Mortality attributable to smoking in Vietnamese men in 2008

Objective

Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies.

Method

We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses.

Results

When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)].

Conclusion

Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.     

Parental and retail supply of tobacco to minors: Findings from a community-based social supply intervention study

Aim

We report on findings from a quasi-experimental community trial of a complex intervention aimed at reducing social and commercial supply of cigarettes to young people.

Materials and methods

The intervention comprised a package of school, community and home-based smokefree strategies implemented over three years from 2007 to 2009 in a low-income area of Auckland, New Zealand, with another area serving as the control population. The main outcome measures were relative change in parental and retailer behaviour and in attitudes to the provision of tobacco to youth. We analysed baseline and follow-up data from questionnaires administered to parents and children living in the intervention and control areas using PASW Statistics 18.

Results

No difference was found between groups in parents’ permissiveness of smoking and in retailer compliance to the tobacco sale legislation over the course of the study, either because our intervention had no or only a limited effect, or alternatively because limitations in the study design diluted any effect.

Conclusions

Nevertheless, a key finding was that parents and retailers persisted as important sources of cigarettes for young people. Further study is required to identify effective interventions to address this issue.     

Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain)

Objective

To assess attitudes towards the extension of outdoor smoke-free areas on university campuses.

Young adult former ever smokers: The role of type of smoker,quit attempts,quit aids,attitudes/beliefs,and demographics

Objective

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.

Method

Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.

Results

Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.

Conclusion

Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.     

Patient-reported recall of smoking cessation interventions from a health professional

Objective

To determine the prevalence and characteristics of current cigarette smokers who report receiving health care provider interventions (‘5A's’: ask, advise, assess, assist, arrange) for smoking cessation.

Methods

Data came from the 2009–2010 National Adult Tobacco Survey, a telephone survey of United States adults aged ≥ 18 years. Among current cigarette smokers who reported visiting a health professional in the past year (n = 16,542), estimates were calculated overall and by sex, age, race/ethnicity, education, income, health insurance coverage, and sexual orientation.

Results

Among smokers who visited a health professional (75.2%), 87.9% were asked if they used tobacco, 65.8% were advised to quit, and 42.6% were asked if they wanted to quit. Among those wanting to quit, 78.2% were offered assistance and 17.5% had follow-up arranged. Receipt of the ‘ask’ component was lower among males and uninsured individuals. Receipt of the ‘advise’ and ‘assess’ components was lower among those aged 18–24 and uninsured individuals. Receipt of the ‘assist’ component was lower among non-Hispanic blacks. No differences were observed for the ‘arrange’ component.

Conclusions

Many current smokers report receiving health care provider interventions for smoking cessation. Continued efforts to educate, encourage, and support all health professionals to provide effective, comprehensive tobacco cessation interventions to their patients may be beneficial.     

Influence of gender role attitudes on smoking and drinking among girls from Jujuy,Argentina

Objective

Evaluate effect of gender role attitudes on tobacco and alcohol use among Argentinean girls.

Method

Cross-sectional survey of 10th grade students attending 27 randomly selected schools in Jujuy, Argentina. Questions about tobacco and alcohol use were adapted from global youth surveys. Five items with 5-point response options of agreement–disagreement assessed attitude towards egalitarian (higher score) gender roles.

Results

2133 girls, aged 13–18 years, 71% Indigenous, 22% mixed Indigenous/European, and 7% European responded. Of these, 60% had ever smoked, 32% were current smokers, 58% ever drinkers, 27% drank in previous month, and 13% had ≥ 5 drinks on one occasion. Mean response to the gender role scale was 3.49 (95% Confidence Intervals = 3.41–3.57) out of 5 tending toward egalitarian attitudes. Logistic regression models using the gender role scale score as the main predictor and adjusting for demographic and social confounders showed that egalitarian gender role was associated with ever smoking (Odds Ratio = 1.25; 95% Confidence Intervals 1.09–1.44), ever drinking (Odds Ratio = 1.24; 95% Confidence Intervals 1.10–1.40), drinking in prior month (Odds Ratio = 1.21; 95% Confidence Intervals 1.07–1.37) and ≥ 5 drinks on one occasion (Odds Ratio = 1.15; 95% Confidence Intervals 1.00–1.33), but was not significant for current smoking.

