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.     

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.     

Workplace Secondhand Smoke Exposure in the U.S. Trucking Industry

Background

Although the smoking rate in the United States is declining because of an increase of smoke-free laws, among blue-collar workers it remains higher than that among many other occupational groups.

Objectives

We evaluated the factors influencing workplace secondhand smoke (SHS) exposures in the U.S. unionized trucking industry.

Methods

From 2003 through 2005, we measured workplace SHS exposure among 203 nonsmoking and 61 smoking workers in 25 trucking terminals. Workers in several job groups wore personal vapor-phase nicotine samplers on their lapels for two consecutive work shifts and completed a workplace SHS exposure questionnaire at the end of the personal sampling.

Results

Median nicotine level was 0.87 μg/m³ for nonsmokers and 5.96 μg/m³ for smokers. As expected, smokers experienced higher SHS exposure duration and intensity than did nonsmokers. For nonsmokers, multiple regression analyses indicated that self-reported exposure duration combined with intensity, lack of a smoking policy as reported by workers, having a nondriver job, and lower educational level were independently associated with elevated personal nicotine levels (model R² = 0.52). Nondriver job and amount of active smoking were associated with elevated personal nicotine level in smokers, but self-reported exposure, lack of a smoking policy, and lower educational level were not.

Conclusions

Despite movements toward smoke-free laws, this population of blue-collar workers was still exposed to workplace SHS as recently as 2005. The perceived (reported by the workers), rather than the official (reported by the terminal managers), smoking policy was associated with measured SHS exposure levels among the nonsmokers. Job duties and educational level might also be important predictors of workplace SHS exposure.     

Evaluating the efficacy of different smoking policies in restaurants and bars in Beijing,China: A four-year follow-up study

Introduction

In 2006, the World Health Organization Framework Convention on Tobacco Control became effective in mainland China. In 2007, advocacy on voluntary smoking bans in restaurants was initiated in Beijing, and in 2008 the Beijing government implemented a smoking regulation, requiring big restaurants to prohibit or restrict smoking.

Objectives

To evaluate the efficacy of different smoking policies adopted by Beijing restaurants and bars from 2006 to 2010.

Methods

The study conducted field observations of patron smoking behavior and monitored fine particulate matter from secondhand smoke (SHS PM) from 91, 85, 94 and 79 Beijing restaurants and bars in 2006, 2007, 2008 and 2010, respectively, during peak-patronage times, with overlaps of venues during each two years. Area nicotine sampling during peak patronage times and servers’ personal nicotine sampling during their working shifts were also conducted in 2010.

Results

Smoking was nominally prohibited or restricted in 18% of restaurants and bars monitored in 2006, in 11% of venues in 2007, in 83% of venues in 2008, and in 69% of venues in 2010. However, smoking was observed in more than 40% of the nominal nonsmoking venues/sections in 2008 and 2010. The median of observed patron active smoker density (ASD) was 0.24, 0.27, 0.00 and 0.10 active smokers per 100 m³ in 2006, 2007, 2008 and 2010, respectively. The median of SHS PM concentrations was 53, 83, 18 and 27 μg/m³, respectively. In 2010, both the median SHS PM and air nicotine concentrations in designated nonsmoking sections were about 40% of those in designated smoking sections, according to simultaneous sampling in both sections. Servers’ personal exposure to air nicotine was quite similar in venues with different nominal smoking policies. In the 15 venues followed from 2006 to 2010, SHS PM concentrations changed randomly from 2006 to 2007, decreased in most venues in 2008, and then increased to some extent in 2010.

Conclusion

Voluntary smoking policy is rarely adopted and cannot protect people from SHS exposure in restaurants and bars. The 2008 Beijing governmental smoking regulation failed to significantly reduce SHS exposure shortly or two years after its implementation. Restricting smoking to designated sections cannot eliminate SHS exposure.     

