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PubMed2000

Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA.

OBJECTIVE: To describe the extent to which comprehensive statewide tobacco control programmes in the USA have made progress toward reducing teenage smoking. DATA SOURCES: Literature search of Medline for reviews of effectiveness of programme and policy elements, plus journal articles and personal request for copies of publicly released reports and working papers from evaluation staff in each of the state programmes of California, Massachusetts, Arizona, Oregon, and Florida. STUDY SELECTION: All studies, reports, and commentaries that provided information on aspects of programme implementation and evaluation. DATA SYNTHESIS: Statewide comprehensive programmes show high levels of advertising recall and generally positive improvement in smoking related beliefs and attitudes among teenagers. More fully funded programmes lead to increased mass media campaign advertising and community initiatives; a greater capacity to implement school based smoking prevention programmes; and an increase in the passage of local ordinances that create smoke free indoor environments and reduce cigarette sales to youth. The combination of programme activity and increased tobacco tax reduce cigarette consumption more than expected as a result of price increases alone, and these effects seem to apply to adolescents as well as adults. Programmes are associated with a decline in adult smoking prevalence, with these effects observed to date in California, Massachusetts, and Oregon. Arizona and Florida have yet to examine change in adult prevalence associated with programme exposure. California and Massachusetts have demonstrated relative beneficial effects in teenage smoking prevalence, and Florida has reported promising indications of reduced prevalence. Arizona has yet to report follow up data, and Oregon has found no change in teenage smoking, but has only two years of follow up available. One of the most critical factors in programme success is the extent of programme funding, and consequent level of programme implementation, and the degree to which this is undermined by the tobacco industry and other competitors for funding. CONCLUSIONS: Despite the different strengths and combinations of programme messages and strategies used in these comprehensive programmes, there is evidence that they lead to change in factors that influence teenage smoking, and to reductions in teenage smoking.

Adolescent↗
PubMed1989

Smoking habits and smoking cessation among North Carolina nurses.

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.

Cross-Sectional Studies↗
PubMed1993

The Healthy Worker Project: a work-site intervention for weight control and smoking cessation.

OBJECTIVES: A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS: Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS: Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS: This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.

Adult↗
PubMed1991

Surveillance of smoking during pregnancy in Sweden, 1983-1987.

Since 1982, prospective information on smoking during early pregnancy is reported to the Swedish Medical Birth Registry for nearly all (93%) women who give birth. The present paper studies the validity of this information: effects on birthweight and perinatal mortality are very similar to those described previously in the literature. For each parity class, smoking decreases in inverse proportion to increasing maternal age; for each maternal age class, smoking increases with parity. A slight reduction in smoking rate is observed between 1983 and 1987, most pronounced for young women. There are marked geographic and social differences in the rate of smoking during pregnancy. This dataset can be used in the future to monitor the prevalence of smoking, and to study various factors associated with smoking and the impact of countermeasures taken against smoking during pregnancy. It can also be used to study possible associations between maternal smoking and rare events like congenital malformations and child cancer.

Birth Weight↗
PubMed1994

Smoking cessation in pregnancy. Intervention among heavy smokers.

OBJECTIVE: To investigate the effects of a low cost multicomponent intervention program among pregnant heavy smokers. DESIGN: A randomized controlled experimental trial. SETTING: The National Hospital, Oslo, Norway. SUBJECTS: 104 pregnant women smoking 10 cigarettes or more daily at the time of routine ultrasound screening around the 18th week of pregnancy. INTERVENTION: Around the 18th week of gestation the women received information about the dangers of smoking in pregnancy together with a self-help manual. The manual was developed especially for pregnant women to aid smoking cessation during a 10 day program. A control ultrasound was performed around the 32nd week of pregnancy. Two encouraging reminders were mailed to them before and after the control ultrasound. MAIN OUTCOME MEASURES: Changes in smoking pattern were investigated at delivery time. Smoking cessation, reduction, increase and no change in smoking consumption was registered. RESULTS: 20% stopped smoking and 65% reduced their smoking in the intervention group compared to 4% and 38% respectively in the control group. 11% in the intervention group did not change their smoking habit and 4% increased their consumption compared to 36% and 22% respectively in the control group. The differences were highly significant. CONCLUSION: This low cost multiple intervention model seems more effective than other intervention models investigated in Norway. The resources invested are probably within the limits of the common pregnancy health care.

Adult↗
PubMed1992

[Efficacy of individual smoking cessation instructions for general smokers among clients of a health center].

