Work factors as predictors of smoking relapse in nurses’ aides

Objectives: The prevalence of tobacco smoking in nurses’ aides (assistant nurses) is high. Many smokers make attempts to stop smoking, but a large portion of these relapse after some period of time. The objective of this study was to identify work factors that predict smoking relapse in nurses’ aides. Methods: Of 1,373 Norwegian nurses’ aides—who were former smokers, not current smokers, and not on leave when they completed a questionnaire in 1999—1,203 (87.6%) filled in a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were assessed by validated questionnaires at baseline. Respondents who reported smoking at least one cigarette per day at the follow-up were considered having resumed daily smoking (relapse). Results: Social climate in the work unit (index with 3 items: supportive, trustful, relaxed) and frequency of exposure to threats and violence were the only work factors that were associated with the occurrence of relapse after adjustments for background factors. In a logistic regression analysis, frequent exposure to threats and violence at work (odds ratio (OR)=2.08; 95% confidence interval (CI): 1.01–4.29), and the lowest quintile of the social climate index (OR=2.12; CI: 1.03–4.36) were associated with increased risk of smoking relapse, after adjustments for age, gender, marital status, and having preschool children. Conclusions: A poor social climate in the work unit and frequent exposure to threats and violence at work may be predictors of smoking relapse in nurses’ aides. It is essential that leaders in the health services put more emphasis on creating a supportive, relaxed, and trustful social climate in the work unit. It is also important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy.     

Is the urban excess in lung cancer in Scotland explained by patterns of smoking?

Numerous studies have shown that lung cancer rates are higher in urban than rural areas, controlling for differences in age and sex profiles. One explanation is that smoking rates are higher in urban areas, although it is not clear whether the variations in smoking behaviour fully account for the observed urban/rural gradient in lung cancer incidence. Indeed, some studies have demonstrated an excess of cases in urban areas, even controlling for smoking behaviour. However, previous studies have been hampered by the lack of small-area smoking estimates which are required if urban/rural variations are to be examined reliably. This paper considers whether there is an urban excess in lung cancer incidence in Scotland, a country with particularly high rates of the disease, for the period 1988-1991. First, we examine whether an urban excess exists in Scotland using Poisson probabilities and a cluster detection technique. Second, regression analysis was then used to test whether any urban excess in lung cancer incidence remained once smoking behaviour was controlled for, using smoking estimates calculated for small areas throughout Scotland. The results demonstrate that the rates of lung cancer were higher in urban areas and that all the significant clusters of cases of lung cancer were located in the large urban centres of Scotland. Smoking behaviour did account for much of this urban excess in lung cancer, although it did not explain the entire effect. These results suggest that there are urban effects that influence the incidence of lung cancer that are not explained entirely by smoking behaviour. Possible explanations include the variations in exposure to air pollution, occupational differences and the legacy of selective migration between urban and rural areas.     

Does the pattern of educational inequalities in smoking in Western Europe depend on the choice of survey?

Objectives

Smoking rates vary according to socioeconomic group. We investigated whether patterns of educational inequalities in smoking prevalence differ across three major European surveys.

Methods

Data on smoking came from National Health Interview Surveys (NHIS), the European Community Household Panel (ECHP) and the Eurobarometer (EB). We calculated prevalence ratios by education. We controlled for sex, country, data source and age. We used likelihood ratio tests to determine whether inequalities in each country differed between surveys and whether the association of education and smoking across countries was the same in different surveys.

Results

Smoking prevalence tended to be lower in the ECHP than in both other surveys, and was highest in the EB. The pattern of inequalities in smoking also differed between surveys. Statistically significant differences between surveys were found mainly in Southern Europe, where EB-based prevalence ratios often deviated from those in the other two surveys.

Conclusions

Relative inequalities in smoking prevalence depend on the survey used. Our results suggest that the NHIS and the ECHP are more reliable sources of information on educational inequalities in smoking than the EB.     

The average age of smoking onset in Germany – trends and correlates

Summary Objectives:  Germany is rated among the countries with the highest prevalence of tobacco use in Europe. This paper analyzes whether the age of smoking onset has decreased in recent years. Methods:  Multivariable event data analyses were performed on the basis of the representative national cross-sectional study “Drug Affinity among Young People in the Federal Republic of Germany 2004”. The survey involved a total net sample of 3032 individuals aged 12 to 25. Results:  Socioeconomic groups starting to smoke at significantly earlier age include those from the economically deprived areas in eastern Germany, low educational achievers and subjects in households with adult smokers. Conclusions:  The average age of smoking onset has decreased further in the 1978–1992 birth cohorts. Submitted: 18 November 2006; Revised: 23 January 2008, 18 March 2008; Accepted: 19 March 2008     