Secondhand Smoke Exposure Among Young Adult Sexual Minority Bar and Nightclub Patrons

Objectives. We compared exposure to secondhand smoke (SHS) and attitudes toward smoke-free bar and nightclub policies among patrons of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT bars and nightclubs.Methods. We conducted randomized time–location sampling surveys of young adults (aged 21–30 years) in 7 LGBT (n = 1113 patrons) and 12 non-LGBT (n = 1068 patrons) venues in Las Vegas, Nevada, in 2011, as part of a cross-sectional study of a social branding intervention to promote a tobacco-free lifestyle and environment in bars and nightclubs.Results. Compared with non-LGBT bars and nightclubs, patrons of LGBT venues had 38% higher adjusted odds of having been exposed to SHS in a bar or nightclub in the past 7 days but were no less likely to support smoke-free policies and intended to go out at least as frequently if a smoke-free bar and nightclub law was passed.Conclusions. The policy environment in LGBT bars and nightclubs appears favorable for the enactment of smoke-free policies, which would protect patrons from SHS and promote a smoke-free social norm.Secondhand smoke (SHS) exposure increases the risk of cardiovascular disease, respiratory conditions, and cancer.1 Bars and nightclubs are tobacco-friendly environments that the tobacco industry uses as marketing and promotional venues.2–4 In the absence of a smoke-free law that covers bars and nightclubs, these venues can also have particularly high levels of SHS.5,6Bars and nightclubs have played an important role historically in the lesbian, gay, bisexual, and transgender (LGBT) rights movement, and they serve as a welcoming social venue.7,8 However, compared with non-LGBT venues, LGBT bars and nightclubs may be particularly tobacco friendly, because smoking rates are higher among LGBT than heterosexual individuals.9,10 According to the 2009 to 2010 National Adult Tobacco Use Survey, prevalence of tobacco use was significantly higher among LGBT than heterosexual participants (38.5% vs 25.3%).10 Also, the tobacco industry has targeted LGBT individuals and young adults with bar and nightclub advertisements and promotions.2,11,12 Previous studies with men who have sex with men conducted in Tucson, Arizona; Portland, Oregon; and Los Angeles, California, indicated an association between frequency of LGBT bar attendance and smoking.13,14 Although it is well established that LGBT individuals have high smoking rates,9,15 less is known about exposure to SHS in LGBT bars and nightclubs.Smoke-free laws, which restrict smoking in certain areas, are an important intervention to reduce or eliminate SHS exposure.5,6,16 Smoke-free policies have been shown to reduce asthma exacerbations and heart attacks17,18 and to contribute to smoking reduction or cessation.19 Smoke-free bar and nightclub environments might contribute to lowering rates of smoking among the LGBT population.Pizacani et al. examined attitudes about SHS in Oregon and Washington among heterosexual and LGB individuals and found no significant differences by sexual orientation among individuals living in Washington.20 However, among Oregon residents, gay smokers were more likely than heterosexual male smokers to support banning smoking in bars. In addition, lesbian nonsmokers living in Oregon were more likely than heterosexual female nonsmokers to support such a ban. McElroy et al. found that a lower percentage of LGBT than non-LGBT individuals in Missouri supported smoke-free bar policies; however, this difference was not significant after adjustment for other demographic factors.21 Kelly et al. found no difference in support for the New York state smoke-free law between LGBT and heterosexual individuals in New York City nightclubs.22 However, in a nationwide study, King et al. found significantly higher prevalence of support for smoke-free bars, casinos, and clubs among heterosexual than LGBT participants. (49.5% vs 43.0%)23Nevada has historically lagged behind the nation in enacting smoke-free policies.24 In 2001, Nevada ranked last in percentage of employees covered by a smoke-free policy. Between 1993 and 1999, the percentage of employees covered ranged from 33.3% to 48.7%. By 1999, Nevada was the only state with fewer than half of employees covered by a smoke-free policy.24 In 2006, Nevada passed a state smoke-free law that exempted bars, nightclubs, and gaming areas. This law also removed preemption, allowing local communities to pass stronger smoke-free policies.25 As of January 2013, bars and nightclubs in Nevada were still exempt from the smoke-free law.26We compared SHS exposure and attitudes toward smoke-free bars and nightclubs among patrons of LGBT and non-LGBT bars and nightclubs in Las Vegas, Nevada, in 2011. We assessed (1) whether being present in an LGBT venue (vs a non-LGBT venue) was an independent predictor of past-7-day exposure to SHS in a bar or nightclub, (2) whether frequently going out to LGBT venues was an independent predictor of 7-day exposure to SHS in a bar or nightclub, (3) whether being present in an LGBT venue (vs a non-LGBT venue) was an independent predictor of intention to continue to go out as frequently as before if a smoke-free law was enacted, and (4) whether being present in an LGBT venue (vs a non-LGBT venue) was an independent predictor of opposition to smoke-free bar and nightclub policies.     

