adult ever-smokers were used (n = 2,998 in 2010 and 2,859 in 2017). The outcome variable comprised three categories: no quit attempt, unsuccessful quit attempt and successful quit attempt. Changes over-time and demographic, socioeconomic, health- and smoking-related factors associated with quitting attempts and success were tested in the pooled sample, using multivariable multinomial logistic regression models. ResultsThe pooled sample of the two surveys included 2,611 participants (44.2%) who were successful quitters, 1,941 (32.7%) who reported an unsuccessful quit attempt, and 1,305 (23.1%) smokers who did not attempt to quit. Compared to 2010, ever-smokers in 2017 were less likely to report an unsuccessful quit attempt (adjusted OR = 0.81, 95%CI: 0.70–0.94). The likelihood of successfully quitting was similar in both surveys. Older age and self-reported health problem were associated with higher likelihood of quitting attempt. Meeting living expenses, being overweight/obese, engaging in physical activity and heavy smoking were associated with higher likelihood of successful smoking cessation; while environmental tobacco exposure was associated with 43% lower likelihood of successful cessation. Finally, there was an interaction between education and ethnicity. Higher education level was associated with a greater likelihood both to attempt to quit smoking and to succeed among Jewish participants, while the opposite phenomenon was observed among Arab smokers. ConclusionsDespite the availability of subsidized smoking cessation services, social disparities in smoking cessation rates persist. Efforts should focus on proactively reaching subpopulations with low cessation rates, using tailored strategies for successful smoking cessation. Promoting smoke free homes and workplaces should be prioritized.

Smoking and mental health conditions: What you need to know

Smoking is the largest single cause of preventable death and accounted for 74,600 deaths in 2019–20. One of the targets in the England Tobacco Control Plan is that the population prevalence of smoking will reach less than 5% of the population. The key to achieving this will be addressing smoking in societal groups where rates are stubbornly high, such as people with mental health conditions. People with mental health problems experience disproportionate levels of tobacco-associated harm, alongside wider social and economic impacts. Primary care can help tackle this health inequality.

Tobacco Usage among Dental Interns in Panchkula, Haryana, India

BACKGROUND: Tobacco use is one of the major preventable reasons for death. Despite this, its prevalence is increasing among dental students. For the purpose of advocacy of planning tobacco control and interventions, data on prevalence of tobacco usage is needed. AIM: To assess prevalence of tobacco usage among dental interns of district Panchkula, Haryana, India. MATERIAL AND METHODS: A cross-sectional study was conducted from July-September 2019 among dental interns of Panchkula using a self-administered questionnaire. Data based on demographic factors, smoking habits, and associated risk factors was collected. Descriptive analysis for demographic variables and smoking habits were analyzed using the SPSS 24.0 software. RESULT: The prevalence of current tobacco use was 29.54% (22.2% males and 6.8% females). Male interns were significantly more likely than female interns to be current cigarette smokers. On probing the cause of smoking, a majority of participants cited friends and stress as the main cause for smoking. The proportion of regular smokers whose parents smoke was more significant compared to occasional smokers. CONCLUSION: The prevalence of tobacco usage among dental interns is more in males as compared to females so dental interns need to be trained regarding anti-tobacco counselling.

‘S’-shaped curve: modelling trends in smoking prevalence, uptake and cessation in Great Britain from 1973 to 2016

BackgroundIt is believed that declines in smoking prevalence naturally slow over time as the smoking population ‘hardens’ and that progress has come primarily from reducing uptake rather than increasing cessation....

Differential pathways into smoking among sexual orientation and social class groups in England: A structural equation model

PurposePrevious research has shown that lesbian, gay and bisexual (LGB) populations smoke more than their heterosexual counterparts. Little is known about the pathways into smoking among LGB populations in England relative to the lower social class populations that are the focus of the current Tobacco Control Plan (TCP). MethodsUsing the 2013/2014 waves of the Health Survey for England (HSE), we created a structural equation model to analyze pathways and interactions between sexual orientation, social class, and the number of cigarettes smoked daily. The path analysis assessed whether three intervening factors—age of initiation, mental wellbeing score, and exposure to smoke—are implicated similarly in smoking among LGB and lower social class populations, and whether interaction between sexual orientation and class is further associated with smoking. ResultsBivariate analysis showed that LGB-identified individuals and individuals in lower occupational classes smoke more cigarettes daily, respectively, than heterosexual individuals and those in professional/managerial-class populations. Path analysis showed that the number of cigarettes smoked daily was mediated by age of initiation, mental wellbeing score and weekly exposure to smoke among routine and manual workers; by mental wellbeing score and exposure to smoke among intermediate class workers, and by mental wellbeing score in the LGB population. Interactions between sexual orientation and social class were not significant. ConclusionsThe differential nature of pathways into smoking for lower social classes and LGB populations in England suggests the need for tailored prevention and cessation efforts, with programming for LGB populations focused on the distinct stressors they face.

