International Journal of Environmental Research and Public Health

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324 KiB

Open AccessArticle

Tobacco Smoke Exposure during Childhood: Effect on Cochlear Physiology

by Alessandra S. Durante, Beatriz Pucci, Nicolly Gudayol, Beatriz Massa, Marcella Gameiro and Cristiane Lopes

Int. J. Environ. Res. Public Health 2013, 10(11), 5257-5265; https://doi.org/10.3390/ijerph10115257 - 24 Oct 2013

Cited by 20 | Viewed by 6658

Abstract

The rate of smoking in Brazil is about 18.8%. Exposure to environmental tobacco smoke is one of the major factors predisposing children to several hazardous health problems. The objective of the present research was to analyze the effect of tobacco smoke exposure during [...] Read more.

The rate of smoking in Brazil is about 18.8%. Exposure to environmental tobacco smoke is one of the major factors predisposing children to several hazardous health problems. The objective of the present research was to analyze the effect of tobacco smoke exposure during childhood on cochlear physiology by measuring the transient evoked otoacoustic emissions (TEOAE) response levels. Cotinine, the main metabolite of nicotine, was measured in 145 students’ (8–10 years old) urine. Sixty students indicated tobacco smoke exposure (TSE) (cotinine urine levels ≥ 5.0 ng/mL) and 85 did not. The evaluation of TEOAE of TSE students showed lower response levels, mainly on frequencies of 2.8 kHz on the right and left ears and 2.0 kHz on left ear and lower signal noise response levels, mainly on the 1.0 kHz and 1.4 kHz frequencies, when compared to controls that were not exposed to tobacco. The mean reduction observed in TEOAE of tobacco smoke exposure children was 2.1 dB SPL. These results have important implications on the damage to the cochlear structures and indicate a possible loss in hearing and hearing ability development. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

“We Made the Rule, We Have to Stick to It”: Towards Effective Management of Environmental Tobacco Smoke in Remote Australian Aboriginal Communities

by Jan Robertson, Boris Shane Pointing, Leah Stevenson and Alan R. Clough

Int. J. Environ. Res. Public Health 2013, 10(10), 4944-4966; https://doi.org/10.3390/ijerph10104944 - 11 Oct 2013

Cited by 12 | Viewed by 8899

Abstract

Smoking prevalence in remote Australian Aboriginal communities remains extraordinarily high, with rates reported of up to 82%. Widespread exposure to environmental tobacco smoke (ETS) is exacerbated by overcrowded housing. Implementation of existing smoke-free policies is challenged by the normalization of smoking and a [...] Read more.

Smoking prevalence in remote Australian Aboriginal communities remains extraordinarily high, with rates reported of up to 82%. Widespread exposure to environmental tobacco smoke (ETS) is exacerbated by overcrowded housing. Implementation of existing smoke-free policies is challenged by the normalization of smoking and a lack of appropriate regulation resources. This paper celebrates a grassroots approach to control of environmental tobacco smoke (ETS) in these settings. We report on selected findings from a tobacco intervention study in Arnhem Land, Northern Territory in 2007–2012. In community-level tobacco use surveys at baseline (n = 400 ≥ 16 years), participants reported concern about the constant exposure of non-smokers to tobacco smoke. Suggestions for action included restricting smoking in private and public spaces. We selected three case studies illustrating management of ETS from observational data during the study’s intervention phase. Using a critical realist approach, the context and mechanisms that contributed to specific strategies, or outcomes, were examined in order to develop a hypothesis regarding more effective management of ETS in these environments. Our results suggest that in discrete, disadvantaged communities, enhanced local ownership of smoke-free policies and development of implementation strategies at the grassroots level that acknowledge and incorporate cultural contexts can contribute to more effective management of ETS. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Disparities and Menthol Marketing: Additional Evidence in Support of Point of Sale Policies

by Sarah Moreland-Russell, Jenine Harris, Doneisha Snider, Heidi Walsh, Julianne Cyr and Joaquin Barnoya

Int. J. Environ. Res. Public Health 2013, 10(10), 4571-4583; https://doi.org/10.3390/ijerph10104571 - 25 Sep 2013

Cited by 23 | Viewed by 8901

Abstract

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 [...] Read more.

