Turning “Smoking Man” Images Around: Portrayals of Smoking in Men's Magazines as a Blueprint for Smoking Cessation Campaigns

Published scholarship documents the prevalence and health risks of smoking among men. There is also a rich tradition of studying the normative influences of the media in constructing and propagating images of healthy/unhealthy behaviors such as smoking. To understand the construction of these media-propagated smoking images toward male audiences, this article studies all advertising and editorial content of 3 major men's magazines for 2001 using rhetorical and content analyses. The emergent themes construct the smoking man as sensual, in another place, independent, and mysterious. The authors recommend turning around these themes of the masculine “smoking man” for the purpose of strategic media planning and developing message-targeting guidelines for smoking cessation and prevention messages directed at men.     

Do Public Smoking Bans have an Impact on Active Smoking? Evidence from the UK

The literature on the effects of public smoking bans on smoking behaviour presents conflicting results and there is limited evidence on their impact on active smoking. This paper evaluates the impact of smoking bans on active smoking using data from the British Household Panel Survey and exploiting the policy experiment provided by the differential timing of the introduction of the bans in Scotland and England. We assess the short‐term impact of the smoking bans by employing a series of flexible difference‐in‐differences fixed effects panel data models. We find that the introduction of the public smoking bans in England and Scotland had limited short‐run effects on both smoking prevalence and the total level of smoking. Although we identify significant differences in trends in smoking consumption across the survey period by population sub‐groups, we find insufficient evidence to conclude that these were affected by the introduction of the smoking bans. These results challenge those found in the public health literature but are in line with the most recent strand of economic literature indicating that there is no firm evidence on the effects of smoking bans on smoking. Copyright © 2013 John Wiley & Sons, Ltd.     

Nationwide Smoking Cessation Treatment Support Program – Turkey project

BackgroundIn 2011, Turkish Ministry of Health (MoH) initiated a nation-wide “Smoking Cessation Treatment Support Program” (SCTSP), to provide smoking cessation drugs free of charge.MethodsSCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix^®, Pfizer) and Bupropion (Zyban^®, GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program.FindingsQuit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates.InterpretationSCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algoritm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.     

Smoking and deprivation: are there neighbourhood effects?

Debate has centred on whether the character of places plays an independent role in shaping individual smoking behaviour. At the small-area scale, particular attention has focused on whether measures of neighbourhood deprivation predict an individual's smoking status independent of their own personal characteristics. This study applies multilevel modelling techniques to data from the British Health and Lifestyle Survey and ward (local neighbourhood) level deprivation scores based on four variables from the national Census. Results suggest that after taking account of a large range of individual characteristics, both as main effects and interactions, together with complex structures of between-individual variation, measures of neighbourhood deprivation continue to have an independent effect on individual smoking status. In addition, significant between-ward differences in smoking behaviour remain which cannot be explained either by population composition or ward-level deprivation. The study suggests that the character of the local neighbourhood plays a role in shaping smoking behaviour.     