Attitudes Toward Smoke-Free Casino Policies Among US Adults, 2017.

Research shows that there is no risk-free level of exposure to secondhand smoke (SHS) and that eliminating smoking indoors fully protects nonsmokers from indoor SHS exposure. Casinos often allow smoking indoors and can be a source of involuntary SHS exposure for employees and visitors. We examined attitudes toward smoke-free casino policies among US adults. During June and July 2017, we used a web-based survey to ask a nationally representative sample of 4107 adults aged ≥18 about their attitudes toward smoke-free casinos. Among 4048 respondents aged ≥18, a weighted 75.0% favored smoke-free casino policies, including respondents who visited casinos about once per year (74.1%), several times per year (75.3%), and at least once per month (74.2%). Although the sociodemographic characteristics of respondents who favored smoke-free casino policies varied, the majority in each group, except current smokers (45.4%), supported smoke-free policies. Allowing smoking inside casinos involuntarily exposes casino employees and visitors to SHS, a known and preventable health risk. Further assessment of public knowledge and attitudes toward smoke-free casinos at state and local levels may help inform tobacco control policy, planning, and practice.

Attitudes towards smokefree high streets: a survey of local shoppers in a northern UK town.

As a local authority we wanted to practically determine the perception of the public to smokefree zones in shopping high streets and other local outdoor public places. A survey was carried out by students on a convenience sample of shoppers on a single busy market day in Barnsley. In all, 142 responses were collected; 28% were smokers and 15% e-cigarette users. The majority (69%) of respondents were not against smokefree high streets, including 68% of smokers; 69% of respondents (including 61% of smokers) were not against all public areas becoming smokefree; 70% of respondents (including 63% of smokers) were not against outdoor seating areas, such as those outside pubs and cafés becoming smokefree. There was a marginal preference that smokefree outdoor zones should be voluntary (42%) rather than enforced (39%). Most respondents believed that people smoking around children was influential in determining whether those children go on to take up smoking when they get older. Most smokers (92%) said they already moderated their smoking behaviour in some way when children were present, including 44% who claimed that when children are around they do not smoke at all. This study gives strength to the argument for local authorities to implement voluntary outdoor smokefree zones in public places such as shopping high streets, as a part of a comprehensive tobacco control plan. Shoppers were generally supportive of smokefree zones and in particular where the rationale for their implementation is to protect children from taking up smoking.

A new approach to public health research funding

BackgroundThe National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC) is the UK's largest funder of public health research. NETSCC is exploring new methods to identify important areas of research to commission aiming for research that is high quality, serves stakeholders (including policy and decision makers), and is unconstrained by traditional programme boundaries. Here we describe such an approach that aims to explore a new approach to public health research funding. MethodsNETSCC develops commissioning briefs to prompt researchers to apply for funding. A new approach is being tested on a small number of key health challenges including tobacco. The new approach is to co-produce and co-create the commissioning brief involving a wide range of stakeholders. Topics are identified and prioritised systematically on the basis of the value of research; burden of disease; degree of uncertainty; and cost to society and the health system. Tobacco was chosen because it remains the UK's single greatest cause of preventable illness, avoidable death, and health inequalities, and there remain important unanswered questions. In-house expertise was used to scope the area and write an initial draft; this was sent to peer reviewers for feedback involving, in addition to the usual academics, evidence-users including directors of public health, local government councillors, and Action on Smoking and Health. The brief was taken to two national committees (Public Health England's Tobacco Control Plan Implementation Board and the Cancer Research UK Tobacco Advisory Board) and to the NETSCC's Programme Directors meeting. At each stage the brief was redrafted in response to comments received allowing continual development. FindingsThe wide range of peer reviewers and committees welcomed involvement in the process. Reviewers gave useful responses and the committees gave sufficient agenda time for engaged discussion. This approach is generalisable to other research calls and will aid the development of NETSCC commissioning. InterpretationNETSCC are developing a flexible and responsive process to address identified research needs. The final commissioning brief will ask for research in a range of areas relevant to end-users' needs in a rapidly changing field. Once advertised (in about November, 2018) its success will be measured by the number of applications and how many are fundable. FundingNone.