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Patterns of Smoking Prevalence among the Elderly in Europe

by Alessandra Lugo, Carlo La Vecchia, Stefania Boccia, Bojana Murisic and Silvano Gallus

Int. J. Environ. Res. Public Health 2013, 10(9), 4418-4431; https://doi.org/10.3390/ijerph10094418 - 17 Sep 2013

Cited by 47 | Viewed by 9413

Abstract

Scant information is available on determinants of smoking prevalence in the vulnerable population of the elderly, particularly in Europe. Therefore, we analyzed smoking patterns among older adults (≥65 years old), using data from a representative survey based on 3,071 elderly, conducted in 17 [...] Read more.

Scant information is available on determinants of smoking prevalence in the vulnerable population of the elderly, particularly in Europe. Therefore, we analyzed smoking patterns among older adults (≥65 years old), using data from a representative survey based on 3,071 elderly, conducted in 17 European countries in 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project. Overall smoking prevalence in 17 European countries was 11.5% (15.3% in men and 8.6% in women). An inverse relation with level of education was observed among men, while no specific pattern was evident among women. Smoking prevalence was highest in eastern/central Europe for men (20.3%) and northern Europe for women (13.1%). In both sexes combined, smokers were more frequent in countries with low implementation of tobacco control activities (14.9%). Anti-tobacco campaigns and smoking cessation interventions specifically targeted to the elderly are urgently needed in Europe. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Differential Impact of Tobacco Control Policies on Youth Sub-Populations

by John A. Tauras, Jidong Huang and Frank J. Chaloupka

Int. J. Environ. Res. Public Health 2013, 10(9), 4306-4322; https://doi.org/10.3390/ijerph10094306 - 12 Sep 2013

Cited by 42 | Viewed by 8377

Abstract

Background: While previous studies have demonstrated the efficacy of tobacco control interventions in reducing tobacco use among youth overall, there have been very few studies that examine the potential differential impact of tobacco control policies on various youth subgroups, defined by socio-economic [...] Read more.

Background: While previous studies have demonstrated the efficacy of tobacco control interventions in reducing tobacco use among youth overall, there have been very few studies that examine the potential differential impact of tobacco control policies on various youth subgroups, defined by socio-economic status (SES), race/ethnicity, and gender. Objective: We examined the relationship between state-level cigarette prices and smoke-free air laws and youth smoking prevalence and intensity for various youth sub-populations in the United States. Methods: We estimated a 2-part model of cigarette demand using data from the 1991 through 2010 nationally representative surveys of 8th-, 10th-, and 12th-grade students as part of the Monitoring the Future project. Findings: We found that real cigarette prices are strong determinants of youth smoking. Blacks, females, Hispanics, and low-SES subpopulations are found to have a larger price response with respect to smoking prevalence than the full sample. Smoke-free air laws are found to have a negative effect on smoking prevalence for the full sample and for the male, white, and high-SES sub-populations. Conclusions: This research concludes that higher cigarette prices will reduce smoking prevalence rates of Blacks, Hispanics, females, and low-SES subpopulations faster than the overall youth population and other youth sub-populations. Moreover, this research concludes that smoke-free air laws will reduce smoking prevalence for the overall youth population with the largest reductions in high SES and male subpopulations. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Gold Standard Program for Heavy Smokers in a Real-Life Setting

by Tim Neumann, Mette Rasmussen, Berit L. Heitmann and Hanne Tønnesen

Int. J. Environ. Res. Public Health 2013, 10(9), 4186-4199; https://doi.org/10.3390/ijerph10094186 - 9 Sep 2013

Cited by 53 | Viewed by 7742

Abstract

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to [...] Read more.

