Changes in Smoking Prevalence and Number of Cigarettes Smoked Per Day Following the Implementation of a Comprehensive Tobacco Control Plan in New York City

The New York City (NYC) Health Department has implemented a comprehensive tobacco control plan since 2002, and there was a 27% decline in adult smoking prevalence in NYC from 2002 to 2008. There are conflicting reports in the literature on whether residual smoker populations have a larger or smaller share of “hardcore” smokers. Changes in daily consumption and daily and nondaily smoking prevalence, common components used to define hardcore smokers, were evaluated in the context of the smoking prevalence decline. Using the NYC Community Health Survey, an annual random digit dial, cross-sectional survey that samples approximately 10,000 adults, the prevalence of current heavy daily, light daily, and nondaily smokers among NYC adults was compared between 2002 and 2008. A five-level categorical cigarettes per day (CPD) variable was also used to compare the population of smokers between the 2 years. From 2002 to 2008, significant declines were seen in the prevalence of daily smoking, heavy daily smoking, and nondaily smoking. Among daily smokers, there is also evidence of population declines in all but the lowest smoking category (one to five CPD). The mean CPD among daily smokers declined significantly, from 14.6 to 12.5. After an overall decline in smoking since 2002, the remaining smokers may be less nicotine dependent, based on changes in daily consumption and daily and nondaily smoking prevalence. These findings suggest the need to increase media and cessation efforts targeted towards lighter smokers.     

Exposure to Tobacco Retail Outlets and Smoking Initiation among New York City Adolescents

This study was designed to estimate the relationship between exposure to tobacco retail outlets and smoking initiation in a racially diverse urban setting. Using data from the 2011 NYC Youth Risk Behavior Survey, multivariable logistic regression analyses were conducted to estimate the exposure–initiation relationship and test for effect modification, while controlling for covariates. The predicted probability of smoking initiation from the multivariable model increased from 7.7 % for zero times a week exposed to tobacco retailers to 16.0 % for exposure seven times or more per week. The odds of initiation were significantly higher among adolescents exposed to tobacco retail outlets two times or more a week compared with those exposed less often (AOR = 1.41; 95 % CI: 1.08, 1.84). Risk-taking behavior modified the relationship between exposure and initiation, with the odds of initiation highest among those low in risk-taking (AOR = 1.78; 95 % CI: 1.14, 1.56). These results are consistent with past research, showing that frequent exposure to tobacco marketing in retail settings is associated with increased odds of initiation. Reducing exposure to tobacco retail marketing could play an important role in curtailing smoking among adolescents, especially those less prone to risk-taking.     

青岛市中小学教师吸烟状况及控烟教学活动调查

目的了解青岛市中小学校教师吸烟状况及控烟教学开展情况,为今后的干预工作提供参考依据。方法随机抽取青岛市12个区(市)的12所中学和12所小学的教学一线教师1134名进行问卷调查。结果青岛市中小学校教师现在吸烟率为12.4%,男性教师吸烟率为29.0%;县市(16.5%)明显高于市区(9.3%);61.9%和21.5%的教师所在的学校有完全或部分禁烟的规定,但仍有58.2%有时在上班时吸烟,50.4%有时在学生面前吸烟,60.2%在办公室里吸烟,11.7%在教室吸烟;学校控烟培训力度相对不足,教师仅19.7%接受过关于预防青少年吸烟的专业培训。多因素Logistic回归分析显示,是否接受过培训为最强的影响因子(OR=4.062)。结论应尽快完善学校禁烟立法,开展无烟学校创建,将控烟纳入到教学环节,加强学校尤其是农村地区学校教师的控烟培训。     