Peer Reviewed: Smoke-Free Law Associated With Higher-Than-Expected Taxable Retail Sales for Bars and Taverns in Washington State

Introduction

Continued progress in implementing smoke-free laws throughout the United States would benefit from documenting positive economic effects, particularly for the hospitality industry. This study describes changes in sales revenue in bars and taverns since December 2005, when a statewide smoke-free law in Washington State went into effect.

Methods

Using 24 quarters of inflation-adjusted taxable retail sales data from 2002 through 2007, we fitted a regression model to estimate the effect of the smoke-free law on sales revenue, controlling for seasonality and other economic factors.

Results

We found no immediate change in bar revenues in the first quarter of 2006, but taxable retail sales grew significantly through the fourth quarter of 2007. In the 2 years after the smoke-free law was implemented, sales revenues were $105.5 million higher than expected for bars and taverns in Washington State.

Conclusion

The higher-than-expected revenue from taxable sales in bars and taverns after the implementation of smoke-free laws in Washington State provided extra funds to the state general fund. Potential increases in revenue in other jurisdictions that implement smoke-free indoor air policies could provide funds to benefit residents of those jurisdictions.     

Peer Reviewed: The Influence of School Policies on Smoking Prevalence Among Students in Grades 5-9, Canada, 2004-2005

Introduction

School characteristics may account for some of the variation in smoking prevalence among schools. The purpose of this study was to investigate the relationships between characteristics of school tobacco policies and school smoking prevalence. We also examined the relationship between these characteristics and individual smoking status.

Methods

Tobacco policy data were collected from schools in 10 Canadian provinces during the 2004-2005 school year. Written tobacco policies were collected from each school to examine policy intent, and school administrators were surveyed to assess policy enforcement. Students in grades 5 through 9 completed the Youth Smoking Survey to assess smoking behaviors and attitudes. We used negative binomial regression and multilevel logistic regression to predict the influence of school policies on smoking behavior at the school and student levels.

Results

School policies that explicitly stated purpose and goals predicted lower prevalence of smoking at the school and individual levels. Policies that prohibited smoking on school grounds at all times predicted lower smoking prevalence at the school level but not at the individual level.

Conclusions

For maximum effectiveness, school smoking policies should clearly state a purpose and goals and should emphasize smoking prohibition. These policies can help reduce smoking prevalence among youths and are part of a comprehensive school approach to tobacco control.     

Peer Reviewed: Changes in Exposure to Secondhand Smoke Among Youth in Nebraska, 2002–2006

Introduction

Secondhand smoke is a major cause of morbidity and mortality. It has been associated with serious health problems in both children and adults. Efforts to reduce exposure to secondhand smoke in Nebraska have included programs to prevent tobacco use among young people and campaigns for smoke-free workplaces and homes. Despite these interventions, young people continue to be exposed to secondhand smoke at an unacceptably high rate. The objective of this study was to examine the extent to which Nebraska public middle and high school students were exposed to secondhand smoke in 2002 and 2006, to evaluate factors associated with this exposure, and to propose interventions.

