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Counting the costs of children's smoking.

The recent publication of the 1994 OPCS survey of smoking among secondary school children confirmed that the Health of the Nation target for children's smoking (a reduction in regular smoking from 8% in 1988 to less than 6% in 1994) has not been achieved. In 1994, 12% of English schoolchildren aged 11-15 were regular smokers (as were 12% in Scotland, 9% in Wales, and 12.5% in Northern Ireland). In 1994 the government spent around 10 million pounds on initiatives to prevent smoking, but received around 8643 million pounds in tax receipts from tobacco sales, about 108 million pounds of which was tax receipts from the illegal sale of cigarettes to children under 16 years old. The tobacco industry spent an estimated 100 million pounds on promotional activities. Improving current trends in children's smoking by the year 2000 will require decisive action by the government. The government should legislate to ban tobacco advertising and should use the 108 million pounds taken each year in taxes from smoking children to fund smoking cessation and prevention initiatives.

Adolescent↗

How state counter-industry campaigns help prime perceptions of tobacco industry practices to promote reductions in youth smoking.

OBJECTIVE: This study assessed the impact of state media campaigns that prominently feature counter-industry messages on youth cigarette smoking, beyond the effects of price, secular trends, tobacco control efforts, and the national truth campaign. METHODS: Rates of youth smoking were compared in three groups of states: (1) those with long funded counter-industry campaigns (California, Florida, and Massachusetts); (2) states with more recently funded counter-industry media campaigns (Indiana, Minnesota, Mississippi, and New Jersey); and (3) other states. An analysis was performed for a series of national telephone surveys of 12-17 year olds between 1999 and 2002, controlling for differences in demographic background, the price of cigarettes, and exposure to the national truth campaign. RESULTS: Between 1999 and 2002, rates of current smoking and established smoking decreased significantly faster in states with established or more newly funded counter-industry campaigns than in other states. State counter-industry campaigns appear to prime, or make more salient, negative perceptions about tobacco industry practices. CONCLUSION: Results highlight the value of continued state counter-industry campaigns.

Adolescent↗

Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey.

OBJECTIVE: To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004. DESIGN: Quasi-experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n = 769) and the UK (n = 416), surveyed before the law (December 2003 to January 2004) and 8-9 months after the law (December 2004 to January 2005). MAIN OUTCOME MEASURES: Respondents' reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law. RESULTS: The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke-free law was a "good" or "very good" thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post-legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit. CONCLUSION: The Ireland smoke-free law stands as a positive example of how a population-level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.

Adolescent↗

Reduction of cigarette smoking in a university cafeteria.

Passive smoking has been shown to be hazardous to the health of nonsmokers. Given this documented link between exposure to smoke-filled environments and deleterious health consequences, there is a need to develop effective procedures that establish and maintain no-smoking areas in various public settings. The present study focused on decreasing cigarette smoking in a section of a university cafeteria. Posting of no-smoking signs was found to decrease levels of smoking only minimally. However, when smokers were verbally prompted not to smoke, in the presence of the signs, marked decreases in smoking occurred in the target area.

Adult↗

Cost reductions from a smoking policy.

The health of its workforce is of paramount importance to a business. The loss of even one key person to heart and lung disease can have a detrimental effect on organizational efficiency. Provided strides similar to those made in the last five years continue, perhaps within the next five years major employers will have all work areas smoke free. In large cities considerable help in implementing a nonsmoking policy is available to employers. Individual companies need to consider the merits of each type of program and then decide which best fits the organization. Compared with a nonsmoker, the average employed smoker in the United States 1. Takes approximately 50% more sick leave 2. Uses the health care system at least 50% more 3. Suffers over twice the mortality rate during working years 4. Spends 6% of working hours smoking 5. Causes indoor work facilities to expend six times the capital and operating outlays to maintain air circulation rates that meet building code specifications 6. Imposes a much greater maintenance burden for cleaning, repairing, repainting and replacing furnishings and equipment 7. Imposes unnecessary costly liability on employers for damages sustained by co-workers who are forced to work in a smoky environment 8. Exacts a high price in employee morale because of the irritation and discomfort suffered by fellow workers.

Cost Control↗

Controlled smoking.