IQOS campaign in Israel

At present, IQOS, Philip Morris’s (PM’s) heated tobacco product, is being test-marketed in 30 countries worldwide.1 Similarly to electronic cigarettes,2 regulation varies widely by country. In the USA, for example,...

What is India's Position in Implementing the WHO Framework Convention on Tobacco Control? A Policy Analysis of the Tobacco Control Law and National Tobacco Control Program

Background and context: The Framework Convention on Tobacco Control (FCTC) is the world's first public health treaty enacted under the World Health Organization (WHO). It is the biggest global initiative in tobacco control. India is a signatory to this treaty since 2004. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. The country is also known for widespread production and consumption of many smokeless forms of tobacco. India's progress in complying with the Framework Convention treaty had been inconsistent. While few states (provinces) are making significant progress, larger parts of the country struggles with gaps in the law, weak regulatory surveillance and overall noncompliance. The protobacco lobbies in India argue against the legislation by forecasting that banning tobacco production would lead to huge loss of employment and significant negative impact on the economy. These issues act as big deterrents to the country's tobacco control initiatives. Aim: There are very few published policy analyses on compliance with the FCTC treaty and identifying gaps in Indian tobacco control laws. This paper looks at India's tobacco use behavior, the national tobacco control laws, and its gaps and barriers. Strategy/Tactics: Using a policy triangle framework developed by Walt and Gilson (1994), it analyzes the national tobacco control policies and laws against the current scenario to identify areas of improvement and policy reform. Program/Policy process: The Indian tobacco control regulations and the National Tobacco Control Plan is evaluated in light of the WHO FCTC treaty to identify gaps and barriers to its implementation using published evidence. Outcomes: The analysis revels significant gaps and legal complexities that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. There are also important ethical issues related to the use of child labor in tobacco trade in India. What was learned: This paper recommends to amend the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers. This also recognizes the political-economic aspects and reflects on the contextual variables and stakeholders that play a significant role in deciding the fate of tobacco production, use and control in India.

Complete smokefree policies in mental health inpatient settings: results from a mixed-methods evaluation before and after implementing national guidance

BackgroundTobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government’s tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation.MethodsThis paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis.ResultsFollowing implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified.ConclusionsOverall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required.

Online informatics system of key outcome indicators to support tobacco control planning, surveillance and reporting

Online informatics system of key outcome indicators to support tobacco control planning, surveillance and reporting

E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys

Objective To examine whether the increase in use of electronic cigarettes in the USA, which became noticeable around 2010 and increased dramatically by 2014, was associated with a change in...

Point-of-sale cigarette purchase patterns among U.S. adult smokers-National Adult Tobacco Survey, 2012-2014.

Tobacco products are ubiquitous in most U.S. retail environments. Given that data on preferred point-of-sale purchase locations among U.S. adult tobacco users are limited, an enhanced understanding of tobacco purchase locations can help inform tobacco control policy, planning, and practice. We investigated prevalence and sociodemographic characteristics associated with cigarette purchase location among U.S. adult smokers. Pooled data came from the 2012-2013 (N=60,192) and 2013-2014 (N=75,233) National Adult Tobacco Surveys. Current cigarette smokers (n=18,005) aged ≥18 were asked if they purchased cigarettes within the previous 30days (n=15,182) and, if so, where they last purchased cigarettes. In 2016, logistic regression adjusted for sex, age, race/ethnicity, education level and annual household income was used to assess characteristics associated with purchase location. Among current smokers, 90.2% reported purchasing cigarettes in the past 30days. The most common purchase locations were convenience stores/gas stations (69.1%), tobacco discount stores (9.9%), drug stores (5.0%), supermarkets (4.9%), and liquor stores (3.6%). The odds of purchasing cigarettes at convenience stores/gas stations were higher among men (adjusted odds ratio (AOR)=1.4; 95% confidence interval (CI)=1.2-1.5) than women; and among adults aged 18-24 (AOR=3.1; 95% CI=2.4-3.9), 25-44 (AOR=3.1; 95% CI=2.7-3.7), and 45-64years (AOR=1.8 95% CI=1.6-2.1) than adults aged ≥65years. Over two-thirds of U.S. smokers last purchased cigarettes from convenience stores/gas stations. Understanding the relationship between purchase location and smoker characteristics may inform tobacco control strategies in the retail environment.