石家庄市卫生工作者吸烟状况及控烟干预效果

目的了解石家庄市卫生工作者吸烟状况和控烟知识态度行为并进行干预,以提高其控烟意识。方法采用分层随机抽样方法,抽取10家卫生机构的1 031名在职人员进行调查,并对全员进行为期6个月的综合干预。结果总吸烟率为21.4%,男性(45.3%)显著高于女性(0.5%),不同岗位男性吸烟率差异有统计学意义(P<0.05)。知识方面:对吸烟、被动吸烟与肺部疾病的关系认知较好,但吸烟易患骨质疏松、男性性功能障碍和牙龈坏死或溃疡的认知低于50%,被动吸烟与婴儿猝死综合征相关的认知仅25.2%。行为方面:听说且使用过戒烟药物的医生仅6人(1.5%)。通过综合干预,男性吸烟率、帮助吸烟者戒烟行为变化的差异有统计学意义(P<0.05),使用戒烟药物的医生没有差异(P>0.05)。结论该市卫生工作者中男性吸烟率较高,对烟草危害认识不全面,医生控烟意识淡薄。应继续深入开展创建无烟医疗机构活动,采取综合干预措施,改变吸烟行为、提高控烟责任意识。     

The Relative Effect of Household and Workplace Smoking Restriction on Health Status Among Chinese Americans Living in New York City

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18–74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Smokers who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure. Shelley and Hung are with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA; Yerneni and Fahs are with the Brookdale Center on Aging, Hunter College, City University of New York, New York, NY, USA. Fahs and Das are with the Economics Program Graduate Center, City University of New York, New York, USA. An erratum to this article can be found at     

Prevalence and determinants of smoking in Tirana city,Albania: a population-based survey

BACKGROUND: Smoking is the leading cause of premature death in Europe yet there are still many countries in which there is little information on its patterns and determinants. Albania is one such country. METHODS: A survey of health and lifestyle, including questions on smoking practice and attitudes, and its determinants was undertaken in Tirana, the capital of Albania in mid 2001. SUBJECTS: One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%). RESULTS: Forty-one percent of the study population (61% male and 24% female) were current or ex-smokers-28% were current smokers (37.6% of males and 19.3% of females) and 13% were ex-smokers (23.4% of males and 4.7% of females). Age-standardized (to the European standard population) prevalence of smoking for the adult population of Tirana was 31.2% (42.8% in males and 21.2% in females). Smoking was most common among those aged 25-34 years (59% of males and 30% of females in this age group). Of the current smokers, 16.5% smoked more than 20 cigarettes/day, and 67.3% smoked the first cigarette within 30 min of waking. Only 11% of current smokers had tried to quit smoking once during their life. Concern about health was the most common reason for quitting cited by ex-smokers (44%). In men, smoking was inversely associated with educational achievement. While the probability of smoking decreases with age, there was no consistent association with employment or income. CONCLUSION: The prevalence of smoking in Albania is comparable with other Western societies. The high rates of smoking among young men and women suggest that tobacco will make an increasingly large contribution to premature morbidity and mortality in the future. The high rate of smoking among young women in Albania, while a common phenomenon in post-communist countries, is especially worrying. This study emphasizes the need for a robust, evidence-based strategy for tobacco control in Albania.     

Assessing the Health and Economic Impact of a Potential Menthol Cigarette Ban in New York City: a Modeling Study

Menthol in cigarettes increases nicotine dependence and decreases the chances of successful smoking cessation. In New York City (NYC), nearly half of current smokers usually smoke menthol cigarettes. Female and non-Latino Black individuals were more likely to smoke menthol-flavored cigarettes compared to males and other races and ethnicities. Although the US Food and Drug Administration recently announced that it will ban menthol cigarettes, it is unclear how the policy would affect population health and health disparities in NYC. To inform potential policymaking, we used a microsimulation model of cardiovascular disease (CVD) to project the long-term health and economic impact of a potential menthol ban in NYC. Our model projected that there could be 57,232 (95% CI: 51,967–62,497) myocardial infarction (MI) cases and 52,195 (95% CI: 47,446–56,945) stroke cases per 1 million adult smokers in NYC over a 20-year period without the menthol ban policy. With the menthol ban policy, 2,862 MI cases and 1,983 stroke cases per 1 million adults could be averted over a 20-year period. The model also projected that an average of $1,836 in healthcare costs per person, or $1.62 billion among all adult smokers, could be saved over a 20-year period due to the implementation of a menthol ban policy. Results from subgroup analyses showed that women, particularly Black women, would have more reductions in adverse CVD outcomes from the potential implementation of the menthol ban policy compared to males and other racial and ethnic subgroups, which implies that the policy could reduce sex and racial and ethnic CVD disparities. Findings from our study provide policymakers with evidence to support policies that limit access to menthol cigarettes and potentially address racial and ethnic disparities in smoking-related disease burden.     