Methods

The Nebraska Youth Tobacco Survey was administered in 2002 and 2006 to a representative sample of students from public middle and high schools. All students who chose to participate completed an anonymous, self-administered survey that included questions on demographics, tobacco use, tobacco-related knowledge and attitudes, and exposure to secondhand smoke. Data were weighted to account for nonresponses at both student and school levels and to ensure generalizability of the estimates for public school students in Nebraska according to their grade, sex, and race/ethnicity. This study analyzed a subset of responses on secondhand smoke exposure, which was defined as being in a room or vehicle during the previous 7 days with someone who was smoking cigarettes.

Results

Secondhand smoke exposure in a room, a vehicle, or both declined significantly among all students from 2002 (69.0%) to 2006 (61.3%). In both 2002 and 2006, students were significantly more likely to be exposed to secondhand smoke in a room than in a vehicle (64.4% vs 48.2% in 2002 and 56.9% vs 40.2% in 2006). Among racial and ethnic groups, only white students experienced a significant decline in exposure from 2002 (70.0%) to 2006 (61.4%). Girls were significantly more likely to be exposed to secondhand smoke in 2006 than were boys, and only boys experienced a significant overall decline in exposure from 2002 (69.3%) to 2006 (57.7%). Smoking behaviors and attitudes continued to influence secondhand smoke exposure from 2002 to 2006, although students experienced significant declines whether they were smokers or nonsmokers, and whether they lived with a smoker or not. Those with close friends who smoked and those who did not perceive secondhand smoke as harmful, however, did not benefit.

Conclusion

These data indicate reductions in exposure to secondhand smoke among Nebraska''s middle and high school students, but exposure remains a problem, particularly in rooms. Adoption of a comprehensive statewide smoke-free policy will contribute to significantly reduced exposure to secondhand smoke among young people in public places, but other measures to address exposure in the home and private vehicles are needed or should be strengthened. These include physician counseling based on behavioral change theory to encourage cessation and home-based no-smoking rules, in addition to interventions that target minorities, who are disproportionately affected by secondhand smoke exposure. Evaluation of existing measures, such as programs to prevent tobacco use among young people and campaigns to collect pledges for smoke-free homes, will be required to determine their effectiveness in reducing exposure to secondhand smoke among youth in Nebraska.     

Mind the Gap

Background

Recent analysis has demonstrated a remarkably consistent, nonlinear relationship between estimated inhaled dose of combustion particles measured as PM_2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) and cardiovascular disease mortality over several orders of magnitude of dose—from cigarette smoking, environmental tobacco smoke (ETS) exposure, and ambient air pollution exposure.

Objectives

Here we discuss the implications of this relationship and point out the gaps in our knowledge that it reveals.

Discussion

The nonlinear exposure–response relationship that is revealed—much steeper at lower than at higher doses—explains the seemingly inconsistent risks observed from ambient air pollution and cigarette smoking but also raises important questions about the relative benefits of control at different points along the curve. This analysis also reveals a gap in the evidence base along the dose–response curve between ETS and active smoking, which is the dose range experienced by half the world’s population from indoor biomass and coal burning for cooking and heating.

Conclusions

The shape of the exposure–response relationship implies much larger public health benefits of reductions at the lower end of the dose spectrum (e.g., from reductions in outdoor air pollution) than from reducing the rate of active smoking, which seems counterintuitive and deserving of further study because of its importance for control policies. In addition, given the potential risks and consequent global disease burden, epidemiologic studies are urgently needed to quantify the cardiovascular risks of particulate matter exposures from indoor biomass burning in developing countries, which lie in the dose gap of current evidence.     

Smoking-related deaths averted due to three years of policy progress

Objective

To evaluate the global impact of adopting highest-level MPOWER tobacco control policies in different countries and territories from 2007 to 2010.

Methods

Policy effect sizes based on previously-validated SimSmoke models were applied to determine the reduction in the number of smokers as a result of policy adoption during this period. Based on previous research suggesting that half of all smokers die from smoking, we also derived the estimated smoking-attributable deaths (SADs) averted due to MPOWER policy implementation. The results from use of this simple yet powerful method are consistent with those predicted by using previously validated SimSmoke models.