Is the UK government still serious about reducing smoking?

The lack of a tobacco control plan since 2015 could damage recent gains in reducing prevalence, Sophie Arie reports

Factors influencing cigarette smoking among soldiers and costs of soldier smoking in the work place at Kakiri Barracks, Uganda

BackgroundAlthough Uganda has a relatively low prevalence of smoking, no data exists on cigarette use among military personnel. Studies in other countries suggests military service is a risk factor for...

Smoking and Its Determinants in Chinese Internal Migrants: Nationally Representative Cross-Sectional Data Analyses.

Migrants often face multiple risk factors for smoking initiation. Former studies that have explored the smoking habits of Chinese migrants have provided inconsistent findings and lacked nationally representative samples. Using data from the 2012 Migrant Dynamics Monitoring Survey in China published by the National Population and Family Planning Commission, this study explored current smoking rates and its determinants among migrants in China. The smoking rates of men (46.9%, 46.3%-47.3%) and women (1.8%, 1.7%-1.9%) differed significantly. Although the overall smoking rates in migrants was slightly lower than in the general population, the rates in certain subgroups were much higher. Among men, the three leading associated factors were the following: higher smoking rates among the divorced or widowed (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.34-1.74); lower smoking rates among those with an educational level of senior high school or above (OR = 0.73, 95% CI: 0.71-0.76), and higher smoking rates in the migrant-receiving area (OR = 1.29, 95% CI: 1.18-1.42). Among women, smoking rates were also higher in the migrant-receiving area (OR = 1.78, 95% CI: 1.34-2.34), when monthly income was more than 3000 Renminbi (OR = 1.65, 95% CI: 1.43-1.90), and among those with an educational level of senior high school or above (OR = 0.65, 95% CI: 0.56-0.75). The social integration of migrants, the duration of stay, and working hours had weaker associations with smoking risk. The sociodemographic features, work pressure, and migration-related features were sex-dependent determinants of smoking rates. These factors need to be considered when planning tobacco control interventions among migrants. Our study was the first to analyze a nationally representative Chinese migrant sample with respect to smoking, its differential rates across various subgroups, and its determinants. Our results provided overall levels of migrant smoking rates. The findings also demonstrated the influences of sex, other sociodemographic variables, migration-related factors, work pressure, and social integration on the smoking habits of migrants. These results provide a database of information for developing and improving tobacco control interventions in migrants.

A roadmap for better mental health in New York City

New York City is frequently at the forefront of public health policy. Aggressive action to combat the dangers of tobacco use, including the 2003 Smoke-Free Air Act, tax policy, and educational campaigns, led to steep declines in smoking rates. 1 New York City Department of Health and Mental HygieneEpiquery: NYC Interactive Health Data System—Community Health Survey 2002–2013. http://nyc.gov/health/epiquery Google Scholar , 2 Coady MH Jasek J Davis K Kerker B Kilgore EA Perl SB Changes in smoking prevalence and number of cigarettes smoked per day following the implementation of a comprehensive tobacco control plan in New York City. J Urban Health. 2012; 89: 802-808 Crossref PubMed Scopus (23) Google Scholar Regulations to improve the food environment, such as labelling about calories in 2006 3 Farley TA Caffarelli A Bassett MT Silver L Frieden TR New York City's fight over calorie labeling. Health Aff (Millwood). 2009; 28: w1098-w1109 Crossref PubMed Scopus (56) Google Scholar and sodium in 2015 4 New York City Department of Health and Mental HygieneSodium Initiatives. http://www.nyc.gov/html/doh/html/diseases/salt.shtml Google Scholar and bans on trans fats in 2008, 5 New York City Department of Health and Mental HygieneNotice of Adoption of an Amendment (§81.08) to Article 81 of the New York City Health Code. http://www.nyc.gov/html/doh/downloads/pdf/public/notice-adoption-hc-art81-08.pdfDate: 2006 Google Scholar continue to be implemented as a way to tackle a growing obesity epidemic and rise in non-communicable diseases. Mary Bassett: trailblazer for health in New York CityMary Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, spent 17 years of her early career in Zimbabwe as the AIDS epidemic, of which she had seen the beginnings in her native Harlem, engulfed sub-Saharan Africa. Returning to New York, the most urgent need was a different one: to tackle non-communicable diseases (NCDs) caused by smoking and poor diets. But on both continents, she identified the same underlying issue that she has fought all her life—health inequalities. Full-Text PDF