Conclusion

Girls in Jujuy who reported more egalitarian gender role attitudes had higher odds of smoking or drinking.     

Strategies implemented by 20 local tobacco control agencies to promote smoke-free recreation areas, California, 2004-2007

Introduction

Since 2000, local jurisdictions in California have enacted hundreds of policies and ordinances in an effort to protect their citizens from the harmful effects of secondhand smoke. We evaluated strategies used by state-funded local tobacco control programs to enact local smoke-free policies involving outdoor recreational spaces.

Methods

The Tobacco Control Evaluation Center analyzed 23 final evaluation reports that discussed adopting local smoke-free policies in outdoor recreational facilities in California. These reports were submitted for the 2004 through 2007 funding period by local tobacco control organizations to the California Department of Public Health, Tobacco Control Program. We used a comparative technique whereby we coded passages and compared them by locale and case, focusing on strategies that led to the enactment of smoke-free policies.

Results

Our analysis found the following 6 strategies to be the most effective: 1) having a "champion" who helps to carry an objective forward, 2) tapping into a pool of potential youth volunteers, 3) collecting and using local data as a persuasive tool, 4) educating the community in smoke-free policy efforts, 5) working strategically in the local political climate, and 6) framing the policy appropriately.

Conclusion

These strategies proved effective regardless of whether policies were voluntary, administrative, or legislative. Successful policy enactment required a strong foundation of agency funding and an experienced and committed staff. These results should be relevant to other tobacco control organizations that are attempting to secure local smoke-free policy.     

Prevalence of Tobacco Use Among Power Loom Workers - A Cross-Sectional Study

Background:

Tobacco use is a major public health problem globally. According to the World Health Organization (WHO), tobacco is the second most important cause of death in the world. It is currently estimated to be responsible for about 5 million deaths each year worldwide. In India, it is responsible for over 8 lakh deaths every year.

Objective:

To estimate the prevalence of tobacco use among power loom workers in Mau Aima Town, District Allahabad, UP.

Materials and Methods:

Five hundred power loom workers were randomly chosen. Out of them 448 workers were interviewed through a questionnaire survey during May-June 2007. Data on demographics, education, and type of work were collected along with details regarding tobacco use and smoking status, duration of the habit, and daily consumption. Prevalence of tobacco chewing and/or bidi and cigarette smoking, and their sociodemographic correlates, were examined.

Results:

The overall prevalence of tobacco use was 85.9%; the prevalence of smoking and tobacco chewing were 62.28% and 66.07%, respectively. Statistical analysis showed that smoking is more common in the elderly, while chewing gutka (a type of chewing tobacco) is popular among the younger age-groups.

Conclusion:

The prevalence of tobacco use among power loom workers is very high compared to that in general population. Immediate intervention programs are warranted to reduce the future burden of tobacco-related morbidity among these workers who are already exposed to the highly polluted environment in power loom factories.     

Incarceration and Current Tobacco Smoking Among Black and Caribbean Black Americans in the National Survey of American Life