Filthy or fashionable? Young people's perceptions of smoking in the media

Research has shown that the media over-estimates smoking rates and often associates smoking with favorable attributes or situations. Given that the media plays a large role in influencing youth culture, portrayal of smoking in the media is of concern. In order to explore young people's perceptions of smoking imagery in the media, 16 focus groups were conducted with 117 school students. Participants were asked to rate smoking images selected from audio-visual and print media, and to discuss their perceptions of these images. The results showed that young people perceived smoking in these media selections to be normal and acceptable. They identified with the stress-relieving and social aspects of smoking, despite being well aware of the harmful health effects. Its acceptability as part of a 'cool' image was also noted. Positive images of smoking in the media have the potential to down-play the serious health consequences of smoking by portraying it in a way that young people interpret as a normal part of everyday life. They may also encourage a more neutral or tolerant attitude towards smoking among young people and therefore act to counteract other health promotion efforts to reduce teenage smoking.     

The dynamics of tobacco smoking among male educated youths in Aleppo–Syria

Understanding the dynamics of the smoking habit among youths at different stages of their development is crucial for the adoption of effective tobacco control policies. We looked at the smoking habits of 576 male university students and compared it with previously studied 555 male high school students in Aleppo–Syria, stratified into four groups with 2-year interval each. The prevalence of current smoking among 1st and 3rd year university students is 18.2% and 29.4% respectively, compared to 10.5% and 22.6% among 10th and 12th year high school students respectively. This study shows a late onset initiation of regular forms of smoking compared to patterns seen in developed countries.     

Adolescents' smoking behaviors, beliefs on the risks of smoking, and exposure to ETS in Juárez, Mexico

OBJECTIVE: To assess the smoking behaviors, beliefs about the risks of smoking, and exposure to ETS among adolescents in Juárez, Mexico. METHODS: A cross-sectional study was conducted with sixth-grade students (N=506), aged 11-13 years old, attending 6 randomly selected schools. Schools were classified by school setting and SES. RESULTS: Students attending a low SES school setting were more likely to have smoked (P < 0.01), be current smokers (P < 0.01), be exposed to ETS at home and in public (P < 0.01) than were students attending a middle or high SES school. CONCLUSION: Smoking interventions should target students attending school in low SES settings.     

Can the stages of change for smoking acquisition be measured reliably in adolescents?

BACKGROUND: was to examine the reliability of the algorithm. METHODS: As part of a randomized controlled trial, 3,930 adolescents completed a paper version of the algorithm questions and a differently worded computerized version on the same day: a parallel form reliability assessment. In a separate assessment, another group of 118 adolescents completed 2 identical paper versions of the same questionnaire 2 weeks apart: a test-retest reliability assessment. Kappa (kappa) for agreement for stage and the individual questions were calculated. Logistic regression was used to examine whether demographic characteristics, smoking status, and stage predicted agreement for stage. RESULTS: Kappa (95% confidence intervals) for stage was 0.57 (0.55-0.60) in the first assessment and 0.46 (0.28-0.63) in the second assessment, indicating moderate reliability. The question concerning trying smoking in the next 6 months was moderately reliable, but that concerning trying within the next thirty days was poorly reliable. Acquisition precontemplation was significantly more reliably coded than all other stages. Demographic characteristics did not predict reliability. CONCLUSIONS: The algorithm reliably allocates individuals into acquisition precontemplation, but for all other stages, its reliability is fair.     

Ethnic differences in daily smoking in Malmö, Sweden. Varying influence of psychosocial and economic factors

BACKGROUND: The aim was to investigate ethnic differences in daily smoking in Malm?, Sweden, and whether these differences could be explained by psychosocial and economic conditions. METHODS: The public health survey in Malm? 1994 is a cross-sectional study. A total of 5,600 individuals aged 20-80 years were randomly chosen to respond to a postal questionnaire. The participation rate was 71%. The study population was divided into seven categories according to country of birth; Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic-speaking countries and all other countries. A multivariate analysis was performed using a logistic regression model in order to investigate the importance of possible confounders on the ethnic differences in daily smoking. Finally, variables measuring social network, social support and economic conditions were introduced. RESULTS: The prevalence of daily smoking was significantly higher among both men and women born in Denmark/Norway (39.1% and 37.0%), men born in other Western countries (32.9%), Poland (34.0%) and Arabic-speaking countries (36.4%) than among Swedish men (21.7%) and women (23.8%). Women born in Arabic-speaking countries had a significantly lower smoking prevalence (7.1%). The multivariate analysis, including age, education and snuff, did not affect these results. A reduction of the odds ratio of daily smoking was observed for men born in Arabic-speaking countries and Poland after the introduction of the psychosocial and economic factors in the model. Only small changes were observed for women. CONCLUSION: There were significant ethnic group differences in daily smoking. Psychosocial and economic conditions in Sweden may be of importance in some ethnic groups.     