Tobacco policy in Israel: 1948-2014 and beyond.

BackgroundTobacco is the only consumer product known to kill half of its users, and is a significant cause of death and disability to exposed nonsmokers. This presents a unique conundrum for modern democracies, which emphasize personal liberty, yet are obligated to protect citizens.In Israel, the death toll in 2014 from smoking is expected to reach 8000 deaths; nearly a fifth of the population smokes, and over two-thirds of the population are exposed to tobacco smoke.AimThis paper provides an overview of tobacco policy in Israel since the inception of the State, presents the development of the National Tobacco Control Plan, and recommends future actions.MethodsSources for this article included the Knesset (Israeli Parliament) and Ministry of Health websites, Health Minister Reports to the Knesset on Smoking, and the scientific literature.ResultsIsrael has an impressive record on tobacco control policy, beginning with taxation in 1952, landmark smoke-free air and marketing legislation in the early 1980’s, tax increases and expansions of smoke-free air and marketing legislation in the ensuing years, and the addition of subsidized smoking cessation technologies in 2010. Until 2011, actions were taken by various organizations without formal coordination; since the passage of the National Tobacco Control Plan in 2011, the Ministry of Health has held responsibility for coordinating tobacco control, with an action plan.The plan has been partially implemented. Smoke-free air laws were expanded, but enforcement is poor. Passage of critical marketing and advertising restrictions is stalled. Requested funds for tobacco control did not materialize.RecommendationsIn order to prevent hundreds of thousands of preventable premature deaths in the coming decades, Israel should considerably strengthen tobacco control policies to include: guaranteed funding for tobacco control; strong curbs on advertising, promotion and sponsorship of tobacco and smoking products; public education; law enforcement; protection of children from exposure to tobacco; regulation of electronic cigarettes and other alternative harm-reducing products; tobacco control research; and systematic monitoring of, and periodic updates to, the National Tobacco Control Plan. Israel should also begin discussions of Endgame scenarios, and consider abolition of tobacco, as it continues its progress towards making smoking history.

Stakeholder engagement: a model for tobacco policy planning in Oklahoma Tribal communities.

BackgroundOklahoma law pre-empts local governments from enacting smoking restrictions inside public places that are stricter than state law, but the sovereign status of Oklahoma’s 38 Tribal nations means they are uniquely positioned to stand apart as leaders in the area of tobacco policy.PurposeTo provide recommendations for employing university–Tribal partnerships as an effective strategy for tobacco policy planning in tribal communities.MethodsUsing a community-based participatory research approach, researchers facilitated a series of meetings with key Tribal stakeholders in order to develop a comprehensive tobacco policy plan. Ongoing engagement activities held between January 2011 and May 2012, including interdepartmental visits, facility site tours, interviews, and attendance at tribal activities, were critical for fostering constructive and trusting relationships between all partners involved in the policy planning process.ResultsThe 17-month collaborative engagement produced a plan designed to regulate the use of commercial tobacco in all Tribally owned properties. The extended period of collaboration between the researchers and Tribal stakeholders facilitated: (1) levels of trust between partners; and (2) a steadfast commitment to the planning process, ensuring completion of the plan amid uncertain political climates and economic concerns about tobacco bans.ConclusionsExtended engagement produced an effective foundation for policy planning that promoted collaboration between otherwise dispersed Tribal departments, and facilitated communication of diverse stakeholder interests related to the goal of tobacco policies. The findings of this study provide useful strategies and best practices for those looking to employ Tribal–university partnerships as strategies for tobacco control planning and policy-based research.