Objectives. We examined the relationship between having a history of incarceration and being a current smoker using a national sample of noninstitutionalized Black adults living in the United States.Methods. With data from the National Survey of American Life collected between February 2001 and March 2003, we calculated individual propensity scores for having a history of incarceration. To examine the relationship between prior incarceration and current smoking status, we ran gender-specific propensity-matched fitted logistic regression models.Results. A history of incarceration was consistently and independently associated with a higher risk of current tobacco smoking in men and women. Formerly incarcerated Black men had 1.77 times the risk of being a current tobacco smoker than did their counterparts without a history of incarceration (95% confidence interval [CI] = 1.20, 2.61) in the propensity score-matched sample. The results were similar among Black women (prevalence ratio = 1.61; 95% CI = 1.00, 2.57).Conclusions. Mass incarceration likely contributes to the prevalence of smoking among US Blacks. Future research should explore whether the exclusion of institutionalized populations in national statistics obscures Black–White disparities in tobacco smoking.In the United States, local, state, and national measures first enacted in the 1970s and 1980s under the “war on drugs” and “tough on crime” policies radically changed the criminal justice system as well as the social, economic, and political landscapes.1 As a result, the US incarceration rate soared higher than that of Russia by 2001.2 The overall incarceration rate has increased by more than 400% since 1980, and the incarceration rate associated with felony drug offenses has increased by 1100%.3,4 Black Americans have borne the brunt of these criminal justice policy changes. One in 21 Black men and 1 in 279 Black women are currently incarcerated, and almost one third of Black men will be incarcerated at least once in their lifetime.4 Mass incarceration is thus potentially an important driver of the distribution of disease and ill-being in Black Americans.Tobacco is an integral part of prison culture, serving as a stress reliever, currency, and means of social interaction. Furthermore, the sensory and social deprivation of the prison environment may encourage tobacco use. Until the 1980s, cigarettes were freely distributed to incarcerated individuals as part of their rations and were (and still remain) the currency of choice for underground prison economies.5–7 However, tobacco policy in US prisons has changed radically in the past 25 years, culminating in the Federal Bureau of Prisons’ indoor smoking ban in federal prisons in 2004.8,9 Meanwhile, state and local prison and jail systems also modified their policies. By 2007, 87% of state prisons reported having either a total or indoor smoking ban in place, with none offering free tobacco.5As a population, people who have been incarcerated have a greater likelihood of having problems with substance abuse, psychiatric illness, and stressful or traumatic life events, potentially increasing susceptibility to nicotine addiction, with smoking prevalence in prison estimated at 40% to 80%.10–13 A systematic review of smoke-free policies in US prisons and jails that included 27 studies cited noncompliance with smoke-free policies ranging from 20% to 76% and demonstrated inconsistent implementation and control of contraband as well as the rise of tobacco black markets.14 In essence, if the available data are representative, the influence of underlying smoking norms seems to outweigh institutional policy changes, although the institutional setting may limit access and therefore consumption.In a systematic review, only 6 studies examining smoking postrelease from smoke-free prisons and jails were identified, and it indicated that individuals released went back to their previous smoking behavior almost immediately.14 With fewer constraints on consumption, individuals released from prison and jail may increase their cigarette consumption to achieve previous nicotine levels, especially those undergoing drug treatment or suffering from mental illness (and perhaps taking antipsychotics).15Even less is known about differences in incarceration-related tobacco smoking by race/ethnicity. Research shows that Blacks are less likely to participate and are not sampled in sufficient numbers to allow subgroup analyses.16,17 Controlling for socioeconomic status, Blacks have lower risk trajectories of cigarette smoking from childhood into adulthood than do Whites; they are also less likely to be heavy or regular smokers and more likely to be nonsmokers, initiating smoking later and reaching lower daily cigarette consumption.18–21 Although this lower tobacco consumption is one of the few health behavior advantages for Blacks compared with Whites, Blacks are more vulnerable to the health consequences of smoking (e.g., lung cancer).22 However, the role of incarceration in tobacco smoking prevalence among Blacks in the United States has not been examined.We therefore sought to evaluate the relationship between adult history of incarceration and tobacco smoking using a national sample of noninstitutionalized Black adults living in the United States, while taking account of differential propensity for having a history of incarceration.     

