The effects of tobacco control policies on smoking rates: a tobacco control scorecard.

This article reviews studies of the effect of tobacco control policies on smoking rates with the aim of providing guidance on the importance of different policies. Based on past studies, we estimate the magnitude of effects of major tobacco control policies, how their effects depend on the manner in which the policies are implemented, the relationship between the different policies, and the barriers to implementation. The most successful campaigns have implemented a combination of tobacco control policies. Of those policies, substantial evidence indicates that higher taxes and clean air laws can have a large impact on smoking rates. Evidence also indicates that media campaigns when implemented with other policies are important. Research on greater access to treatment and telephone support hotlines indicates a strong potential to increase quit rates and may be important in affecting heavier smokers. Direct evidence on the effects of advertising bans and health warnings is mixed, but these policies appear to be important in some of the countries that have had success in reducing smoking rates. School education programs and limits on retail sales are not likely to have much impact if implemented alone, but may be more important when combined with other policies.     

School tobacco control policies related to students' smoking and attitudes toward smoking: national survey results, 1999-2000.

The belief that schools can play a powerful role in preventing tobacco use among adolescents has led to the implementation of various tobacco-related policies and practices. This study examines the association between school policies regarding monitoring student behavior, severity of action taken for infraction of policies, and tobacco use by staff, and student smoking behavior and attitudes. Data on students' smoking behavior and attitudes were obtained from the 1999 and 2000 Monitoring the Future surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students. Data on school policies and practices were obtained from administrators in those same schools. Hierarchical analyses using HLM5 were conducted. Strictness of monitoring was significantly negatively associated with daily cigarette use by middle school students. Permitting staff to smoke was significantly positively associated with students' daily cigarette use and negatively with their disapproval of cigarette use. Policy implications are discussed.     

Smoking policies and smoking cessation programs of large employers in Massachusetts.

To assess the current extent of programs and policies to facilitate smoking cessation among employees, we queried 128 large employers in Massachusetts in mid-1978. Eighty-four (66 per cent) responded. Fifty-four (64 per cent) of the respondents had designated jobs or work areas in which smoking was prohibited usually because of potential danger to products or equipment. Seven (8 per cent) of the employers provided counseling, and 10 (12 percent) provided smoking cessation programs for those employees who desired to quit smoking. There is a clear need for the development and evaluation of workplace policies and programs aimed at reducing smoking.     

Integrating a multimode design into a national random-digit-dialed telephone survey

The Behavioral Risk Factor Surveillance System (BRFSS) was originally conducted by using a landline telephone survey mode of data collection. To meet challenges of random-digit-dial (RDD) surveys and to ensure data quality and validity, BRFSS is integrating multiple modes of data collection to enhance validity. The survey of adults who use only cellular telephones is now conducted in parallel with ongoing, monthly landline telephone BRFSS data collection, and a mail follow-up survey is being implemented to increase response rates and to assess nonresponse bias. A pilot study in which respondents' physical measurements are taken is being conducted to assess the feasibility of collecting these data for a subsample of adults in 2 states. Physical measures would allow for the adjustment of key self-reported risk factor and health condition estimates and improve the accuracy and usefulness of BRFSS data. This article provides an overview of these new modes of data collection.     

The status of restrictive smoking policies: a survey of medical schools in the United States and Canada.

All schools of medicine in the United States (N = 128) and Canada (N = 16) were surveyed by telephone to determine if they had instituted policies to restrict smoking. Some policy restricting smoking was reported by 80.56 percent of US schools (N = 103) and by 93.8 percent of Canadian schools (N = 15). However, only 52.3 percent of US (N = 67) and 56.3 percent of Canadian medical schools (N = 9) indicated they had formal written policy statements. Only 13 percent of US schools and 19 percent of Canadian schools had banned smoking totally.     