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Tobacco Use and Environmental Smoke Exposure among Taiwanese Pregnant Smokers and Recent Quitters: Risk Perception, Attitude, and Avoidance Behavior

by Ming-Cheng Lai, Feng-Sha Chou, Yann-Jy Yang, Chih-Chien Wang and Ming-Chang Lee

Int. J. Environ. Res. Public Health 2013, 10(9), 4104-4116; https://doi.org/10.3390/ijerph10094104 - 3 Sep 2013

Cited by 21 | Viewed by 7080

Abstract

In this study, we conducted an empirical survey of the avoidance behaviors and risk perceptions of active and passive smoking pregnant smokers and recent quitters. We employed an online questionnaire survey by recruiting 166 voluntary participants from an online parenting community in Taiwan. [...] Read more.

In this study, we conducted an empirical survey of the avoidance behaviors and risk perceptions of active and passive smoking pregnant smokers and recent quitters. We employed an online questionnaire survey by recruiting 166 voluntary participants from an online parenting community in Taiwan. The results of the empirical survey revealed that three-fourths of smokers quit smoking during pregnancy and one-fourth continued smoking. All pregnant women who continued smoking had partners or lived with relatives who smoked. Current smokers and quitters differed significantly in their risk perceptions and attitudes toward smoking during pregnancy. Most pregnant smokers and quitters adopted passive smoking avoidance behaviors at home and in public. Nevertheless, one-fifth of pregnant women chose not to avoid passive smoking. We concluded that most women stop smoking during pregnancy; however, most women continue to be exposed to passive-smoking environments. Perceived fetal health risks and attitudes toward smoking during pregnancy are critical predictors of the anti-smoking behaviors of pregnant women. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Perception of Tourists Regarding the Smoke-Free Policy at Suvarnabhumi International Airport, Bangkok, Thailand

by Nithat Sirichotiratana, Subash Yogi and Chardsumon Prutipinyo

Int. J. Environ. Res. Public Health 2013, 10(9), 4012-4026; https://doi.org/10.3390/ijerph10094012 - 30 Aug 2013

Cited by 4 | Viewed by 6449

Abstract

This study was conducted during February-March 2012 to determine the perception and support regarding smoke-free policy among tourists at Suvarnabhumi International Airport, Bangkok, Thailand. In this cross-sectional study, 200 tourists (n = 200) were enrolled by convenience sampling and interviewed by structured [...] Read more.

This study was conducted during February-March 2012 to determine the perception and support regarding smoke-free policy among tourists at Suvarnabhumi International Airport, Bangkok, Thailand. In this cross-sectional study, 200 tourists (n = 200) were enrolled by convenience sampling and interviewed by structured questionnaire. Descriptive statistics, chi-square, and multinomial logistic regression were adopted in the study. Results revealed that half (50%) of the tourists were current smokers and 55% had visited Thailand twice or more. Three quarter (76%) of tourists indicated that they would visit Thailand again even if it had a 100% smoke-free regulation. Almost all (99%) of the tourists had supported for the smoke-free policy (partial ban and total ban), and current smokers had higher percentage of support than non-smokers. Two factors, current smoking status and knowledge level, were significantly associated with perception level. After analysis with Multinomial Logistic Regression, it was found that perception, country group, and presence of designated smoking room (DSR) were associated with smoke-free policy. Recommendation is that, at institution level effective monitoring system is needed at the airport. At policy level, the recommendation is that effective comprehensive policy needed to be emphasized to ensure smoke-free airport environment. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Population-Based Study of Smoking Behaviour throughout Pregnancy and Adverse Perinatal Outcomes

by Deirdre J. Murphy, Clare Dunney, Aoife Mullally, Nita Adnan and Richard Deane

Int. J. Environ. Res. Public Health 2013, 10(9), 3855-3867; https://doi.org/10.3390/ijerph10093855 - 27 Aug 2013

Cited by 26 | Viewed by 6808

Abstract

There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban [...] Read more.