Smoking,stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma,Prejudice, Discrimination and Health Special Issue (67: 3)

In recent years, addictions policy has stressed the need to counteract stigmatization in order to promote public health. However, as recent observers have noted, through the widespread implementation of tobacco ‘denormalization’ strategies, tobacco control advocates appear to have embraced the use of stigma as an explicit policy tool. In a recent article, Ronald Bayer (2008) argues that the mobilization of stigma may effectively reduce the prevalence of smoking behaviors linked to tobacco-related morbidity and mortality and is therefore not necessarily antithetical to public health goals. This commentary takes up this question of whether stigmatizing smoking may ultimately serve the interests of public health. Through an examination of the unique contours of tobacco control policy, we suggest that stigmatizing smoking will not ultimately help to reduce smoking prevalence amongst disadvantaged smokers – who now represent the majority of tobacco users. Rather, it is likely to exacerbate health-related inequalities by limiting smokers’ access to healthcare and inhibiting smoking cessation efforts in primary care settings.     

控烟条例实施1年对北京市15岁及以上人群烟草使用的影响

目的 监测北京市≥15岁人群吸烟及戒烟状况,评价《北京市控制吸烟条例》实施效果。方法 2014年和2016年参照全球成年人烟草调查的原则和方法,采用多阶段整群概率抽样法从北京市324个街道/乡镇中抽取50个,再从每个街道/乡镇抽取2个居/村委会,共计100个监测点;以简单随机抽样法在每个监测点抽取100个家庭户;用掌上电脑从所有满足条件的家庭成员中以简单随机抽样法自动抽取1名≥15岁的家庭成员作为调查对象。以入户调查形式获得数据。用SPSS 20.0软件的复杂抽样数据分析模块,以基本权重、未应答权重和后分层校正调整权重的乘积进行加权,计算现在吸烟率、每日吸烟率、戒烟率等指标,并估算可信区间。结果 2014年和2016年分别获得有效个人问卷8 484份和9 372份,总体应答率分别为86.5%和96.5%。2014年北京市≥15岁人群现在吸烟率为23.4%,2016年为22.3%,按照北京市第六次人口普查数据,现在吸烟者的数量减少了19.9万人。每日吸烟者比例由2014年的20.7%下降到2016年的19.2%。现在吸烟者的日平均吸烟量由2014年的14.6支上升为2016年的15.4支。戒烟率由14.9%上升为16.8%。现在吸烟者在过去12个月中至少尝试一次戒烟的比例由2014年的22.3%上升为2016年的23.2%。现在吸烟者有戒烟意愿的比例由2014年的11.6%上升为2016年的15.5%。过去12个月看过医生的吸烟者中,收到医生戒烟建议的比例2014年和2016年分别为58.9%和59.2%。2016年人群中过去12个月内尝试过戒烟的现在吸烟者中戒烟门诊和戒烟热线的知晓率分别为36.8%和29.5%,7.7%的知晓者去过戒烟门诊,5.5%的知晓者使用过戒烟热线。结论 《北京市控制吸烟条例》实施1年≥15岁人群现在吸烟率下降。下一步应加大戒烟服务宣传,提高现在吸烟者对戒烟服务的知晓,促进其寻求戒烟服务。     