Worksite health promotion survey: smoking control activities

As part of the National Worksite Health Promotion Survey, a representative sample of worksites across the United States with 50 or more employees was asked about the presence and types of activities they sponsor to promote smoking control. Smoking control activities were reported at 35.6% (CI 32.6-38.6) of all worksites. Among worksites with any smoking control activity 76.5% (CI 71.7-81.3) had a formal policy restricting smoking, 54.3% (CI 48.7-59.9) provided information about the harmful effects of smoking, and 49.6% (CI 44.4-54.8) made self-help materials available. Individual counseling, group classes, workshops, follow-up support and reinforcement, or special events were available at 38.3% (CI 32.9-43.7) of worksites with any smoking control activities. Frequency increased as worksite size increased, with large frequency differences between the smallest and largest worksites. Smoking policies were most often put into effect to protect the health of nonsmokers (39.1%, CI 32.1-46.1) or to comply with regulations or laws (38.2%, CI 32.2-44.2). The most frequently reported benefit to the worksite of smoking control activities was improved employee health (35%, CI 26.2-43.8). Benefits were considered to outweigh the cost of activities at 36% (CI 29.6-42.4) of worksites, although 41.7% (CI 34.7-48.7) said it was too soon to gauge the relative size of costs and benefits.     

高血压发病危险因素的性别差异研究

  目的   对比分析云南省景颇族与汉族居民的吸烟和尼古丁依赖流行现状。  方法   于2015 — 2017年采用按比例概率抽样方法从云南省德宏州芒市1个景颇族聚集乡和宜良县1个汉族乡中随机抽取2 816名≥35岁常住居民进行面对面问卷调查。  结果   景颇族和汉族现在吸烟率和尼古丁依赖率分别为47.7 %（652/1 367）和30.6 %（433/1 449）、18.1 %（248/1 367）和14.6 %（211/1 449）,且均是景颇族高于汉族（P < 0.01）。景颇族和汉族均是男性的吸烟率和尼古丁依赖率高于女性（P < 0.01）,且景颇族女性的现在吸烟率明显高于汉族女性（23.2 %,160/695和1.1 %,10/728,P < 0.01）。吸烟类型中景颇族和汉族均以吸食过滤嘴香烟为主（60.8 %,392/645和70.5 %,311/441）,景颇族其次为嚼烟（27.9 %,180/645）和手卷烟（13.3 %,86/645）,而汉族为无过滤嘴香烟（17.5 %,77/441）和水烟袋（17.5 %,77/441）。景颇族与汉族的开始吸烟年龄和规律吸烟年龄均集中在12~20岁,且景颇族早于汉族（P < 0.05）。  结论   云南省景颇族和汉族的吸烟率、尼古丁依赖率和吸烟习惯存在民族差异。应根据不同民族的特点开展健康教育工作和制定相应的烟草干预措施。     

Integrating smoking cessation treatment into primary care: an effectiveness study

BACKGROUND: Lack of interest has been cited as a reason not to offer cessation assistance to smokers, but research suggests that smokers accept treatments offered proactively. This study assessed acceptability, utilization, and effectiveness of free smoking cessation treatment among diverse primary care patients. METHOD: Medical assistants invited 4174 adult smokers to participate. Enrollees (1869) self-selected or were assigned to receive free nicotine patch therapy alone or in combination with the Committed Quitters(R) program, and for some, individual counseling. RESULTS: In nearly 68% of cases, patients accepted a treatment invitation; 77% of eligible smokers enrolled; 85% of these picked up free patches. Given a choice of treatments, 75% of participants elected a psychosocial treatment in addition to patch therapy. Thirteen percent of treatment initiators achieved biochemically confirmed 7-day point-prevalence abstinence at 1 year, with no significant treatment effects. Minority patients showed greater initial interest but less utilization did than White patients. CONCLUSIONS: Free, readily accessible smoking cessation treatment offered in primary care settings was accepted and used by the majority of unselected smokers of diverse racial/ethnic origins. Psychosocial treatment components did not significantly increase abstinence rates. Barriers, rather than lack of interest, may keep minority smokers from using cessation treatments.     