There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. Adverse perinatal outcomes were compared for “non-smokers”, “ex-smokers” and “current smokers”. Of the 907 women, 270 (30%) reported smoking in the six months prior to pregnancy, and of those 160 (59%) had stopped smoking and 110 (41%) continued to smoke at the time of the first antenatal visit. There was virtually no change in smoking behaviour between the first antenatal visit and the third trimester of pregnancy. Factors associated with continuing to smoke included unplanned pregnancy (OR 1.9; 95% CI 1.3, 2.9), alcohol use (OR 3.4; 95% CI 2.1, 6.0) and previous illicit drug use (OR 3.6; 95% CI 2.1, 6.0). Ex-smokers had similar perinatal outcomes to non-smokers. Current smoking was associated with an average reduction in birth weight of 191g (95% CI −294, −88) and an increased incidence of intrauterine growth restriction (24% versus 13%, adjusted OR 1.39 (95% CI 1.06, 1.84). Public Health campaigns emphasise the health benefits of quitting smoking in pregnancy. The greatest success appears to be pre-pregnancy and during the first trimester where women are largely self-motivated to quit. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Effectiveness of the Gold Standard Programmes (GSP) for Smoking Cessation in Pregnant and Non-Pregnant Women

by Mette Rasmussen, Berit Lilienthal Heitmann and Hanne Tønnesen

Int. J. Environ. Res. Public Health 2013, 10(8), 3653-3666; https://doi.org/10.3390/ijerph10083653 - 16 Aug 2013

Cited by 13 | Viewed by 7153

Abstract

Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women [...] Read more.

Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Supporting Pacific Island Countries to Strengthen Their Resistance to Tobacco Industry Interference in Tobacco Control: A Case Study of Papua New Guinea and Solomon Islands

by Judith McCool, Jeanie McKenzie, Annabel Lyman and Matthew Allen

Int. J. Environ. Res. Public Health 2013, 10(8), 3424-3434; https://doi.org/10.3390/ijerph10083424 - 6 Aug 2013

Cited by 12 | Viewed by 6588

Abstract

Tobacco use is the biggest single preventable cause of non-communicable diseases (NCDs) in the Western Pacific region. Currently, 14 Pacific Island countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) and, in having done so, are committed to implementing tobacco control [...] Read more.

Tobacco use is the biggest single preventable cause of non-communicable diseases (NCDs) in the Western Pacific region. Currently, 14 Pacific Island countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) and, in having done so, are committed to implementing tobacco control measures aligned with the FCTC. Progressing strong and effective tobacco control legislation is essential to achieving long term gains in public health in small island countries. However, survey evidence suggests that pervasive tobacco industry interference serves to undermine tobacco control and public policy in several Pacific countries. An initiative was developed to provide dedicated, in-country technical support for developing legislation and policy to support implementation of Article 5.3 of the FCTC in the Solomon Islands and Papua New Guinea. This paper examines the factors that have assisted the two Pacific countries to make progress in implementing Article 5.3 and what this might mean for supporting progress in other Pacific settings. A document analysis was undertaken to identify the process and outcome of the intervention. Two significant outputs from the project including having identified and documented specific examples of TII and the development of draft legislation for Article 5.3 and other key resources for public servants both within and outside the health sector. Key determinants of progress included a motivated and engaged Ministry of Health, active civil society group or champion and access to media to prepare tobacco industry related material to stimulate public and policy sector debate. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

The Association of Lone-Motherhood with Smoking Cessation and Relapse: Prospective Results from an Australian National Study

by Mohammad Siahpush, Raees A. Shaikh, Melissa Tibbits, Terry T-K Huang and Gopal K. Singh

Int. J. Environ. Res. Public Health 2013, 10(7), 2906-2919; https://doi.org/10.3390/ijerph10072906 - 12 Jul 2013

Cited by 4 | Viewed by 6239

Abstract

The aims were to examine the association of lone-motherhood with smoking cessation and relapse, and to investigate the extent to which this association was accounted for by socioeconomic status (education, occupation, and income), social support, and mental health. We used data from 10 [...] Read more.