Assessing the Relationship Between Work–Family Conflict and Smoking

Objectives. We examined the relationship between smoking and work–family conflict among a sample of New England long-term-care facility workers.Methods. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities.Results. There was a strong association between smoking likelihood and work–family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict.Conclusions. The results of this study indicate that there is a robust relationship between work–family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.Tobacco use is the foremost cause of preventable death and illness in the United States. Tobacco use, primarily in the form of cigarette smoking, is responsible for 1 in 5 deaths, or about 440 000 Americans every year,1 and about 5 million people worldwide each year.2 In addition to shortening human lives, tobacco also places a significant economic burden on society. Cigarette smoking is not distributed randomly among the population but is associated with social and economic disadvantage and stress.3 Smoking is highest in groups with lower socioeconomic status and increasingly occurs in areas marked by low income, limited services, and chronic unemployment.4–7 In addition, research on the relationship between working conditions and smoking has been the focus of public health research, which has demonstrated that smoking and occupation are linked and that job stress may be associated with increased levels of smoking.8–11 Both the social environment and work-based factors have been demonstrated to be influential in determining tobacco use, but there has been little attention to date paid to smoking in relation to work–family conflict.Work–family conflict refers to the expectations, demands, skills, or knowledge associated with one domain (e.g., work) affecting the other domain (e.g., family), with the term “conflict” implying that the 2 domains compete for the individual’s time and energy in a negative interaction.12 There are well-established links between work–family conflict and health outcomes, including depression and general well-being,13–15 and the research has shown that the direction of the conflict (i.e., work interfering with family vs family interfering with work) is an important distinction to make when one is studying work–family conflict.12 In addition to health outcomes, researchers are investigating links between work–family conflict and health behaviors, such as substance use and diet.16,17 Work–family conflict has been found to be associated with alcohol consumption among diverse groups.18–20 This association suggests the need to examine the relationship between work–family conflict and tobacco use, another substance believed to relieve stress.21,22Finally, much of the work performed by workers in long-term-care facilities is both physically and emotionally demanding, provides relatively low wages, and is likely to be associated with adverse health consequences.23–25 These characteristics make these workers important to consider when one is investigating the links between working conditions, work–family conflict, and health.We examined the relationship between smoking and work–family conflict among workers in 4 New England long-term-care facilities. We assessed both the direction of work–family conflict (i.e., work-to-home vs home-to-work) and the effects of overall conflict (i.e., experiencing both forms of conflict) because we hypothesized that experiencing conflict in both directions may influence smoking likelihood more than experiencing conflict in 1 direction alone. We also examined the contributions of work and home factors as potential confounders because each may be separately associated with both smoking and work–family conflict.     

Adolescent Cigarette Smoking: Health-Related Behavior or Normative Transgression?

Relations among measures of adolescent behavior were examined to determine whether cigarette smoking fits into a structure of problem behaviors—behaviors that involve normative transgression—or a structure of health-related behaviors, or both. In an ethnically and socioeconomically diverse sample of 1782 male and female high school adolescents, four first-order problem behavior latent variables—sexual intercourse experience, alcohol abuse, illicit drug use, and delinquency—were established and together were shown to reflect a second-order latent variable of problem behavior. Four first-order latent variables of health-related behaviors—unhealthy dietary habits, sedentary behavior, unsafe behavior, and poor dental hygiene—were also established and together were shown to reflect a second-order latent variable of health-compromising behavior. The structure of relations among those latent variables was modeled. Cigarette smoking had a significant and substantial loading only on the problem-behavior latent variable; its loading on the health-compromising behavior latent variable was essentially zero. Adolescent cigarette smoking relates strongly and directly to problem behaviors and only indirectly, if at all, to health-compromising behaviors. Interventions to prevent or reduce adolescent smoking should attend more to factors that influence problem behaviors.All results not tabled are available on request     

Smoking in Ontario schools: does policy make a difference?

OBJECTIVE: Studies in other countries have shown that school tobacco control policy has potential to prevent smoking uptake in adolescents. Since no Canadian research has studied this association, we assessed the statistical link between school tobacco policy and smoking status in Ontario elementary and secondary schools. METHODS: We conducted secondary analysis of data collected using the School Smoking Profile, a cross-sectional, self-report questionnaire. School policy variables were formed from five survey items concerning students' perceptions of school tobacco control policy. Smoking status was determined through self-report measures which had been validated by carbon monoxide testing. Logistic regression models used school policy variables to explain smoking status in elementary and secondary schools, controlling for school location, school size, and student's grade level. RESULTS: The smoking policy variables, rules and enforcement, explained smoking status after controlling for other variables. In elementary schools, perceptions of stronger enforcement reduced the odds of being a smoker (OR = 0.39, CI99 = 0.34-0.44). In secondary schools, enforcement lost its protective effect (OR = 1.05, CI99 = 1.00-1.10). In addition, student perceptions that rules were strong were indicative of increased smoking in secondary schools (OR = 1.32, CI99 = 1.27-1.37). DISCUSSION: Strong enforcement of school tobacco control policy appears to be effective in elementary schools but is not as helpful in secondary schools. Secondary school policymakers should consider modifying their sanctions to avoid alienating smokers.     