The role of public policies in reducing smoking prevalence in California: results from the California tobacco policy simulation model

Tobacco control policies are examined utilizing a simulation model for California, the state with the longest running comprehensive program. We assess the impact of the California Tobacco Control Program (CTCP) and surrounding price changes on smoking prevalence and smoking-attributable deaths. Modeling begins in 1988 and progresses chronologically to 2004, and considers four types of policies (taxes, mass media, clean air laws, and youth access policies) independently and as a package. The model is validated against existing smoking prevalence estimates. The difference in trends between predicted smoking rates from the model and other commonly used estimates of smoking prevalence for the overall period were generally small. The model also predicted some important changes in trend, which occurred with changes in policy. The California SimSmoke model estimates that tobacco control policies reduced smoking rates in California by an additional 25% relative to the level that they would have been if policies were kept at their 1988 level. By 2004, the model attributes 59% of the reduction to price increases, 28% of the overall effect to media policies, 11% to clean air laws, and only a small percent to youth access policies. The model estimates that over 5000 lives will be saved in the year 2010 alone as a result of the CTCP and industry-initiated price increases, and that over 50,000 lives were saved over the period 1988-2010. Tobacco control policies implemented as comprehensive tobacco control strategies have significantly impacted smoking rates. Further tax increases should lead to additional lives saved, and additional policies may result in further impacts on smoking rates, and consequently on smoking-attributable health outcomes in the population.     

Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization

Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization. By monitoring the intervention implementation process, such problems were identified early. This allowed for implementing strategies to overcome many of these barriers and to assess their effectiveness. Keys to implementation success included simplifying the intervention activities, considering stakeholder needs, and providing tangible organizational resources and goals.     

Parent-inclusive pediatric units: a survey of policies and practices.

A nation-wide survey of Parent-Inclusive Pediatric Units identified innovations and restrictions in policies and practices. Questionnaires mailed to Directors of Nursing Service at 84 general hospitals which encourage parental "living-in" indicated that parents are provided with a place to sleep but infrequently are offered additional facilities, services, and guidance necessary to optimize their presence on the Parent-Inclusive Pediatric Unit. Restrictions on parents remaining with their children are common during highly stressful procedures. Results indicate a gap between research on the importance of parental presence and current hospital practice.     

Survey of restaurants regarding smoking policies.

The New Hampshire Indoor Smoking Act was implemented in 1994 to protect the public's health by regulating smoking in enclosed places. A survey was conducted of New Hampshire restaurants to determine smoking policies, to determine restaurant characteristics associated with smoking policies, and to evaluate compliance with the Indoor Smoking Act. A list of New Hampshire restaurants was obtained from a marketing firm. Establishments were selected randomly until 400 had completed a 22-question telephone survey. Forty-four percent of restaurants permitted smoking. Characteristics positively associated with permitting smoking were being a non-fast-food restaurant, selling alcohol, selling tobacco, and having greater than the median number of seats. Of restaurants permitting smoking, 96.1% had a designated smoking area, 87.0% had a ventilation system to minimize secondhand smoke, 83.6% had a physical barrier between smoking and nonsmoking areas, and 53.1% exhibited signs marking the smoking area. Forty percent of restaurants permitting smoking met all four requirements of the Indoor Smoking Act. Smoking policies differ, by type of restaurant. Compliance with the Indoor Smoking Act is low.     

Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project.