The aims were to examine the association of lone-motherhood with smoking cessation and relapse, and to investigate the extent to which this association was accounted for by socioeconomic status (education, occupation, and income), social support, and mental health. We used data from 10 yearly waves (2001 to 2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Response rate in the first wave was 66%. Logistic regression was used to examine the effect of lone-motherhood and other covariates on smoking cessation (n = 2,878) and relapse (n = 3,242). Results showed that the age-adjusted odds of smoking cessation were 32% smaller among lone mothers than partnered mothers (p = 0.004). The age-adjusted odds of relapse was 172% greater among lone mothers than partnered mothers (p < 0.001). We found that socioeconomic status, social support, and mental health account for some of the association of lone motherhood and cessation and relapse. While efforts to reduce the smoking prevalence among lone mothers should focus on their material deprivation, availability of social support, and addressing mental health issues, other factors unique to the lives of lone mothers also need to be taken into account. More research is needed to discover other factors that can explain the association of lone-motherhood and smoking behavior. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Influence of Rural Non-Smoking Adolescents’ Sense of Coherence and Exposure to Household Smoking on Their Commitment to a Smoke-Free Lifestyle

by Olalekan A. Ayo-Yusuf and Masego M. Rantao

Int. J. Environ. Res. Public Health 2013, 10(6), 2427-2440; https://doi.org/10.3390/ijerph10062427 - 13 Jun 2013

Cited by 5 | Viewed by 6873

Abstract

This 18-month longitudinal study examined the influence of adolescents’ sense of coherence (SOC) and exposure to household smoking on their commitment to a smoke-free lifestyle. This study investigated a representative sample of 8th graders from 21 randomly selected high schools in the rural [...] Read more.

This 18-month longitudinal study examined the influence of adolescents’ sense of coherence (SOC) and exposure to household smoking on their commitment to a smoke-free lifestyle. This study investigated a representative sample of 8th graders from 21 randomly selected high schools in the rural Limpopo Province of South Africa (n = 2,119). Of the total sample of 2,119 participants, 294 (14%) reported smoking at baseline and were therefore excluded from further analysis. Of those who did not smoke at baseline, 98.1% (n = 1,767) reported no intention of smoking in the upcoming 12 months. Of those who completed follow-up and had no intention of smoking at baseline (n = 1,316), 89.1% still did not smoke and remained committed to being smoke-free. Having a lower SOC, reporting alcohol binge-drinking at baseline, and having a household member who regularly smokes indoors (OR = 0.46: 0.26–0.82), as compared to not having any smoker in the household, were associated with lower odds of honoring a commitment to a smoke-free lifestyle. Furthermore, those who identified themselves as black Africans, as opposed to belonging to other race groups, were more likely to maintain a smoke-free lifestyle. Our findings suggest that interventions to prevent adolescent smoking should prioritize stress-coping skills and promote smoke-free homes. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Public Place Smoke-Free Regulations, Secondhand Smoke Exposure and Related Beliefs, Awareness, Attitudes, and Practices among Chinese Urban Residents

by Tingzhong Yang, Abu S. Abdullah, Li Li, Ian R. H. Rockett, Yan Lin, Jun Ying, Wei Guo, Dan Wu and Mu Li

Int. J. Environ. Res. Public Health 2013, 10(6), 2370-2383; https://doi.org/10.3390/ijerph10062370 - 7 Jun 2013

Cited by 14 | Viewed by 8786

Abstract

Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. [...] Read more.

Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. A structured self-administered questionnaire was used for data collection, and implemented at two time points across a 20-month interval. Both unadjusted and adjusted logistic methods were considered in analyses. Multiple regression procedures were performed in examining variation between final and baseline measures. Results: Smoke-free regulations in the intervention city were associated with a significant decline in personal secondhand smoke exposure in government buildings, buses or taxis, and restaurants, but there was no change in such exposure in healthcare facilities and schools. In terms of personal smoking beliefs, awareness, attitudes, and practices, the only significant change was in giving quitting advice to proximal family members. Conclusions: There was a statistically significant association between implementation of smoke-free regulations in a city and inhibition of secondhand tobacco smoking exposure in public places. However, any such impact was limited. Effective tobacco control in China will require a combination of strong public health education and enforcement of regulations. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia

by Bayard Roberts, Ivdity Chikovani, Nino Makhashvili, Vikram Patel and Martin McKee