Association of Campus Tobacco Policies With Secondhand Smoke Exposure,Intention to Smoke on Campus,and Attitudes About Outdoor Smoking Restrictions

College campus tobacco-free policies are an emerging trend. Between September 2013 and May 2014, we surveyed 1309 college students at 8 public 4-year institutions across California with a range of policies (smoke-free indoors only, designated outdoor smoking areas, smoke-free, and tobacco-free).Stronger policies were associated with fewer students reporting exposure to secondhand smoke or seeing someone smoke on campus. On tobacco-free college campuses, fewer students smoked and reported intention to smoke on campus. Strong majorities of students supported outdoor smoking restrictions across all policy types.Comprehensive tobacco-free policies are effective in reducing exposure to smoking and intention to smoke on campus.Exposure to tobacco smoke harms nearly every organ of the body.1 Young adults smoke at rates higher than any other age group,2 likely in part because the tobacco industry aggressively markets to young adults3 as the youngest age group that they can legally target. Between 2001 and 2011, undergraduate enrollment increased 32% from 13.7 million to 18.1 million, with 42% of young adults (aged 18–24 years) attending a 2- or 4-year college or university. The National Center for Educational Statistics projects that this trend will continue, with a 13% increase in enrollment of students aged 24 years and younger from 2011 to 2021.4 Colleges are rapidly adopting a range of policies on tobacco, including tobacco-free policies that prohibit tobacco use on the entire grounds for students, faculty, staff, and visitors.Smoke-free college campus policies have been associated with a drop in student smoking rates.5 On North Carolina college campuses, as tobacco policy strength increased (none, designated areas, or tobacco-free), less cigarette butt litter was found on the ground outside building entrances.6 As tobacco control advocates shift focus to promoting comprehensive tobacco-free policies, a more nuanced understanding of the benefits of these policies is necessary.Previous research has indicated that college smoke-free policies lead to a reduction in student smoking rates,5 and strength of policy is linked to cigarette butt litter on college campuses.6 The purpose of this study was to examine the relationship between the strength of the tobacco policy and exposure to secondhand smoke, seeing someone smoking, and intention to smoke on campus. We studied a range of policies on 8 public 4-year colleges and universities in California and found that the stronger the policy provisions, the lower the reported exposure to secondhand smoke, and seeing someone smoking. In addition, students on the tobacco-free campuses reported the lowest intention to smoke on campus in the next 6 months.     

Motivations for tobacco consumption among adolescents in an urban high school

Objective

To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents.

Methods

This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results.

Results

There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time.

Conclusions

This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence.     

Tobacco‐Control Policies in Tobacco‐Growing States: Where Tobacco Was King

Context

The 5 major tobacco-growing states (Kentucky, North Carolina, South Carolina, Tennessee, and Virginia) are disproportionately affected by the tobacco epidemic, with higher rates of smoking and smoking-induced disease. These states also have fewer smoke-free laws and lower tobacco taxes, 2 evidence-based policies that reduce tobacco use. Historically, the tobacco farmers and hospitality associations allied with the tobacco companies to oppose these policies.

Methods

This research is based on 5 detailed case studies of these states, which included key informant interviews, previously secret tobacco industry documents (available at http://legacy.library.ucsf.edu), and media articles. This was supplemented with additional tobacco document and media searches specifically for this article.

Findings

The tobacco companies were particularly concerned about blocking tobacco-control policies in the tobacco-growing states by promoting a pro-tobacco culture, beginning in the late 1960s. Nevertheless, since 2003, there has been rapid progress in the tobacco-growing states’ passage of smoke-free laws. This progress came after the alliance between the tobacco companies and the tobacco farmers fractured and hospitality organizations stopped opposing smoke-free laws. In addition, infrastructure built by National Cancer Institute research projects (COMMIT and ASSIST) led to long-standing tobacco-control coalitions that capitalized on these changes. Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states.

Conclusions

The environment has changed in the tobacco-growing states, following a fracture of the alliance between the tobacco companies and their former allies (tobacco growers and hospitality organizations). To continue this progress, health advocates should educate the public and policymakers on the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced.     

Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study

Objective

To describe the custodial hepatitis B vaccination programme performance and examine these data by geographical region and prison category.

Design

Retrospective ecological study.