Findings

In total, 41 countries adopted at least one highest-level MPOWER policy between 2007 and 2010. As a result of all policies adopted during this period, the number of smokers is estimated to have dropped by 14.8 million, with a total of 7.4 million SADs averted. The largest number of SADs was averted as a result of increased cigarette taxes (3.5 million), smoke-free air laws (2.5 million), health warnings (700 000), cessation treatments (380 000), and bans on tobacco marketing (306 000).

Conclusion

From 2007 to 2010, 41 countries and territories took action that will collectively prevent nearly 7.5 million smoking-related deaths globally. These findings demonstrate the magnitude of the actions already taken by countries and underscore the potential for millions of additional lives to be saved with continued adoption of MPOWER policies.     

Peer Reviewed: Regional and Racial Differences in Smoking and Exposure to Secondhand Smoke: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction

Stroke mortality rates differ by race and region, and smoking and exposure to secondhand smoke are associated with stroke. We evaluated regional and racial differences in current smoking and secondhand smoke exposure among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods

African American and white adults (n = 26,373) aged 45 years or older were recruited during 2003 through 2007. Logistic regression was used to examine the likelihood of current smoking and secondhand smoke exposure by race (African American vs white) and region. We compared the buckle of the stroke belt (the coastal plain region of North Carolina, South Carolina, and Georgia) with the stroke belt (the remainder of North Carolina, South Carolina, and Georgia, plus Alabama, Mississippi, Tennessee, Arkansas, and Louisiana) and compared each of these regions with the remaining contiguous states.

Results

Among whites, no regional differences in current smoking were seen, but among African Americans, the odds of current smoking were 5% lower in the stroke belt, and 24% lower in the stroke buckle than those in the nonbelt region. Similarly, among whites no regional differences in exposure to secondhand smoke were found, whereas among African Americans, the odds of being exposed to secondhand smoke were 14% lower in the stroke buckle than for nonbelt residents.

Conclusions

These data suggest that rates of current smoking and secondhand smoke exposure are not higher in regions that have higher stroke mortality and therefore cannot contribute to geographic disparities; nevertheless, given that 15% of our participants reported current smoking and 16% reported secondhand smoke exposure, continued implementation of tobacco control policies is needed.     

Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2012

Background

Exposure to secondhand smoke (SHS) from burning tobacco causes disease and death in nonsmoking children and adults. No risk-free level of SHS exposure exists.

Methods

National Health and Nutrition Examination Survey (NHANES) data from 1999–2012 were used to examine SHS exposure among the nonsmoking population aged ≥3 years. SHS exposure among nonsmokers was defined as a serum cotinine level (a metabolite of nicotine) of 0.05–10 ng/mL. SHS exposure was assessed overall and by age, sex, race/ethnicity, poverty level, education, and whether the respondent owned or rented their housing.

Results

Prevalence of SHS exposure in nonsmokers declined from 52.5% during 1999–2000 to 25.3% during 2011–2012. During this period, declines were observed for all population subgroups, but disparities exist. During 2011–2012, SHS was highest among: children aged 3–11 years (40.6%), non-Hispanic blacks (46.8%), persons living below the poverty level (43.2%), and persons living in rental housing (36.8%). Among children aged 3–11 years, 67.9% of non-Hispanic blacks were exposed to SHS compared with 37.2% of non-Hispanic whites and 29.9% of Mexican Americans.

Conclusion

Overall, SHS exposure in the United States has been reduced by half since 1999–2000. However, 58 million persons were still exposed to SHS during 2011–2012, and exposure remains higher among children, non-Hispanic blacks, those living in poverty, and those who rent their housing.

Implications for Public Health Practice

Eliminating smoking in indoor spaces fully protects nonsmokers from SHS exposure; separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot completely eliminate exposure. Continued efforts to promote implementation of comprehensive statewide laws prohibiting smoking in workplaces and public places, smoke-free policies in multiunit housing, and voluntary smoke-free home and vehicle rules are critical to protect nonsmokers from this preventable health hazard in the places they live, work, and gather.     