Int. J. Environ. Res. Public Health 2013, 10(6), 2185-2197; https://doi.org/10.3390/ijerph10062185 - 29 May 2013

Cited by 18 | Viewed by 7767

Abstract

Background: There is very little evidence globally on tobacco use and nicotine dependence among civilian populations affected by armed conflict, despite key vulnerability factors related to elevated mental disorders and socio-economic stressors. The study aim was to describe patterns of smoking and [...] Read more.

Background: There is very little evidence globally on tobacco use and nicotine dependence among civilian populations affected by armed conflict, despite key vulnerability factors related to elevated mental disorders and socio-economic stressors. The study aim was to describe patterns of smoking and nicotine dependence among conflict-affected civilian men in the Republic of Georgia and associations with mental disorders. Methods: A cross-sectional household survey using multistage random sampling was conducted in late 2011 among conflict-affected populations in Georgia. Respondents included in this paper were 1,248 men aged ≥18 years who were internally displaced persons (IDPs) and former IDPs who had returned in their home areas. Outcomes of current tobacco use, heavy use (≥20 cigarettes per day), and nicotine dependence (using the Fagerström Test for Nicotine Dependence) were used. PTSD, depression, anxiety and hazardous alcohol use were also measured, along with exposure to traumatic events and a range of demographic and socio-economic characteristics. Results: Of 1,248 men, 592 (47.4%) smoked and 70.9% of current smokers were heavy smokers. The mean nicotine dependence score was 5.0 and the proportion with high nicotine dependence (≥6) was 41.4%. In multivariate regression analyses, nicotine dependence was significantly associated with PTSD (β 0.74) and depression (β 0.85), along with older age (except 65+ years), and being a returnee (compared to IDPs). Conclusions: The study reveals very high levels of heavy smoking and nicotine dependence among conflict-affected persons in Georgia. The associations between nicotine dependence, PTSD and depression suggest interventions could yield synergistic benefits. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

A History of Ashes: An 80 Year Comparative Portrait of Smoking Initiation in American Indians and Non-Hispanic Whites—the Strong Heart Study

by Raymond Orr, Darren Calhoun, Carolyn Noonan, Ron Whitener, Jeff Henderson, Jack Goldberg and Patrica Nez Henderson

Int. J. Environ. Res. Public Health 2013, 10(5), 1747-1762; https://doi.org/10.3390/ijerph10051747 - 2 May 2013

Cited by 3 | Viewed by 7893

Abstract

The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a [...] Read more.

The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessArticle

Changes in Tobacco Use, Susceptibility to Future Smoking, and Quit Attempts among Canadian Youth over Time: A Comparison of Off-Reserve Aboriginal and Non-Aboriginal Youth

by Tara Elton-Marshall, Scott T. Leatherdale, Robin Burkhalter and K. Stephen Brown

Int. J. Environ. Res. Public Health 2013, 10(2), 729-741; https://doi.org/10.3390/ijerph10020729 - 21 Feb 2013

Cited by 13 | Viewed by 7268

Abstract

The purpose of this study was to determine whether there is a growing inequity in tobacco use, susceptibility to future smoking, and quit attempts among Off-Reserve Aboriginal (ORA) youth in Canada relative to Non-Aboriginal youth. Current smoking, susceptibility to future smoking and quit [...] Read more.