Data source

Health Protection Agency (HPA) published data.

Setting

Custodial primary healthcare providers located in prisons across England and Wales.

Participants

147 prisons which reported vaccination data between July 2003 and April 2010 to the HPA Prison Infection Prevention team.

Main outcome measures

Hepatitis B vaccination coverage (July 2003 to April 2010) and uptake (December 2007 to April 2010).

Results

Median hepatitis B vaccination coverage was 22% (interquartile range [IQR] 5–49%) and uptake was 36% (IQR 16–59%). Vaccination coverage varied significantly between July 2003 and November 2007 compared to December 2007 and April 2010 (median 12% [IQR 2–31%] versus median 48% [IQR 26–67%], Mann–Whitney W = 14,689,158.0, p < 0.001). There was significant variation between vaccination coverage (Kruskal–Wallis H = 613.44, DF = 9, p < 0.001) and uptake (Kruskal–Wallis H = 247.99, DF = 9, p < 0.001) across the HPA regions. Compared to England and Wales, estimated population median vaccination coverage was significantly (p ≤ 0.05) lower in three regions and one prison category and higher in four regions and seven prison categories; estimated population median vaccination uptake was significantly lower in three regions and three prison categories and higher in two regions and four prison categories.

Conclusion

Prisoners are a vulnerable group with a high prevalence of hepatitis B infection and the custodial setting plays an important role in the delivery of hepatitis B vaccination to this hard to reach group. This study suggests that variation in hepatitis B vaccination coverage and uptake may exist by geographical region and prison category. Further research is required to confirm and identify possible explanations for our findings.     

Factores predictores de éxito según género en el tratamiento del tabaquismo

Objective

To identify factors predictive of the outcome of a smoking cessation program by gender.

Methods

A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002 to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits, the social context of smoking and psychiatric comorbidity prior to or during the smoking cessation process. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry (CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success.

Results

A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years, were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerström test score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positive predictors were lower nicotine dependence and having a non-smoking partner in men and older age, smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression or anxiety during the treatment in women.

Conclusions

Men and women have similar tobacco abstinence outcomes although gender factors play a role in determining abstinence. The gender perspective should be incorporated in smoking prevention and cessation programs.     

Cigarette characteristic and emission variations across high-, middle- and low-income countries

Objectives

The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries.

Study design

Multicountry observational study.

Methods

Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank’s per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences.

Results

Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ²(4) = 25.92, P < 0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features.

Conclusions

This study showed that as a country’s income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries.     

Children’s right to smoke-free air: Public support in Norway for banning smoking in vehicles with children present

Background

Children have a statutory right to a smoke-free environment, and tobacco control advocates are now considering regulation of smoking behavior in the private sphere. The Norwegian Institute of Public Health has investigated the support for a ban on smoking in cars with children compared to other possible extensions of the tobacco act among the Norwegian public.

Peer Reviewed: Using Indoor Air Quality Monitoring in 6 Counties to Change Policy in North Carolina

Introduction

Indoor air quality monitoring has become a valuable tool for states wanting to assess levels of particulate matter before and after smoke-free policies are implemented. However, many states face barriers in passing comprehensive smoke-free legislation, making such study comparisons unlikely. We used indoor air monitoring data to educate decision makers about the value of comprehensive smoke-free laws in a state with strong historical ties to tobacco.

Methods

We trained teams in 6 counties in North Carolina to monitor air quality in hospitality venues with 1 of 3 possible smoking policy designations: 1) smoke-free, 2) separate smoking and nonsmoking sections (mixed), or 3) smoking allowed in all areas. Teams monitored 152 venues for respirable suspended particles that were less than 2.5 μm in diameter and collected information on venue characteristics. The data were combined and analyzed by venue policy and by county. Our findings were presented to key decision makers, and we then collected information on media publicity about these analyses.