Smoking cessation instruction for individuals using a standardized smoking cessation manual and a handout developed by the authors was studied in a controlled trial among employees who visited a health center for Industrial Safety and Health Law mandated annual health examinations. Smokers in the study group were given 5-10 minutes smoking cessation instruction mainly by public health nurses and nutritionists following the above-mentioned manual and using the handouts. Subjects in both groups were interviewed by telephone to assess changes in smoking habits one month after the first contact. Smoking clients who came on Friday (132) and on Monday (93) were assigned to study and control groups, respectively. One hundred and nineteen members (90.2%) of the study group and 88 (94.6%) of the control group were successfully followed until one month after the initial contact. Seven subjects in the study group were not smoking one month after the instruction, while no one gave up smoking in the control group (p less than 0.05). It was confirmed by telephone survey that 6 of the 7 subjects who were not smoking at one month were still maintaining abstinence from smoking one year after the instruction. Smokers who did not stop smoking reported a reduction in their smoking dose in the study group. Lighter smokers reacted more readily to instruction than did heavier smokers and the knowledge level of subjects was positively associated with the success rate.

Adolescent↗
PubMed2006

Smoke from traditional commercial, harm reduction and research brand cigarettes impairs oviductal functioning in hamsters (Mesocricetus auratus) in vitro.

BACKGROUND: Cigarette smoke from 2R1 research brand cigarettes and specific toxicants in smoke inhibit oviductal functioning. Our purpose was to test the hypothesis that smoke from commercial cigarettes, including harm reduction cigarettes, inhibits oviductal functioning and to measure the concentration of previously identified toxicants in smoke from research and commercial cigarettes. METHODS: Mainstream (MS) and sidestream (SS) smoke solutions from two research, six traditional commercial and three harm reduction brands were tested in vitro using an oviductal assay that measures ciliary beat frequency, oocyte retrieval rate and smooth muscle contraction. RESULTS: Generally, smoke from each brand of cigarette was inhibitory in the three oviductal bioassays. SS, the major component of environmental tobacco smoke, was usually more inhibitory than MS, the smoke inhaled by active smokers. Nine cigarette toxicants, previously shown to be highly inhibitory in the oviductal bioassays, were quantified in MS and SS. 4-Methylpyridine, which was inhibitory by itself in picomolar doses, was present in the highest concentration in MS and SS solutions from all brands tested. In general, toxicant concentrations were higher in SS than in MS solutions. CONCLUSIONS: These data show that commercial brands of cigarettes, including harm reduction cigarettes, contain toxicants that inhibit biological processes in the oviduct and could affect reproductive outcomes.

Animals↗
PubMed2026

Effect of flavored on!® nicotine pouch products on smoking behaviors: A sequential, multiple assignment, randomized controlled trial.

PURPOSE: To evaluate whether flavored versus unflavored nicotine pouch (NP) access affects cigarette reduction and smoke exposure among adults who smoke daily, and whether delayed flavor introduction affects these outcomes. METHODS: Adults who smoked ≥ 5 cigarettes/day (CPD) with interest in replacing cigarettes with NPs were enrolled in a remote, six-week, sequential multiple assignment randomized trial (n = 402 randomized; n = 400 analyzed). Participants were randomized to immediate access to seven NP flavors (Flavor), unflavored-only access for six weeks (Original), or unflavored-only for three weeks followed by flavor access (Delayed Flavor). Primary outcomes were ≥ 50% reduction in weekly mean expired-air carbon monoxide (CO) from baseline and mean CO at Week 6. Secondary outcomes included ≥ 50% CPD reduction, mean CPD, CO-verified 7-day abstinence, and incident smoke-free days. RESULTS: At Week 6, Flavor and Original did not differ in ≥ 50% CO reduction (14.3% vs 14.2%; IRR=1.0, 95% CI=0.6-1.8) or mean CO (18.3 vs 16.5 ppm; β=1.9, 95% CI=-1.3-5.0). CPD decreased across groups by Week 6, with no differences between Flavor and Original in ≥ 50% CPD reduction (50.3% vs 51.6%; IRR=1.0, 95% CI=0.8-1.2) or CO-verified abstinence (9.3% vs 8.9%; IRR=1.0, 95% CI=0.5-2.2). Flavor increased smoke-free days early, with attenuation over time. Among Week 3 non-responders, delayed flavor access increased ≥ 50% CPD reduction at Week 6 (33.3% vs 18.6%; IRR=1.8, 95% CI=1.0-3.2). CONCLUSIONS: NP access supported cigarette reduction regardless of flavor availability, but flavors may accelerate smoke-free days and improve response among individuals who do not reduce cigarette consumption with unflavored products alone.

Humans↗
PubMed1984

Skin blood flow reduction induced by cigarette smoking: role of vasopressin.