More than words? The status and impact of smoking policies in Scottish schools

The aim of this study was to investigate the current status of smoking policies in Scottish schools, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among pupils and teachers. A representative sample of 15-year-old school pupils from 77 Scottish secondary schools was surveyed in 1998 regarding their perceptions of smoking in several locations within and outside the school building. Two staff members from each school were also surveyed regarding school smoking policies for pupils and teachers, the nature of the school's smoking restrictions, and the extent to which the restrictions were enforced. The results showed that more schools had a written policy on teacher smoking than on pupil smoking. All schools in the sample banned smoking by pupils, but the majority allowed smoking by teachers in restricted areas. Irrespective of the type of policy or restrictions on smoking, pupils reported seeing smoking among both pupils and teachers on school premises in all of the sample schools. Whether or not a school had a written policy appeared to be unrelated to pupil smoking in the toilets or teacher smoking outdoors on school premises. However, pupils were less likely to be aware of pupils smoking outdoors and teachers smoking in the staff rooms in schools where there were written policies on pupil and teacher smoking, respectively. Consistent enforcement of a ban on pupil smoking was associated with lower levels of perceived smoking among pupils. Where a complete ban on teacher smoking existed, smoking among teachers was seen less often in the staff rooms, but more often in outside areas on school premises. The results have implications for the use of policy in promoting a healthy school environment.     

The burden of smoking in Israel–attributable mortality and costs (2014)

Background

Tobacco use is the single most preventable cause of death, incurring huge resource costs in terms of treating morbidity and lost productivity. This paper estimates smoking attributable mortality (SAM) as health costs in 2014 in Israel.

Methods

Longitudinal data on prevalence of smokers and ex-smokers were combined with diagnostic and gender specific data on Relative Risks (RR) to gender and disease specific population attributable risks (PAR). PAR was then applied to mortality and hospitalization data from 2011, adjusted by population growth to 2014 to calculate SAM and hospitalization days (SAHD) caused by active smoking. These were used as a base for calculating deaths, hospital days and costs attributable to passive smoking, smoking by pregnant women, residential fires and productivity losses based on international literature.

Results

The lagged model estimated active SAM in Israel in 2014 to be 7,025 deaths. Cardio-vascular causes accounted for 45.0% of SAM, malignant neoplasms (39.2%) and respiratory diseases (15.5%). Lung cancer alone accounted for 24.1% of SAM. There were an estimated 793, 17 and 12 deaths from passive smoking, mothers-to-be smoking and residential fires. Total SAM is around 7,847 deaths (95% CI 7,698-7,997) in 2014.We estimated 319,231 active SAHD days (95% CI 313,135-325,326). Respiratory care accounted for around one-half of active SAHD (50.5%). Cardio-Vascular causes for 33.5% and malignant neoplasms (13.2%). Lung cancer only for 4.6%. Total SAHD was around 356,601 days including 36,049 days from passive smoking. Estimated direct acute care costs of 356,601 days in a general hospital amount to around 849 (95% CI 832–865) million NIS ($244 million). Non acute care costs amount to an additional 830 million NIS ($238 million). The total health service costs amount to 1,678 million NIS (95% CI 1,646-1,710) or $482 million, 0.2% of GNP. Productivity losses account for a further 1,909 million NIS ($548 million), giving an overall smoking related cost of 3,587 million NIS (95% CI 3,519-3,656) or $1,030 million, 0.41% of GNP).

Conclusions

Smoking causes a considerable burden in Israel, both in terms of the expected 7,847 lives lost and the financial costs of around 3.6 million NIS ($1,030 million or 0.42% of GNP).

     

Is smoking delayed smoking averted?

Antismoking efforts often target teenagers in the hope of producing a new generation of never smokers. Teenagers are more responsive to tobacco taxes than are adults. The author summarizes recent evidence suggesting that delaying smoking initiation among teenagers through higher taxes does not generate proportionate reductions in prevalence rates through adulthood. In consequence, the impact of taxes on smoking among youths overstates the potential long-term public health effects of this tobacco control strategy.     

How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes

Background

The number of smoking-attributable deaths is commonly estimated using current and former smoking prevalences or lung cancer mortality as an indirect metric of cumulative population smoking. Neither method accounts for differences in the timing with which relative risks (RRs) for different diseases change following smoking initiation and cessation. We aimed to develop a method to account for time-dependent RRs.

Methods

We used birth cohort lung cancer mortality and its change over time to characterize time-varying cumulative smoking exposure. We analyzed data from the American Cancer Society Cancer Prevention Study II to estimate RRs for disease-specific mortality associated with current and former smoking, and change in RRs over time after cessation.