Results

Overall, smoke-free venues had the lowest particulate matter levels (15 µg/m³), well below established Environmental Protection Agency standards. Venues with mixed policies and venues that permitted smoking in all areas had particulate matter levels that are considered unhealthy by Environmental Protection Agency standards. The media coverage of our findings included newspaper, radio, and television reports. Findings were also discussed with local health directors, state legislators, and public health advocates.

Conclusion

Study data have been used to quantify particulate matter levels, raise awareness about the dangers of secondhand smoke, build support for evidence-based policies, and promote smoke-free policies among policy makers. The next task is to turn this effort into meaningful policy change that will protect everyone from the harms of secondhand smoke.     

Effects of Household Socialization on Youth Susceptibility to Smoke: Differences Between Youth Age Groups and Trends Over Time

A Canadian biennial youth survey facilitated repeating investigation of susceptibility to smoke and household socialization. We operationalized susceptibility to smoke by 3 levels on the basis of intention and behavior. Variables consistently predicting greater susceptibility across time and age groups were sibling smoking, household restrictions, and vehicle smoke exposure. Gender was predictive among older youths. Household restrictions and emerging legislation to ban smoking in vehicles with youth passengers provide protection against secondhand smoke exposure and sustained resolve to remain smoke-free.Supporting youths to remain smoke-free is an ongoing global public health priority.1 Preventative strategies, clean air policies, higher tobacco taxes, community- or school-based programs, tobacco-marketing bans, and age restrictions on tobacco purchases1–3 are effective in diminishing tobacco use among those aged 18 years and younger. Still, because every youth begins life as a nonsmoker with no intention of using tobacco, it is imperative to research socialization mechanisms in diverse contexts.4Youth smoking rates in developed countries vary,5–8 but a common trend among youths older than 15 years is higher rates of both tobacco use and weakened certainty of never smoking in the future.5–8 Tobacco use among youths’ social networks appears to have a stronger influence on their smoking behaviors than do population health strategies.9–15 Alternately, household smoking bans prevent secondhand smoke exposure and function as a denormalization strategy to support sustained resolve to remain smoke-free and not start smoking,16–18 regardless of the smoking status of parents living in the home.19 Prohibiting smoking in cars with children is in early phases of legislation adoption globally; Canada and Australia have widely adopted this law, and 4 of the 50 states in the United States have taken this action.20 When youths reported riding in a vehicle with a person who was smoking in the past week, they were less likely to feel certain about never smoking in the future; thus, their resolve to remain smoke-free was weaker.19Household context has a role in shaping youths’ resolve to remain smoke-free; one’s perception of susceptibility (i.e., future intention) to smoke is strongly associated with future smoking behaviors.4 We performed a secondary analysis of the Canadian 2006–2007 Youth Smoking Survey (YSS) to examine household contextual variables’ influence on youths’ (grades 5–12) intentions and behaviors related to smoking. The study partially replicates a study of the 2004–2005 YSS that included youths in grades 5 to 9.19     

Peer Reviewed: Moving Multiunit Housing Providers Toward Adoption of Smoke-Free Policies

Background

Tenants in multiunit housing are at elevated risk for exposure to secondhand smoke at home because of smoke migration from other units.

Community Context

In 2004, tobacco control advocates in the Portland, Oregon, metropolitan area began to address this issue by launching a campaign to work with landlord and tenant advocates, private- and public-sector property managers, and other housing stakeholders to encourage smoke-free policies in multiunit housing.

Methods

We outline the 6-year campaign that moved local housing providers toward adopting no-smoking policies. We used the stages of change model, which matches potential messages or interventions to a smoker''s readiness to quit smoking.

Outcome

The campaign resulted in Oregon''s largest private property management company and its largest public housing authority adopting no-smoking policies for their properties and a 29% increase in the availability of smoke-free rental units in the Portland-Vancouver metro area from 2006 through 2009.

Interpretation

We learned the importance of building partnerships with public and private stakeholders, collecting local data to shape educational messages, and emphasizing to landlords the business case, not the public health rationale, for smoke-free housing.