江苏省无锡市卫生系统单位控烟现状调查

目的了解江苏省无锡城区卫生系统单位的烟草流行和控烟状况,为实施盖茨中国控烟项目提供数据支持和科学依据。方法以问卷方式对24家机关类单位和23家社区卫生服务机构的在岗员工分别进行全员调查。结果总的吸烟率为16.25%,男、女吸烟率分别为45.08%和0.07%,二手烟暴露率为44.76%;吸烟员工在工作单位、在禁烟区域吸烟的分别占72.35%和58.94%,准备12个月以内(包括1个月内)戒烟的占36.31%;调查对象中认为医院、工作场所和本单位应室内禁烟的分别占98.14%、94.96%和94.14%,知晓本单位规定室内全面禁烟的占66.27%,希望本单位有更严格控烟规章的占87.15%。结论 47家目标单位员工的吸烟率,男、女性吸烟率和二手烟暴露率均低于全国总体水平,对烟草危害知识及单位室内禁烟规章的知晓率较低。     

景德镇市卫生系统员工吸烟状况和控烟态度调查

目的了解景德镇市卫生系统员工吸烟状况和对控烟工作的态度。方法采取自行设计的调查问卷,采用分层整群随机抽样的方法调查了6所医院的1693名员工。结果被调查对象的总吸烟率为18.2%,而男员工吸烟率则为47.3%,在303名男性吸烟员工中医务人员又占了64.4%;另外,大多数人知道吸烟有害健康,但缺乏对相关法律、法规知识的了解;对控烟工作绝大多数人持赞成态度。结论大力开展医院控烟健康教育,卫生系统员工要作控烟工作的表率。     

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.     

Demographic and psychological moderators of the relationship between neighborhood cigarette advertising and current smoking in New York City

BackgroundTobacco advertising in retailers influences smoking, but little research has examined how this relationship differs among population subgroups. This study merged data on neighborhood cigarette advertising with geocoded survey data to assess the association between advertising prevalence and current smoking among New York City (NYC) residents, and whether demographic and psychological characteristics moderate this relationship.MethodsAudit data from a stratified, random sample of 796 NYC tobacco retailers generated neighborhood prevalence estimates of cigarette advertising, which were linked with unweighted 2017 NYC Community Health Survey data (n = 7837 adult respondents with residential geocodes). Multilevel regression estimated adjusted odds ratios (aOR) of current smoking by level of neighborhood cigarette advertising (quartiles). Interactions assessed differences in this relationship by demographic characteristics and current depression (analyses conducted in 2019).ResultsThere was no main effect of advertising on smoking status or significant interactions with demographic variables, but current depression was an effect modifier (p = 0.045). Cigarette advertising was associated with current smoking among those with current depression (p = 0.023), not those without (p = 0.920). Specifically, respondents with depression who resided in neighborhoods in the highest quartile for cigarette advertising prevalence had higher odds of current smoking, compared to those living in the lowest advertising quartile [aOR: 1.72 (1.04, 2.86)].ConclusionRetail cigarette advertising may serve as an environmental cue to smoke among adults with depression. Efforts to restrict or counteract this practice, such as the development of community-level public health interventions and counter-marketing programs, may particularly benefit those with depression and, perhaps, other mental health disorders.     

Attitudes of detainees and prison staff towards tobacco control policy in Switzerland: A qualitative interview study

Purpose

To explore detainees and staff's attitudes towards tobacco use, in order to assist prison administrators to develop an ethically acceptable tobacco control policy based on stakeholders’ opinion.

Design

Qualitative study based on in-depth semi-structured interviews with 31 prisoners and 27 staff prior (T1) and after the implementation (T2) of a new smoke-free regulation (2009) in a Swiss male post-trial prison consisting of 120 detainees and 120 employees.

Results

At T1, smoking was allowed in common indoor rooms and most working places. Both groups of participants expressed the need for a more uniform and stricter regulation, with general opposition towards a total smoking ban. Expressed fears and difficulties regarding a stricter regulation were increased stress on detainees and strain on staff, violence, riots, loss of control on detainees, and changes in social life. At T2, participants expressed predominantly satisfaction. They reported reduction in their own tobacco use and a better protection against second-hand smoke. However, enforcement was incomplete. The debate was felt as being concentrated on regulation only, leaving aside the subject of tobacco reduction or cessation support.