Results

When lung cancer was used to measure cumulative smoking exposure, 254,700 male and 227,000 female deaths were attributed to smoking in the US in 2005. A modified method in which RRs for different diseases decreased at different rates after cessation yielded similar but slightly lower estimates [251,900 (male) and 221,100 (female)]. The lowest estimates resulted from the method based on smoking prevalence [225,800 (male) and 163,700 (female)].

Conclusions

Although all methods estimated a large number of smoking attributable deaths, future efforts should account for temporal changes in smoking prevalence and in accumulation/reversibility of disease-specific risks.     

Regional surveillance of social and geographic inequalities in smoking: the case of Montréal, Canada

Surveillance of social inequalities in health is a platform for action. We examined the trends in smoking behaviours (current and ever smoking, quit ratios) according to education and place of residence and we quantified the observed inequalities. Data were from repeated cross-sectional surveys (2003-2009) of Montreal (Canada) residents ≥15 years (n=12,053). Trends in smoking behaviours according to education were measured with logistic and log-binomial regressions. Spatial distribution of smoking behaviours across local areas was assessed with Morans' Index. Observed inequalities were quantified with prevalence ratio and difference, population attributable risk, and slope index of inequality. Results showed that ever smoking rose among low-educated individuals. Among their high-educated fellow-citizens, current smoking decreased and quit ratios increased. Adverse smoking behaviours (current and ever smoking) were clustered in south-central areas. We conclude that smoking inequalities in Montreal are growing. We thus encourage a closer monitoring of smoking social differentials.     

Town-level characteristics and smoking policy adoption in Massachusetts: are local restaurant smoking regulations fostering disparities in health protection?

OBJECTIVES: We identified and quantified differences in sociodemographic characteristics of communities relative to the strength of local restaurant smoking regulations in Massachusetts. METHODS: We examined the relationship between the strength of the 351 local restaurant smoking regulations in Massachusetts and a number of town-level characteristics, using a multinomial logistic regression model. RESULTS: Characteristics important to the adoption of stronger restaurant smoking regulations included higher education and per capita income, geographic region, voter support for a state cigarette tax initiative, board of health funding to promote clean indoor air policy making, and the presence of a bordering town with a strong regulation. CONCLUSIONS: The current pattern of smoke-free restaurant policy enactment fosters socioeconomic and geographic disparities in health protection, undermining an important national health goal.     

One size fits all? A process evaluation--the turn of the 'story' in smoking cessation

OBJECTIVES: This qualitative process evaluation aimed to make explicit the assumptions shaping the practice of smoking cessation groups using the medium of the story, and assessed the smokers' perceptions of the value of the new method in their attempts to quit smoking. STUDY DESIGN: This narrative analysis represents a holistic-content perspective and considers the multiple narratives of the smoking cessation groups, as both context and content, and provides unique insights into the assumptions that inform smoking cessation. The analysis of stories is "a unique means to get inside the world of health promotion practice" (Riley T, Hawe P. Researching practice: the methodological case for narrative inquiry. Health Educ Res 2005;20:226-36). METHODS: Data were firstly collected by observing a snapshot of 12 existing smoking cessation groups in a low-income community over six weeks. Secondly, five debriefing sessions were held with the group facilitator to unpack the assumptions informing the practice. Thirdly, 11 interviewees were purposively selected out of a total group sample of 67 in order to assess their perceptions and experience of the groups. These 11 interviewees were people who had made use of the service at least three times within six consecutive months. RESULTS: The findings of this study challenge current smoking cessation guidelines (West R, McNeill A, Raw M. Smoking cessation guidelines for Scotland 2004 update. Edinburgh, Scotland: ASH Scotland and NHS Health Scotland; 2004) and suggest highly structured standardized 6-8 week programmes in smoking cessation are insufficient to meet the needs of many smokers. Stories are used to both locate the process of change within people's daily lives as well as to enable people to engage in a supportive process with others. The intention to change is perceived by many smokers to be unstable and requires opportunities for longer-term support. Flexibility in their attendance and ongoing support to both make the decision to stop and stay stopped is clearly valued by the participants. In addition, including people at the different stages of change seems to be positive and the participants appear to incorporate without difficulty those who are still smoking with those who have stopped. Many find the insights of those at the different stages very valuable in their own attempts to quit. Current practices of excluding smokers who are still unsure of their own motivation are challenged. CONCLUSIONS: The hypotheses generated by the work suggest that flexible services that offer support to a range of smokers are beneficial and valued. In addition, programmes that are tailored to the individual's context and culture, as well as the individual's personal life situation, through the medium of the story, are valued and acceptable to the participants.