The effect of vasopressin released by cigarette smoking on blood pressure (BP), heart rate (HR), and skin blood flow (SBF) was investigated in 12 normotensive habitual smokers. At a 1-wk interval, each subject smoked within 10 min two cigarettes before and after intravenous injection of either the specific vascular vasopressin antagonist d(CH2)5Tyr(Me)AVP (5 micrograms/kg) or its vehicle administered in double-blind fashion. SBF was assessed with a laser Doppler flowmeter. Smoking increased plasma vasopressin (P less than 0.01). In six subjects subsequently treated with the antagonist, plasma vasopressin rose to greater than 10 pg/ml and SBF fell by 18.2 +/- 4.8%. This SBF reduction was prevented by the vasopressin antagonist. In contrast, the vehicle had no effect. In the 24 studies taken together, there was a significant correlation (r = -0.60, P less than 0.01) between the SBF decrease during the first smoking period and the plasma vasopressin levels measured afterwards. The BP and HR rise caused by smoking was not modified by the antagonist. Thus it appears that the decrease in SBF induced by smoking is due to enhanced vasopressin secretion.

Adolescent↗
PubMed1981

Changes in smoking, serum cholesterol and blood pressure levels during a community-based cardiovascular disease prevention program--the North Karelia Project.

A comprehensive community-based program to control cardiovascular disease was carried out in North Karelia, Finland, in 1972--1977. Reductions in smoking, serum cholesterol and blood pressure (BP) levels were among the central intermediate objectives. The effect was evaluated by examining independent population samples at the outset and at the end, both in the program area and in a matched reference area. More than 10,000 subjects were studied each time (participation rate about 90%). This paper presents the analyses of the estimated effect of the program on the risk factor means by comparing the baseline and terminal situations among the population aged 30--59 years. The effect of the program among men was estimated to be a reduction of 13% in smoking, 4% in serum cholesterol and 3% in systolic and diastolic BP means. Among women, there was a net reduction of 5% in systolic BP and 4% in diastolic BP means. The net reductions in smoking (8%) and serum cholesterol (1%) among women were within sampling variation. It is concluded that the population means of the major coronary heart disease risk factors were reduced during the program more in the intervention area than in the reference area, and it seems likely that most of this difference was due to the program.

Adult↗
PubMed1983

Maternal diseases, alcohol consumption and smoking during pregnancy associated with reduction limb defects.

To evaluate the association of acute and common chronic diseases, alcohol consumption and smoking during pregnancy with reduction limb defects (RLD) 453 cases of RLD from the Finnish Registry of Congenital Malformations were studied. RLD cases without additional malformations were analyzed separately. Statistical associations were observed with maternal influenza. Alcohol consumption, and smoking were likewise associated with the defects. Medication, fever and/or other factors may explain the association of RLD with influenza. The relation to smoking was not explained by alcohol consumption or mother's age, and these variables were independent of each other.

Adult↗
PubMed2006

Time and generational trends in smoking among men and women in Great Britain, 1972-2004/05.

This article examines General Household Survey data from 1972 to 2004/05. It describes trends in cigarette smoking over time, observes how prevalence by age has changed over the last four decades, then examines pseudo-cohort trends in cigarette smoking for both men and women in Great Britain. The findings show that, for men, there were generational reductions in smoking prevalence, and when this trend began to slow, a trend for generational reductions in heavy smoking started. The remaining smokers were less likely to smoke 20 or more cigarettes than those in previous cohorts. However both these trends have now stopped, suggesting the levels of cigarette consumption we are observing today among men may be maintained in future generations if these patterns continue.

Adolescent↗
PubMed2005

Short-term impact of smoking cessation on myocardial infarction and stroke hospitalisations and costs in Australia.

OBJECTIVE: To estimate the short-term benefits of a reduction in smoking on acute myocardial infarction (AMI) and stroke hospitalisations and costs. DESIGN AND SETTING: Epidemiological study which applied functions describing reductions over time in risk of AMI and stroke in people quitting smoking to hospitalisation rates and costs for Australia. MAIN OUTCOME MEASURES: The numbers of AMI and stroke hospitalisations in 35-64-year-olds and the associated costs that could have been avoided over a 7-year period from 2001-02 if smoking prevalence had decreased by 1% in the first year (Scenario 1) or by 1% per annum for 5 consecutive years (Scenario 2). RESULTS: Under Scenario 1, almost 1000 hospitalisations for AMI and about 350 hospitalisations for stroke would have been avoided over 7 years, saving about $20.4 million in health care costs. Under Scenario 2, over 3000 AMI hospitalisations and over 1000 stroke hospitalisations would be avoided, and health care costs could be reduced by $61.6 million (2.75% of costs for AMI and stroke over the period). CONCLUSIONS: This study provides further support for the proposition that modest and achievable reductions in smoking rates can substantially improve health outcomes and reduce health care costs, even in the short term.