The purpose of this study was to determine whether there is a growing inequity in tobacco use, susceptibility to future smoking, and quit attempts among Off-Reserve Aboriginal (ORA) youth in Canada relative to Non-Aboriginal youth. Current smoking, susceptibility to future smoking and quit attempts were examined among a nationally representative sample of ORA and Non-Aboriginal Canadian youth. Data are from cross-sectional surveys of 88,661 respondents in Grades 6 to 9 across the 2004, 2006 and 2008 survey waves of the Youth Smoking Survey (YSS). At each wave, ORA youth were more likely to be current smokers (overall OR = 3.91, 95% CI 3.47 to 4.41), to be susceptible to future smoking (overall OR = 1.37, 95% CI 1.27 to 1.48), and less likely to have ever made a quit attempt compared to Non-Aboriginal youth (overall OR = 0.74, 95% CI 0.57 to 0.96). Although susceptibility to future smoking declined for Non-Aboriginal youth, the prevalence of susceptibility remained stable among ORA youth. The percentage of ORA youth reporting making a quit attempt increased, however, current smoking rates among ORA youth did not decline. These findings suggest that the disparity in susceptibility to future tobacco use among ORA and Non-Aboriginal youth has increased over time. Despite increased rates of quit attempts, current smoking rates remain significantly higher among ORA youth. Tobacco control programs for Aboriginal youth should be a public health priority. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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226 KiB

Open AccessArticle

Factors Associated with Parents’ Perceptions of Parental Smoking in the Presence of Children and Its Consequences on Children

by Yu-Ting Chen, Fei-Hsiu Hsiao, Nae-Fang Miao and Ping-Ling Chen

Int. J. Environ. Res. Public Health 2013, 10(1), 192-209; https://doi.org/10.3390/ijerph10010192 - 7 Jan 2013

Cited by 9 | Viewed by 7689

Abstract

Parental smoking is the major source of children’s secondhand smoke exposure and is influenced by parents’ perception of children’s exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents’ perceptions about [...] Read more.

Parental smoking is the major source of children’s secondhand smoke exposure and is influenced by parents’ perception of children’s exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents’ perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents’ perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents’ gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents’ evaluation of the consequences of parental smoking in the presence of children. Parents’ gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents’ perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

Review

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Open AccessReview

Can Tobacco Control Be Transformative? Reducing Gender Inequity and Tobacco Use among Vulnerable Populations

by Lorraine Greaves

Int. J. Environ. Res. Public Health 2014, 11(1), 792-803; https://doi.org/10.3390/ijerph110100792 - 7 Jan 2014

Cited by 24 | Viewed by 7573

Abstract

Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework [...] Read more.

Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework Convention on Tobacco Control there is much yet to be done to fully understand how gender operates in tobacco control. Policies, program and research in tobacco control need to not only integrate gender, but rather operationalize gender with the goal of transforming gender and social inequities in the course of tobacco control initiatives. Gender transformative tobacco control goes beyond gender sensitive efforts and challenges policy and program developers to apply gender theory in designing their initiatives, with the goal of changing negative gender and social norms and improving social, economic, health and social indicators along with tobacco reduction. This paper outlines what is needed to progress tobacco control in enhancing the status of gendered and vulnerable groups, with a view to reducing gender and social inequities due to tobacco use and exposure. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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A Systematic Review of Peer-Support Programs for Smoking Cessation in Disadvantaged Groups

by Pauline Ford, Anton Clifford, Kim Gussy and Coral Gartner

Int. J. Environ. Res. Public Health 2013, 10(11), 5507-5522; https://doi.org/10.3390/ijerph10115507 - 28 Oct 2013

Cited by 97 | Viewed by 14807

Abstract

The burden of smoking is borne most by those who are socially disadvantaged and the social gradient in smoking contributes substantially to the health gap between the rich and poor. A number of factors contribute to higher tobacco use among socially disadvantaged populations [...] Read more.