Peer Reviewed: Demographic and Geographic Differences in Exposure to Secondhand Smoke in Missouri Workplaces, 2007-2008

Introduction

African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law.

Methods

We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure.

Results

Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work.

Conclusion

Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.     

Measuring Indoor Air Quality of Hookah Lounges

Many states have implemented smoke-free workplace laws to protect employees and customers from exposure to secondhand smoke. However, exemptions in these laws have allowed indoor tobacco smoking in hookah lounges to proliferate in recent years. To describe the amount of secondhand smoke in hookah lounges, we measured the indoor air quality of 10 hookah lounges in Oregon. Air quality measurements ranged from “unhealthy” to “hazardous” according to Environmental Protection Agency standards, indicating a potential health risk for patrons and employees.Hookahs are pipes used to smoke flavored, sweetened tobacco. Hookah tobacco smoke contains tar, carbon monoxide and other toxins found in cigarette smoke, and in a typical hookah session, smokers inhale more than 40 times the volume of smoke produced by a cigarette.1–3 Hookah lounges are businesses that provide an indoor environment for hookah smoking and sell hookah tobacco in dozens of candy and fruit flavors.4 Indoor smoking in hookah lounges can expose employees and customers to secondhand smoke. Many states have implemented comprehensive smoke-free workplace laws that protect employees and patrons from exposure to secondhand smoke.5 Whereas some laws ban all tobacco use, others include exemptions which have allowed hookah lounges to proliferate.6,7Tobacco smoke is a mixture of chemical compounds that are bound to aerosol particles or are free in the gas phase.8 The concentration of particulate matter in the air is a strong indicator of pollution from tobacco smoke. Studies have measured particulate matter from cigarette smoke in bars and restaurants that allow indoor smoking, revealing employees and customers were exposed to hazardous levels of air pollution.9–11 Hookah smoke contains many of the same toxins as cigarette smoke2,3 and has been associated with lung cancer, respiratory illness, low birth weight, and periodontal disease.12 Laboratory studies have measured the chemical components of hookah smoke, and carbon monoxide levels have been measured in patrons exiting a hookah lounge.1–3,13 However, no study to date has described the concentration of particulate matter in the air inside hookah lounges. This study fills a research gap by analyzing the air quality inside hookah lounges in Oregon.     

Factors Associated with Active Smoking,Quitting, and Secondhand Smoke Exposure among Pregnant Women in Greece

Background

Pregnant women are exposed to tobacco smoke through active smoking and contact with secondhand smoke (SHS), and these exposures have a significant impact on public health. We investigated the factors that mediate active smoking, successful quitting, and SHS exposure among pregnant women in Crete, Greece.

Methods

Using a cotinine-validated questionnaire, data were collected on active smoking and exposure to secondhand smoke from 1291 women who had successfully completed the first contact questionnaire of the prospective mother-child cohort (Rhea) in Crete during the 12th week of pregnancy.

Results

Active smoking at some time during pregnancy was reported by 36% of respondents, and 17% were current smokers at week 12 of gestation. Those less likely to quit smoking during pregnancy were those married to a smoker (OR, 1.76; P = 0.008), those who were multiparous (1.72; P = 0.011), and those with young husbands. Of the 832 (64%) nonsmokers, almost all (94%, n = 780) were exposed to SHS, with the majority exposed at home (72%) or in a public place (64%). Less educated women and younger women were exposed more often than their better educated and older peers (P < 0.001). Adjusting for potential confounders, parental level of education, age, and ethnicity were the main mediators of exposure to SHS during pregnancy.

Conclusions

Active smoking and exposure to SHS are very prevalent among pregnant women in Greece. The above findings indicate the need for support of population-based educational interventions aimed at smoking cessation in both parents, as well as of the importance of establishing smoke-free environments in both private and public places.Key words: smoking, cessation, pregnancy, fetal health, passive smoking, SHS     

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.     