The Relationship Between Maternal–Fetal Attachment and Cigarette Smoking Over Pregnancy

Cigarette smoking during pregnancy is one of the most preventable causes of infant morbidity and mortality, yet 80 % of women who smoked prior to pregnancy continue to smoke during pregnancy. Past studies have found that lower maternal–fetal attachment predicts smoking status in pregnancy, yet past research has not examined whether maternal–fetal attachment predicts patterns or quantity of smoking among pregnant smokers. The aim of this study was to examine the relationship between maternal–fetal attachment and patterns of maternal smoking among pregnant smokers. We used self-reported and biochemical markers of cigarette smoking in order to better understand how maternal–fetal attachment relates to the degree of fetal exposure to nicotine. Fifty-eight pregnant smokers participated in the current study. Women completed the Maternal–Fetal Attachment Scale, reported weekly smoking behaviors throughout pregnancy using the Timeline Follow Back interview, and provided a saliva sample at 30 and 35 weeks gestation and 1 day postpartum to measure salivary cotinine concentrations. Lower maternal–fetal attachment scores were associated with higher salivary cotinine at 30 weeks gestation and 1 day postpartum. As well, women who reported lower fetal attachment reported smoking a greater maximum number of cigarettes per day, on average, over pregnancy. Lower maternal–fetal attachment is associated with greater smoking in pregnancy. Future research might explore whether successful smoking cessation programs improve maternal assessments of attachment to their infants.     

Smoking kills (alcoholics)! shouldn't we do something about it?

In general, 'drinkers smoke', and a high proportion of the alcohol-dependent population is also nicotine-dependent. Statistically, the majority of alcoholics will die of smoking-related, rather than alcohol-related, disease. This co-dependent sub-population may have higher levels of nicotine dependence, and find smoking cessation more difficult. Major reasons are that concurrent alcohol use, and/or prior alcohol exposure, may change the reinforcing effects of nicotine, and that each drug becomes a pharmacological cue for the expectation of the other. If so, then smokers whose nicotine dependence is impacted by alcohol, represent a large and distinct sub-population in which both the therapeutic and molecular targets for smoking cessation are altered. This, in turn, has implications for the validity of animal models of nicotine reinforcement, and for the development of novel smoking cessation medications. It is no longer possible to ignore the fact that the two most prevalent and damaging addictive drugs in our society are very commonly used by the same individuals. Without a better understanding of the psychological and pharmacological interactions between alcohol and nicotine that impact dependence, we cannot hope to provide appropriate medications for this large and problematic patient group. Our intention in this opinion overview is to use the current literature to provide a framework for future studies into the impact of alcohol use on the reinforcing effects of nicotine.     

Prenatal Smoking in Two Consecutive Pregnancies: Georgia, 1989–1992

Objective: To explore the patterns of prenatal smoking among women whose first and second pregnancies ended in live births. Methods: We used population-based data to explore prenatal smoking among 14,732 white and 8968 black Georgia residents whose first and second pregnancies ended in live births during 1989–1992. Smoking status was obtained from birth certificates linked for individual mothers. Because of demographic differences, we analyzed white and black women separately. Results: Approximately 15% (2253) of white women and 4% (318) of black women smoked during their first pregnancy. Of those smokers, 69% (1551) of white women and 58% (184) of black women also smoked during their second pregnancy. For both white and black nonsmokers during the first pregnancy, low education was the most significant predictor of smoking during the second pregnancy, after adjusting for consistency of the father's name on the birth certificate, prenatal care, birth interval, mother's county of residence, and birth outcome. Conclusions: The prevalence of smoking in this study may be low because of underreporting of prenatal smoking on birth certificates. The majority of women who smoked during their first pregnancy also smoked during their second, suggesting that these women exposed their first infant to tobacco smoke both in utero and after delivery. Practitioners should offer smoking cessation programs to women during, as well as after, pregnancy. Pediatricians should educate parents on the health risks to young children of exposure to environmental tobacco smoke and refer smoking parents to smoking cessation programs.