The burden of smoking is borne most by those who are socially disadvantaged and the social gradient in smoking contributes substantially to the health gap between the rich and poor. A number of factors contribute to higher tobacco use among socially disadvantaged populations including social (e.g., low social support for quitting), psychological (e.g., low self-efficacy) and physical factors (e.g., greater nicotine dependence). Current evidence for the effectiveness of peer or partner support interventions in enhancing the success of quit attempts in the general population is equivocal, largely due to study design and lack of a theoretical framework in this research. We conducted a systematic review of peer support interventions for smoking cessation in disadvantaged groups. The eight studies which met the inclusion criteria showed that interventions that improve social support for smoking cessation may be of greater importance to disadvantaged groups who experience fewer opportunities to access such support informally. Peer-support programs are emerging as highly effective and empowering ways for people to manage health issues in a socially supportive context. We discuss the potential for peer-support programs to address the high prevalence of smoking in vulnerable populations and also to build capacity in their communities. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Open AccessReview

Smoking Behaviour and Mental Health Disorders—Mutual Influences and Implications for Therapy

by Amedeo Minichino, Francesco Saverio Bersani, Wanda Katharina Calò, Francesco Spagnoli, Marta Francesconi, Roberto Vicinanza, Roberto Delle Chiaie and Massimo Biondi

Int. J. Environ. Res. Public Health 2013, 10(10), 4790-4811; https://doi.org/10.3390/ijerph10104790 - 10 Oct 2013

Cited by 58 | Viewed by 13624

Abstract

Tobacco use is strongly associated with a variety of psychiatric disorders. Smokers are more likely than non-smokers to meet current criteria for mental health conditions, such as mood disorders, anxiety disorders and psychosis. Evidence also suggest that smokers with psychiatric disorders may have [...] Read more.

Tobacco use is strongly associated with a variety of psychiatric disorders. Smokers are more likely than non-smokers to meet current criteria for mental health conditions, such as mood disorders, anxiety disorders and psychosis. Evidence also suggest that smokers with psychiatric disorders may have more difficulty quitting, offering at least a partial explanation for why smoking rates are higher in this population. The mechanisms linking mental health conditions and cigarette smoking are complex and likely differ across each of the various disorders. The most commonly held view is that patients with mental health conditions smoke in an effort to regulate the symptoms associated with their disorder. However some recent evidence suggests that quitting smoking may actually improve mental health symptoms. This is particularly true if the tobacco cessation intervention is integrated into the context of ongoing mental health treatment. In this paper we reviewed and summarized the most relevant knowledge about the relationship between tobacco use and dependence and psychiatric disorders. We also reviewed the most effective smoking cessation strategies available for patients with psychiatric comorbidity and the impact of smoking behavior on psychiatric medication. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research

by Sharon Lawn and Jonathan Campion

Int. J. Environ. Res. Public Health 2013, 10(9), 4224-4244; https://doi.org/10.3390/ijerph10094224 - 10 Sep 2013

Cited by 75 | Viewed by 12791

Abstract

The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from [...] Read more.

The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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HIV-Infected Adolescent, Young Adult and Pregnant Smokers: Important Targets for Effective Tobacco Control Programs

by Gerome Escota and Nur Önen

Int. J. Environ. Res. Public Health 2013, 10(6), 2471-2499; https://doi.org/10.3390/ijerph10062471 - 18 Jun 2013

Cited by 4 | Viewed by 7666

Abstract

Tobacco use is inextricably linked to a number of health risks both in the general and HIV-infected populations. There is, however, a dearth of research on effective tobacco control programs among people living with HIV, and especially among adolescents, young adults and pregnant [...] Read more.

Tobacco use is inextricably linked to a number of health risks both in the general and HIV-infected populations. There is, however, a dearth of research on effective tobacco control programs among people living with HIV, and especially among adolescents, young adults and pregnant women, groups with heightened or increased vulnerability secondary to tobacco use. Adolescents and young adults constitute a growing population of persons living with HIV infection. Early and continued tobacco use in this population living with a disease characterized by premature onset multimorbidity and chronic inflammation is of concern. Additionally, there is an increased acuity for tobacco control among HIV-infected pregnant women to reduce pregnancy morbidity and improve fetal outcome. This review will provide an important summary of current knowledge of tobacco use among HIV-infected adolescents, young adults and pregnant women. The effects of tobacco use in these specific populations will be presented and the current state of tobacco control within these populations, assessed. Full article

(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)

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