Biomedical subjects

D T Levy

Publications and source records attributed to D T Levy.

At least 19 recordsLinked to original sources

PubMed2006

Smokeless tobacco use 1992-2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements.

BACKGROUND: As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups. METHODS: We examine the prevalence of SLT use and smoking, 1992-2002, using the Current Population Survey-Tobacco Use Supplements (CPS-TUS), which used US nationally representative samples based on stratified clusters of households. RESULTS: Consistent with declines in smoking, the prevalence of current SLT use declined over the period 1992-2002 for males and females ages 18 and older. The overall separate declines in SLT use and in smoking are mirrored by a decline in concurrent use of SLT and cigarettes. SLT use is becoming more associated with white males, but use is declining faster among the youngest males. CONCLUSIONS: The findings indicate that relative reductions in smoking prevalence are exceeded by relative reductions in SLT use, with sizeable reductions in concurrent use. These results suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products. In light of potential policy implications of SLT use as a potential reduced exposure product (PREP), current survey methods require more careful measurement of SLT use in terms of initiation, duration, quantity, and cessation.

Adolescent↗

PubMed2005

Increasing taxes to reduce smoking prevalence and smoking attributable mortality in Taiwan: results from a tobacco policy simulation model.

OBJECTIVE: To develop a simulation model to predict the effects of tax policies on smoking prevalence rates and smoking attributable deaths. METHODS: Using data from Taiwan, a simulation model is developed that projects population using birth and death rate data, future smoking rates using initiation, cessation and relapse data, and smoking attributable deaths using smoking prevalence and relative risk estimates. The model projects the number of smokers and smoking related deaths from a baseline year forward. The effects of taxes of different sizes, indexed and unindexed, and temporary versus sustained are modelled using elasticities based on published studies of demand. RESULTS: The model predicts that sustained tax increases have the potential to substantially reduce the number of smokers and the number of premature deaths, with the effects growing over time. Indexing taxes to inflation stems erosion of the tax effect. In our model, when the tax increases by 10 times (NTD 50) over the recent tax increase (NTD 5) and taxes are indexed to inflation, the smoking prevalence rate falls by over 15% soon after the tax increase, and by about 30% in relative terms by the year 2040, resulting in 4500 lives saved per year. CONCLUSIONS: Tax rises have the ability to substantially affect smoking rates in Taiwan. These effects grow over time and lead to substantial savings in lives and health care costs.

Adolescent↗

PubMed2005

Smoking attributable mortality for Taiwan and its projection to 2020 under different smoking scenarios.

OBJECTIVES: To estimate smoking attributable mortality (SAM) in Taiwan for the years 2001 through 2020 under scenarios of reductions in smoking rates by 0%, 2%, 4%, and 10% per year. METHOD: The smoking attributable fraction (SAF) was used to calculate SAM from the risk experience in following up a large cohort (86 580 people) in Taiwan. Smoking rates were based on the 2001 National Health Interview Survey and other national surveys. An average 10 year lag was assumed between smoking rates and subsequent mortality. RESULTS: In 2001, 18 803 deaths, or 1 out of 4 deaths (27%), in middle aged men (35-69 years old) were attributable to smoking. SAM has been increasing and will continue to increase if smoking rates remain constant or even if reduced annually by 2%. SAM would begin to decrease only if rates were to be reduced by at least 4% a year. CONCLUSIONS: The projected SAM in this study illustrates the seriousness of smoking caused mortality. Current efforts in tobacco control would lead to a progressive increase in SAM, unless efforts were doubled and smoking rates reduced by more than 4% a year. The urgency in requiring stronger tobacco control programmes to attenuate the staggering death tolls is compelling.

Adult↗

PubMed2005

Are marketing campaigns in Taiwan by foreign tobacco companies targeting young smokers?