Conclusion

Besides an appropriate smoke-free regulation, further developments are necessary in order to have a comprehensive tobacco control policy in prisons.     

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration,Dual Use,and Relationship to Quit Attempts and Former Smoking

PurposeAs elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.MethodsData from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13–18 years were analyzed with logistic regression.ResultsA total of 9.4% (8.0% ever–dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever–e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39–1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09–.12).ConclusionsSome Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.     

Smoking habits in relation to reproductive events among Japanese women: Findings of the Japanese Nurses' Health Study

Objective

The purposes of this study were to examine smoking habits in relation to the reproductive events of pregnancy and menopause and clarify the reasons for smoking cessation among ex-smokers.

Method

This is a cross-sectional study based on a baseline survey of a prospective cohort study. From 2001 to 2007, a self-administered questionnaire survey was conducted on 49,927 female nurses from all 47 prefectures in Japan. Logistic regression models were used to estimate age-adjusted odds ratios.

Results

Of the respondents, 17.2% were current smokers, 11.6% were ex-smokers and 69.8% had never smoked. The prevalence of smoking during pregnancy was 7.8%. Among ex-smokers, 30.3% gave “reproductive events” as their reason for smoking cessation. Current smoking and the number of cigarettes smoked per day before menopause were significantly related to onset of menopause.

Conclusion

Women's smoking habits have mutual relationships with reproductive events such as pregnancy and menopause. Although “reproductive events” were an important reason for smoking cessation among women, 7.8% of women still smoked during pregnancy. Smoking was correlated with onset of menopause. Support for smoking cessation is an important healthcare issue throughout women's lifetimes.     

2010年青岛市部分医院员工吸烟状况及控烟相关认知态度调查

[目的]了解青岛市医院工作人员吸烟状况与控烟相关知识知晓情况,为进一步开展无烟医院的创建提供科学依据。[方法]2010年6～8月,对青岛市5所市级医院的员工进行问卷调查。[结果]调查1 970人中,现在吸烟的占9.34%,原来吸烟已戒烟的占2.84%,从不吸烟的占87.82%。现在吸烟率,男性为27.31%,女性为0.31%(P<0.01);临床人员为8.99%,非临床人员为10.57%(P<0.01);<30岁的为1.60%,30～45岁为8.73%,>45岁为19.25%(P<0.01);高中及以下学历者为9.55%,大学、专科学历者为8.30%,研究生及以上学历者为11.65%(P<0.01)。调查者中,96.35%、79.54%、81.93%、96.19%的人认为吸烟会导致严重疾病、会导致中风、会导致心脏病、会导致肺癌;认为本单位不应允许室内吸烟的占95.93%,95%以上认为医院、公共交通工具、学校、工作场所、大学室内不应该吸烟,84.87%和79.34%认为饭店和咖啡吧、酒吧室内不应该吸烟。[结论]青岛市市属医院工作人员现在吸烟率不高,控烟相关知识知晓率较高。无烟医院今后的工作重点,除了做好医务人员的教育外,行政和后勤人员的教育同样重要。     

长沙与国内五城市吸烟者吸烟特征的比较

目的探讨长沙成年吸烟者不同吸烟行为、戒烟行为、控烟政策支持的特征。为长沙市进一步开展控烟工作提供科学依据。方法根据国际烟草政策研究评估调查（ITC项目）要求，分别在长沙、北京、上海、沈阳、广州和银川6个城市使用多阶段抽样法，各抽取800名成年吸烟者，采用人户录音的方式进行面对面问卷调查。结果与结论与其他5个项目城市相比，长沙市吸烟者吸烟行为特征主要为：1．长沙市吸烟者每日吸烟量为21．47支／d、成瘾性HIS为2．80、吸本地烟的比例为95．07％；2．吸烟者戒烟5次以上的比例占10．5％、戒烟意愿不强、戒烟信心不足；3．控烟政策支持力度不够。