The health risks of smoking are related to the interaction of what is smoked, smoking rate, and the topography of consumption. Assessment and treatment efforts should take all three of these factors into account. A working model of smoking behavior is proposed which involves the consideration of antecedents, concomitants, and consequences of smoking on cognitive, behavioral, situational and physiological levels. Further, the relative importance of these factors is not assumed to be the same across individuals. An approach to smoking risk reduction, called controlled smoking, is proposed which includes the elements of: (1) comprehensive assessment, (2) individualized goals, (3) emphasis on regulation, and (4) a skill development approach to treatment. Finally, some possible commonalities among behavioral approaches to substance abuse are presented.

Behavior Therapy↗

[Risk reduction strategies in smoking].

INTRODUCTION: Around the world, due to its high efficiency in delivering nicotine, cigarette is, by far, the first device used to consume tobacco. But, as far as health is concerned, cigarette is the worst nicotine delivery system and cleaner delivery systems would be welcome. In respect to tobacco smoking, up to now, most doctors have supported the "quit smoking or die" dogma. However, some smokers cannot or do not want to completely give up the consumption of nicotine. BACKGROUND: Indeed, while some smokers can stop smoking and, for some of them, simply switch to a nicotine replacement therapy (NRT), other smokers crave the acute effects associated with the rapid massive surge of nicotine delivered to the brain by tobacco smoke. Currently, this rapid nicotine "high" is mainly experienced by smoking cigarettes, thus explaining the high rate of smoking relapse. VIEWPOINT: Thus, for smokers who cannot totally give up nicotine, it is sound to evaluate the rationale for the use of tobacco products with possible lower toxicity than cigarette smoke. CONCLUSIONS: Unfortunately, this important question triggers off passionate statements, while scientific and experimental observations are still very tenuous. Furthermore, the tobacco companies, by producing new tobacco products and promoting the use of smokeless tobacco such as snus, put a constant pressure on the Public Health community.

Adolescent↗

Maternal smoking during pregnancy and limb reduction malformations in Sweden.

OBJECTIVE: This study was undertaken to investigate a possible connection between different types of limb reduction defects and maternal smoking during pregnancy. METHODS: With the use of the Swedish health registries, 610 cases of limb reduction malformations were selected from among 1 109 299 infants born between 1983 and 1993 with known smoking exposure in early pregnancy. Confounders such as maternal age and parity were controlled for with the use of the Mantel-Haenszel technique. RESULTS: The odds ratio for any maternal smoking among all cases of limb reductions was 1.26 (95% confidence interval = 1.06, 1.50). The main subgroups of limb reduction defects showed similar odds ratios, but in longitudinal reduction defect, only unilateral cases showed an association with maternal smoking. CONCLUSIONS: This study supports an association between maternal smoking and limb reduction malformations, but further work is needed before a causal inference can be made.

Confounding Factors, Epidemiologic↗

A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia.

The purpose of this study was to investigate the effect of adding sustained-release (SR) bupropion to cognitive behavioral therapy (CBT) on smoking behavior and stability of psychiatric symptoms in patients with schizophrenia. We conducted a 3-month, double-blind, placebo-controlled trial of bupropion SR, 150 mg/day, added to a concurrent CBT program with 3-month follow-up in 19 stable outpatients with schizophrenia who wanted to quit smoking. Eighteen subjects completed the trial. Bupropion treatment was associated with significantly greater reduction in smoking, as measured by self-report verified by expired-air carbon monoxide (6/9 subjects, 66%), than placebo (1/9 subjects, 11%) during the 3-month active treatment period and the 3-month follow-up period. One subject in the bupropion group (11%) and no subjects in the placebo group achieved sustained tobacco abstinence for the 6-month trial. Bupropion treatment was associated with improvement in negative symptoms and greater stability of psychotic and depressive symptoms, compared with placebo, during the quit attempt. Subjects in the bupropion group experienced significant weight loss, compared with those on placebo during the smoking cessation attempt. These data suggest that bupropion SR, 150 mg/day, combined with CBT, may facilitate smoking reduction in patients with schizophrenia while stabilizing psychiatric symptoms during a quit attempt.

Aged↗