Adult↗
PubMed1996

A meta-analysis of smoking prevention programs after adjustment for errors in the unit of analysis.

This article presents the results of a meta-analysis designed to test the prevailing view that we largely understand why adolescents start to smoke and how to delay it. This view has developed even though none of the major reviews of the last 12 years has adjusted for the important methodological problems that all of those reviews identified as common in the published literature. School-based smoking prevention programs based on peer or social-type programs, published between 1974 and 1991, were included in this meta-analysis. Treatment characteristics were used to predict an effect size after adjustment for study design and population characteristics, and in particular, after a post hoc correction for errors in the original unit of analysis. The results suggest that the average effect for peer or social-type programs is likely to be quite limited in magnitude, and that the reduction in smoking may be only 0.10 standard deviation units, or perhaps 5%. Even under optimal conditions, the reduction in smoking may be only 0.50 to 0.75 standard deviation units, or perhaps 20%-30%.

Adolescent↗
PubMed2005

Mixed messages: a qualitative study of the meanings and context of high school students' tobacco use in Turkey.

Although smoking by adults in Turkey is a widely practiced, socially accepted habit, social influences on tobacco uptake by Turkish youth have been studied little. This paper reports findings from interviews (42 10th graders plus 10 other students and 24 adults) and three focus groups in a study with high school students in Dursunbey, Turkey. Interviewees reported that youth smoking is not culturally acceptable, but that contradictory messages and pressures abound. A context in which smoking is embedded in men's and women's social environments influences many youth to become smokers. Smoking is expected of men by the time they enter military service or are economically independent. Smoking by women, especially professionals, is increasingly common. Although virtually all adults disapprove of youth's smoking as age-inappropriate behavior, ubiquitous counter-examples of adult smoking in homes, schools, coffee houses and media dilute tobacco controls. Few youth or adults expressed concern about the relationship of tobacco to health. Sanctions in family and school environments are little enforced. Students' smoking-related attitudes and behaviors appear modeled more after behavior of their teachers than their less-educated parents, and smoking is common by teachers at school. Reduction of smoking by Turkish youth calls for comprehensive, sustained programs to de-normalize tobacco use in family, school and other settings, with special attention to smoking uptake by young women.

Adolescent↗
PubMed1990

Smoking in a public health agency: its relationship to sick leave and other life-style behavior.

A survey questionnaire was administered to employees of a public health agency regarding their involvement with smoking and other life-style behavior. Responses were analyzed and combined with sick leave data to determine the use of sick leave among employees who currently smoke, those who never smoked, and those who formerly smoked. Current smokers took significantly more sick leave than those who have never smoked ("nonsmokers") or former smokers. Using an analysis of variance model, only smoking status, education level, and sex, among selected demographic variables, were significantly related to the amount of sick leave taken. Current smokers took excess sick leave (amounting to nearly $40,000) as compared with nonsmokers and ex-smokers combined over a 21-month period. This study also characterizes the relationship between smoking status and selected life-style behavior. Smokers were less active, less likely to use seat belts, less likely to believe that smoking is related to health, and more likely to be heavier and to eat a poor diet than their nonsmoking or former smoking counterparts. We make suggestions regarding the reduction of smoking and other deleterious behavior as a means of controlling costs and reducing employee morbidity.

Absenteeism↗
PubMed1986

International control of smoking and the US experience.

International data demonstrate convincingly that lung cancer death rates follow and parallel cigarette smoking prevalence rates in both men and women. Effective control of lung cancer and the many other diseases associated with smoking can be achieved only by continued reductions in smoking prevalence in developed countries and the arrestment of smoking in developing countries. Smoking control strategies can take the form of prevention programs, cessation programs, regulatory and legislative measures, and modifications in tobacco product composition. Because of uncertainties surrounding the efficacies of specific smoking control approaches, the National Cancer Institute recently initiated a major intervention research program to identify and assess the most promising strategies to reduce smoking prevalence in the general public and high-risk populations; heavy smokers, blacks, Hispanics, women, youth, and smokeless tobacco users. By 1990, trial results will be available to allow systematic application of smoking control strategies (demonstrations) using physicians and dentists, mass media, school programs, self-help materials, and the community as a laboratory. For a number of reasons, such approaches are strongly recommended over efforts to reduce cigarette tar and nicotine levels as the primary focus of lung cancer control.

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