OBJECTIVE: To assess the impact of promotions on cigarette sales in Taiwan after the cigarette market opened to foreign companies, and to assess whether young smokers were targeted by these companies. METHODS: Trends in cigarette sales, advertising expenditure, brand preference, and cigarette consumption were examined for the period following the 1987 opening of the cigarette market. Tobacco industry internal documents from Legacy Tobacco Documents Library of the University of California, San Francisco, were searched for corporate strategies on promoting youth consumption in Taiwan. RESULTS: Between 1995 and 2000, the inflation adjusted advertising expenditures by all foreign firms increased fourfold. Much of the expenditure was spent on brand stretching the Mild Seven (Japan) and Davidoff (Germany) brands in television advertising. By 2000, the market share of foreign cigarettes exceeded domestics by three to one among young smokers and the leading brand preferred by this segment shifted from the most popular domestic brand (Long Life) to a foreign brand (Mild Seven). Furthermore, there was a sudden increase of 16.4% in smoking rates among young adults (from 36.1% to 42.0%) during the first five years after the market opened. This was also accompanied by increased per capita cigarette consumption and decreased age of smoking initiation. Industry documents confirmed the use of strategies targeted at the young. In particular, establishing new point of sale (POS) retail stores or promotional activities at POS were found to be more effective than advertising in magazines. CONCLUSIONS: This study provides evidence that advertising increased with increased competition following the market opening, which, in turn, spurred cigarette sales and consumption. Foreign tobacco companies have deliberately targeted youth in Taiwan and succeeded in gaining three quarters of their cigarette purchases within a decade. Expanding youth consumption will incur excessive future health care costs borne by society. Foreign tobacco companies should be obligated to reimburse these expenses through higher tariffs on cigarettes.

Adolescent↗

PubMed2005

The health benefits of smoking cessation for adult smokers and for pregnant women in Taiwan.

OBJECTIVE: To assess the benefits of smoking cessation regarding mortality reduction after smokers quit, and regarding the health of newborns after smoking mothers quit. METHODS: Relative mortality risks (RR) for smokers aged 35 or older who quit years ago were calculated from the follow up of 71 361 civil servants and teachers recruited since 1989. Data from the Pregnancy Risk Assessment Monitoring System in Taipei City were used to calculate the odds ratios of body weights of newborns born to mothers of different smoking status. RESULTS: Mortality risk for ex-smokers was significantly lower than that of current smokers for all causes (18%), all cancer (22%), lung cancer (39%), and ischaemic heart disease (54%). These benefits were not distinguishable initially, up to five years, but by year 17 and thereafter, substantial benefits of cessation accrued. Two thirds of smoking women quit during the first trimester of pregnancy, and only 2.2% of mothers smoked throughout pregnancy. The newborns from smoking mothers were smaller than those from never smoking mothers, but, if these mothers quit early in the first trimester, birth weights were normal. CONCLUSIONS: The health benefits of smoking cessation, rarely reported for Asian populations, have been largely ignored by smokers in Taiwan, where cessation activities have been extremely limited. Findings of this study that risks from smoking can be attenuated or reversed should be widely communicated to motivate smokers to quit. Smokers should quit early, including smoking mothers, and not wait till medical conditions surfaced, to have the maximal benefits of cessation.

Accidents↗

PubMed2005

Uncovering the relation between betel quid chewing and cigarette smoking in Taiwan.

OBJECTIVE: To describe the characteristics of betel quid chewers and to investigate the behavioural and mortality relations between betel quid chewing and cigarette smoking. METHOD: Prevalence and mortality risks of betel quid chewers by smoking status were calculated, based on the National Health Interview Survey in 2001 and a community based cohort, respectively. Cox's proportional hazards model was used to adjust mortality risks for age, alcohol use, and education. RESULTS: Almost all betel quid chewers were smokers, and most started chewing after smoking. Chewers were predominantly male, mostly in their 30s and 40s, more likely being among the lowest educational or income group, and residing in the eastern regions of Taiwan. On average, betel quid chewers who smoked consumed 18 pieces of betel quid a day, and smoked more cigarettes per day. Far more smokers use betel quid than non-smokers (27.5% v 2.5%), but ex-smokers quit betel quid more than smokers (15.1% v 6.8%). The significantly increased mortality of betel quid users who also smoked, for all causes, all cancer, oral cancer, and cancer of the nasopharynx, lung, and liver, was the result of the combined effects of chewing and smoking. Smokers who chewed betel quid nearly tripled their oral cancer risks from a relative risk of 2.1 to 5.9. Increasing the number of cigarettes smoked among betel quid chewers was associated with a synergistic effect, reflective of the significant interaction between the two. CONCLUSION: To a large extent, the serious health consequences suffered by betel quid chewers were the result of the combined effects of smoking and chewing. Betel quid chewing should not be considered as an isolated issue, but should be viewed conjointly with cigarette smoking. Reducing cigarette smoking serves as an important first step in reducing betel quid chewing, and incorporating betel quid control into tobacco control may provide a new paradigm to attenuate the explosive increase in betel quid use in Taiwan.

Adolescent↗

PubMed2005

Smoking behaviour in Taiwan, 2001.

PURPOSE: To examine smoking behaviours in Taiwan and compare those behaviours to those in the USA. METHODS: Using the National Health Interview Survey (NHIS) of Taiwan (2001), a survey of over 20 000 participants, frequencies were calculated for smoking, ex-smoking, quantity smoked, and exposure to environmental tobacco smoke (ETS). Breakdowns by age, sex, and socioeconomic status were also calculated. RESULTS: The ratio of male to female smoking rates was 10.9 to 1 among adults (46.8%/4.3%), but 3.6 to 1 among underage teenagers (14.3%/4.0%). The proportion of underage to adult smokers was three times higher for girls than for boys. Smoking prevalence substantially increased during and after high school years, and peaked in those aged 30-39 years. Smoking rates of high school age adolescents increased more than threefold if they did not attend school or if they finished their education after high school. Low income and less educated smokers smoked at nearly twice the rate of high income and better educated smokers. The smoker/ex-smoker ratio was close to 7. Male daily smokers smoked on average 17 cigarettes/day, and females, 11. Half of the total population, especially infants and women of childbearing age, were exposed to ETS at home. CONCLUSIONS: Taiwan has particularly high male smoking prevalence and much lower female prevalence. The low female prevalence is likely to increase if the current sex ratio of smoking by underage youth continues. The low quit rate among males, the high ETS exposure of females and young children at home, and the sharp increase in smoking rates when students leave school, are of particular concern. These observations on smoking behaviour can provide valuable insights to assist policymakers and health educators in formulating strategies and allocating resources in tobacco control.

Adolescent↗

PubMed2004

Recent trends in home and work smoking bans.

OBJECTIVES: Home and work smoking bans at the national and state level in the USA, and their relation to smoking prevalence and to tobacco control policies, are examined. DATA: The Current Population Survey's 1992/93 and 1998/99 tobacco use supplement surveys are the primary data source, supplemented with information on state level tobacco control policies. METHODS: The national and state rate of bans are estimated, and changes over the course of the 1990s and their relation to smoking rates and tobacco control policies are examined. RESULTS: The prevalence of work and home bans has increased considerably between 1992/93 and 1998/99. By 1999, over 65% of the population age 15 and above work in places with smoking bans, and over 60% live in homes with bans. We found that states with lower than average ban rates in 1993 tended to have had larger increases in ban rates between 1993 and 1999. We also found that home and work bans became more prevalent in states with initially low smoking rates, and that the growth in home bans coincided with a declining prevalence of smoking. States with higher levels of bans by 1999 also tended to have higher cigarette taxes, stricter clean air laws, and media/comprehensive campaigns in place. CONCLUSIONS: The results indicate that lower smoking rates are associated with higher rates of work and home bans, although substantial progress has also been made by those states with initially low rates of bans. While further work is needed to establish the direction of causality, it would appear that reductions in smoking rates, either through stronger tobacco control policies or otherwise, may reduce exposure to tobacco smoke not only by reducing the number of smokers, but also through increasing the number of firms and homes with smoking restrictions.

Family Health↗

PubMed2002

Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model.

OBJECTIVES: To develop a simulation model to predict the effects of different smoking treatment policies on quit rates, smoking rates, and smoking attributable deaths. METHODS: We first develop a decision theoretic model of quitting behaviour, which incorporates the decision to quit and the choice of treatment. A model of policies to cover the costs of different combinations of treatments and to require health care provider intervention is then incorporated into the quit model. The policy model allows for the smoker to substitute between treatments and for policies to reduce treatment effectiveness. The SimSmoke computer simulation model is then used to examine policy effects on smoking rates and smoking attributable deaths. RESULTS: The model of quit behaviour predicts a population quit rate of 4.3% in 1993, which subsequently falls and then increases in recent years to 4.5%. The policy model suggests a 25% increase in quit rates from a policy that mandates brief interventions and the coverage of all proven treatments. Smaller effects are predicted from policies that mandate more restricted coverage of treatments, especially those limited to behavioural treatment. These policies translate into small reductions in the smoking rate at first, but increase to as much as a 5% reduction in smoking rates. They also lead to substantial savings in lives. CONCLUSIONS: Tobacco treatment policies, especially those with broad and flexible coverage, have the potential to increase smoking cessation substantially and decrease smoking rates in the short term, with fairly immediate reductions in deaths.

Computer Simulation↗

PubMed2001

A computer simulation model of mass media interventions directed at tobacco use.

OBJECTIVES: The goal of this study was to develop a simulation model to examine the effects of tobacco control mass media interventions on smoking rates and smoking-attributable deaths. METHODS: The model projects the number of smokers and smoking-related deaths. Based on empirical and theoretical research, the effects of media interventions, varying in magnitude and duration, directed at all smokers and directed specifically at youth under age 18 are modeled. RESULTS: The model predicts that sustained media interventions of sufficient magnitude and duration directed at all smokers have the potential to substantially reduce the number of smokers and premature deaths, with the effects growing over time. For the same expenditures, youth interventions would appear to have smaller and more delayed effects. CONCLUSIONS: Media interventions, particularly those targeted at the general population and of sufficient scale and duration, have the ability to substantially reduce smoking rates and save lives, but their effects are likely to depend on how they are implemented.

Adolescent↗

PubMed2001

Smoking treatment interventions and policies to promote their use: a critical review.

Despite evidence regarding the effectiveness and cost-effectiveness of smoking cessation treatments, the involvement of health care workers in providing advice and the use of treatment is limited. Barriers to treatment access have been suggested as part of the reason physicians do not routinely provide brief interventions and smokers do not use proven cessation methods. The purpose of this paper is to review tobacco treatments and policy research, and highlight where more research is warranted to develop more effective policies at the private and public levels. Special attention is devoted to the recently released Guidelines (Fiore et al., Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: USDHHS, 2000). We also consider the policy issues faced by private and public insurers, such as cost-effectiveness, the different forms that policies could take, and potential problems in implementing those policies. The efficacy of brief interventions and cessation treatments has been well studied. Less understood, however, is their impact in population-based investigations. In particular, more information is needed on the prevalence of their use and on how treatment use depends on prior smoking, treatment history, and demographic subgroup. Public and private health policies designed to increase access to cessation treatments and information dissemination through brief interventions by health care providers also have the potential to increase cessation. Further research on the impact of these interventions on use and quit rates, particularly over longer periods of time, and how these effects depend on the form of the intervention, is warranted.

Cost-Benefit Analysis↗

PubMed2001

A framework for evaluating and improving clean indoor air laws.

Recent attention has focused on clean indoor air laws as part of a comprehensive tobacco control strategy. Clean air laws have the potential to reduce smoking behaviors as well as second-hand smoke. Many states do not have these laws but most firms now have policies restricting smoking indoors. The authors developed a framework intended to guide in the evaluation and improvement of clean air laws. This article examines the relationship between public laws and private restrictions and how smoking restrictions are likely to affect smoking behavior throughout the population. The article also discusses the information needed to better understand clean air laws and improve future public policy.

Air Pollution, Indoor↗

PubMed2001

Effect of policies directed at youth access to smoking: results from the SimSmoke computer simulation model.

OBJECTIVES: To develop a simulation model to predict the effects of youth access policies on retail compliance, smoking rates, and smoking attributable deaths. METHODS: A model of youth access policies is developed based on empirical research and a theory of perceived risk. The model incorporates substitution into other sources as retail sales are restricted, and is used to project the number of smokers and smoking related deaths. Various policies to limit youth access to cigarettes are evaluated, and we explore how efficient policies may be developed. RESULTS: The model predicts that a well designed and comprehensive policy that includes sufficient compliance checks, penalties, and community involvement has the potential to reduce the number of young smokers. Because smoking related deaths occur later in life, the effects on health are largely delayed. CONCLUSIONS: A well designed youth access policy has the ability to affect youth smoking rates in the short term, and will lead to savings in lives in future years. The ability of retail oriented policies to reduce youth smoking, however, is limited. Other tobacco control policies, including those directed at non-retail sources of cigarettes, are also needed.

Adolescent↗

PubMed2001

Effect of clean indoor air laws on smokers: the clean air module of the SimSmoke computer simulation model.

OBJECTIVES: To develop a simulation model to examine the effects of clean indoor air laws on prevalence rates and smoking attributable deaths. METHODS: Based on empirical and theoretical research, the effects of clean air laws are modelled by type of law. The model considers clean air laws at the state levels between 1993 and 2000, and projects the number of smokers and smoking attributable deaths in the USA under different scenarios from 2000 onward. RESULTS: The model predicts that comprehensive clean air laws have the potential to reduce substantially the number of smokers and smoking attributable deaths, and these effects are predicted to grow over time. The predicted impact of new worksite laws are reduced when previously implemented private and public worksite restrictions are taken into account. CONCLUSIONS: Clean indoor air laws have the ability to reduce smoking rates substantially and save lives, but their impact is likely to depend on their comprehensiveness and prior private worksite restrictions in place.

Adult↗

PubMed2001

Financial risk, plan types, and authorizations for managed alcohol treatment services.

OBJECTIVE: To estimate the effects of a managed behavioral healthcare organization's (MBHO's) products/plans and financial risk on levels and amount of care authorized for patients with alcohol-related problems. STUDY DESIGN: Secondary analysis of 1995-1998 MBHO authorization files. PATIENTS: Individuals diagnosed as having an alcohol-related problem without comorbidities. METHODS: Episodes (n = 10,872) were constructed with 60-day clear zones. Multinomial regression equations were used to analyze the proportional distribution of care authorized within episodes at 5 levels: inpatient, residential, partial hospitalization, intensive outpatient, and traditional outpatient. Care equivalency hours were calculated to combine data across outpatient sessions and inpatient days. A linear regression equation analyzed quantity of care within episodes. Product/plan types, financial risk, state of residence, and participation in the MBHO's network were explanatory variables. Age, sex, diagnosis, and episode number were control variables. RESULTS: Most utilization management care hours authorized are inpatient and residential. Relative to other products/plans for managing care, utilization management leads to 50% more authorized hours. More financial risk does not predict fewer care units authorized but shifts hospitalizations toward residential treatment. Increasing age and higher-severity diagnoses predict more overnight care authorizations. Pennsylvania, which mandates minimum levels of care and follows American Society of Addiction Medicine criteria, has significantly more care authorized compared with 8 other states with data. CONCLUSIONS: Other than in utilization management, MBHO financial risk does not predict less care authorization. The MBHO authorizes higher-level care for older adults, for those with more severe diagnoses, and for those with episodes of care beyond the second. Authorization data do not necessarily reflect utilization but can provide a useful, partial view of management strategies.

Adult↗

PubMed2000

Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model.

OBJECTIVES: The aim of this study was to develop a simulation model to predict the effects of taxes on the smoking rate and smoking-attributable deaths. METHODS: The model projects the number of smokers and smoking-related deaths from a baseline year forward. The effects of taxes of different sizes, indexed and unindexed, and temporary vs sustained are modeled. RESULTS: The model predicts that sustained tax increases have the potential to substantially reduce the number of smokers and the number of premature deaths, with the effects growing over time. Indexing taxes to inflation stems erosion of the tax effect. CONCLUSIONS: Tax hikes have the ability to substantially affect smoking rates in the near term. These effects grow over time and lead to substantial savings in lives and health care costs.

Adolescent↗

PubMed2000

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

OBJECTIVES: The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. DATA SOURCES: Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. MEASURES: Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. RESULTS: More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. CONCLUSIONS: Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

Accident Prevention↗

PubMed2000

Gauging the effects of mass media policies: what do we need to know?

This article explores the components of an effective mass media policy and the role of mass media campaigns as part of a comprehensive set of tobacco control strategies. First, the main findings of the empirical literature are briefly reviewed. Then a framework for understanding mass media policies is developed showing the influence of concurrent tobacco control policies and the interrelationship between the two. A model will be presented that draws on concepts and research from the advertising and marketing literature, as well as from public health studies. A discussion of limitations of the extant literature and issues that warrant further examination will conclude.

Advertising↗