Peer Reviewed: An Observational Study of the Secondary Effects of a Local Smoke-Free Ordinance

Introduction

The secondary, sometimes unintended effects of smoke-free ordinances have not been thoroughly evaluated. In this observational study, we evaluated the association of a local ordinance implemented in Madison, Wisconsin, with changes in public disturbances; smoking, drinking, and bar-going behaviors in the general population; and smoking and drinking behaviors among university students.

Methods

We obtained data from 4 sources: police records, key informant interviews, a community survey, and an undergraduate survey. Except for interviews, which we conducted postenactment only, we compared measures before and after the ordinance was put into effect.

Results

We found no evidence of association of the ordinance with public disturbances. We found that the ordinance was not associated with changes in smoking rates, drinking rates, or bar-going in the general population, although bar-going decreased among the 16% of the general adult population who smokes (from 84% in 2005 to 70% in 2007, P < .001). Student smoking rates also decreased (from 23% in 2005 to 16% in 2007, P < .001), but student binge drinking did not change.

Conclusion

The study adds unique information to the evidence base on the effect of smoke-free policies, finding little evidence of their secondary, unintended effects. With the addition of these results to existing evidence, we conclude that the potential health benefits of smoke-free ordinances outweigh the potential harms from unintended effects.     

Peer Reviewed: The Impact of a Communitywide Smoke-Free Ordinance on Smoking Among Older Adults

Introduction

Clean-air and smoke-free ordinances have been shown to reduce the prevalence of smoking among the overall population, but their effects on the smoking prevalence among older adults deserves further attention. We examined changes in self-reported cigarette smoking and in attitudes toward smoking after the implementation of such ordinances in Fort Collins, Colorado, in 2003.

Methods

Communitywide health status surveys were mailed out to northern Larimer County residents recruited via random-digit dialing in 2001 and 2004. Secondary data analysis was conducted for respondents living in Fort Collins, comparing the entire sample with a subsample of adults aged 50 years or older. Univariate analyses were used to determine differences in self-reported cigarette smoking between the groups across the 2 surveys. Multivariate logistic regression models estimated differences in smoking status and in attitudes toward acceptability of public smoking between the 2 survey administrations, controlling for demographic correlates.

Results

Smoking rates among older respondents failed to change, despite significant decreases in smoking rates in the entire adult population. Furthermore, attitudes toward smoking in public did not change between the 2 surveys for either of the groups.

Conclusion

Different factors may influence the decision to stop smoking for older adults and younger adults. We recommend the use of multiple approaches on different ecological levels to ensure that communitywide antismoking intervention efforts reach all population segments.     

Air Nicotine Monitoring for Second Hand Smoke Exposure in Public Places in India

Background:

Air nicotine monitoring is an established method of measuring exposure to second hand smoke (SHS). Not much research has been done in India to measure air nicotine for the purpose of studying exposure to SHS. It is a risk factor and many diseases are known to occur among non smokers if they are exposed to second hand smoke.

Objective:

To conduct monitoring of air nicotine for second hand smoke exposure in public places across major cities in India.

Materials and Methods:

A cross sectional survey was conducted across four cities across the country, using passive air monitoring. The buildings included hospitals, secondary schools, Governmental offices, bars and restaurants. The buildings were selected through convenience sampling method keeping in view specific sentinel locations of interest.

Result:

The presence of air nicotine was recorded in most of the buildings under the study, which included government buildings, hospitals, schools, restaurants and entertainment venues (bars) in all four cities under the study. The highest median levels of air nicotine were found in entertainment venues and restaurants in cities.

Conclusion:

The presence of air nicotine in indoor public places indicates weak implementation of existing smoke free law in India. The findings of this study provide a baseline characterization of exposure to SHS in public places in India, which could be used to promote clean indoor air policies and programs and monitor and evaluate the progress and future smoke-free initiatives in India.