OBJECTIVES. In 1986, the state health departments of Colorado, Maryland, and Missouri conducted a federally-funded demonstration project to increase smoking cessation among pregnant women receiving prenatal care and services from the Women, Infants, and Children (WIC) program in public clinics. METHODS. Low-intensity interventions were designed to be integrated into routine prenatal care. Clinics were randomly assigned to intervention or control status; pregnant smokers filled out questionnaires and gave urine specimens at enrollment, in the eighth month of pregnancy, and postpartum. Urine cotinine concentrations were determined at CDC by enzyme-linked immunosorbent assay and were used to verify self-reported smoking status. RESULTS. At the eighth month of pregnancy, self-reported quitting was higher for intervention clinics than control clinics in all three states. However, the cotinine-verified quit rates were not significantly different. CONCLUSIONS. Biochemical verification of self-reported quitting is essential to the evaluation of smoking cessation interventions. Achieving changes in smoking behavior in pregnant women with low-intensity interventions is difficult.     

Effect of workplace smoking policies on smoking cessation: results of a longitudinal study

Studies of worksite smoking bans often find that they fail to increase the rate of smoking cessation. To see whether duration of exposure to restrictive policies was an important element, we surveyed workers by phone to examine the effect of being continuously employed at a smokefree worksite for 3 years. Results showed that worksite policy was unrelated to smoking cessation. However, 12% of respondents at smokefree worksites reported that smoking had taken place in their work area, and over 20% reported at least 2 hours of worksite environmental tobacco smoke (ETS) exposure during the prior week. When minimal ETS exposure is used as an indicator of an effectively enforced smoking ban, logistic regression demonstrates that continuous employment at such a worksite strongly predicts smoking cessation. Failure to demonstrate a significant impact of worksite smoking bans on cessation in this and other studies may be due to poor enforcement of smoking policies.     

Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy

ABSTRACT: BACKGROUND: While Italy has implemented some tobacco control policies over the last few decades, which resulted in a decreased smoking prevalence, there is still considerable scope to strengthen tobacco control policies consistent with the World Health Organization (WHO) policy guidelines. The present study aims to evaluate the effect of past and project the effect of future tobacco control policies on smoking prevalence and associated premature mortality in Italy. METHODS: To assess, individually and in combination, the effect of seven types of policies, we used the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for Italy. RESULTS: Significant inroads to reducing smoking prevalence and premature mortality can be achieved through tobacco price increases, high intensity media campaigns, comprehensive cessation treatment program, strong health warnings, stricter smoke-free air regulations and advertising bans, and youth access laws. With a comprehensive approach, the smoking prevalence can be decreased by as much as 12 % soon after the policies are in place, increasing to a 30 % reduction in the next twenty years and a 34 % reduction by 30 years in 2040. Without effective tobacco control policies, a total of almost 300 thousand lives will be prematurely lost due to smoking by the year 2040. CONCLUSION: Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps identify information gaps in surveillance and evaluation schemes that will promote the effectiveness of future tobacco control policy in Italy.     

Smoking ban policies and their influence on smoking behaviors among current California smokers: A population-based study

ObjectiveTo assess whether smoking ban policies are associated with smoking reduction and quit attempts among California smokers.MethodsData were examined for 1718 current smokers from follow-up telephone interviews conducted in 2011 of persons previously identified as smokers in a representative sample of the adult population of California. Population weighted logistic regressions controlling for demographic and other variables were used to evaluate the association between smoking ban policies (home, work, and town) and changes in tobacco use (past year quit attempt or reduction in smoking rate).ResultsLiving in a home with a total ban was significantly associated with smoking reduction (adjusted odds ratio, AOR: 2.4, 95% CI: 1.4–4.2) and making a quit attempt (AOR: 2.3, 95% CI: 1.3–3.9) compared to living in a home with no home ban. Self-reported perception of an outdoor ban in one's city/town was associated with smoking reduction (AOR: 1.7, 95% CI: 1.02–2.7) and making a quit attempt (AOR: 1.8, 95% CI: 1.05–2.9).ConclusionThese results indicate that smoking bans not only protect nonsmokers from the harms of secondhand smoke, but are also associated with smoking reduction and cessation.     

Total smoking bans in psychiatric inpatient services: a survey of perceived benefits,barriers and support among staff

Background  

The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit.