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Payroll contracting for smoking cessation: a worksite pilot study.

Twenty-one men and 38 women participated in a worksite smoking cessation/smoking reduction program that combined financial contracts, organized through payroll deduction, and biweekly group treatment sessions. At the end of the program the smoking cessation rate was 51%, validated by expired air carbon monoxide. Six months later the validated cessation rate was 12%. We conclude that payroll incentives may be effective in helping workers quit smoking and offer suggestions for ways to promote better maintenance of this important behavior change.

Adult↗

Smoking cessation in patients with cardiopulmonary disease: an initial study.

Thirty-five smokers, all with current, long-standing, cardiovascular or pulmonary disease, were randomly assigned to either health motivation treatment, or to aversive smoking. The former included self-management skills, a film model, verbal commitment, and discussion of the costs and benefits of smoking and abstinence. The latter included normally paced (every 30 sec.) aversive smoking, relaxation training, role playing high risk situations, and discussion of maladaptive thought patterns. Strong differences between the conditions in abstinence rate and reduction from baseline did not emerge; however, the data generally favored the health motivation condition both in attrition rates and in outcome immediately posttreatment and at six month follow-up. Negative mood states were found to be related to minimal reduction in smoking; and consistent mood dysphoria at pre and posttreatment predicted relapse at three month follow-up.

Affect↗

The effects of clean indoor air laws: what do we know and what do we need to know?

Our objective was to review the research on the effects of public clean air laws on smoking rates, compare these effects to those found in studies on the impact of private worksite restrictions and derive estimates of the potential reductions in smoking rates that might be expected from the implementation of the two types of policies. Data sources were computerized databases, references identified from pertinent peer-reviewed journal articles and books, and suggestions by experts on tobacco control policy. Comprehensive public clean air laws have the potential to reduce prevalence and consumption rates of the entire population (including non-working and non-indoor working smokers) by about 10%. Studies on private worksite regulations also suggest that strong worksite restrictions have the potential to reduce the prevalence rate of the entire population by about 6% over the long-term and the quantity smoked by continuing smokers by 28%, depending on the length of time after the ban. Further research is needed on the effects of the different types of public clean air policies on the entire smoking population and on different sociodemographic groups, how the effects of public clean indoor air laws depend on private restrictions already in place, and how the effect of private restrictions depend on whether or not they are supported by public clean air laws.

Adolescent↗

Minors' access to tobacco--Missouri, 1992, and Texas, 1993.

Approximately 75% of adults who have regularly smoked cigarettes tried their first cigarette before their 18th birthday, and about half became regular smokers by age 18 years. Despite the importance of reducing smoking among adolescents, the prevalence of smoking among high school seniors has not decreased substantially from 1981 through 1991. National health objectives for the year 2000 have targeted substantial reductions in smoking among persons aged < 20 years, and reducing access to cigarettes through laws or statutes is an important strategy in reaching this goal. This report describes the results of efforts in two states--Missouri and Texas--to characterize access of minors to cigarettes and other tobacco products.

Adolescent↗

Impact of smoking, physical training and weight reduction on FVII, PAI-1 and hemostatic markers in sedentary men.

The variations of FVII, PAI-1, TAT complexes, fibrinopeptide A, D-Dimers and beta thromboglobulin plasma levels were studied on 30 sedentary men, smokers and non-smokers, who were admitted to a 6 months' program of physical training and smoking cessation. After 3 months of intervention, sustained physical training was associated with the decrease of FVII and PAI-1 levels. Mild exercise performed during a second 3-month period could maintain normal FVII and PAI-1 activities but participants who stopped the training increased their FVII and PAI-1 plasma levels. FVII was not influenced by smoking habits. Smoking cessation seemed to slightly potentiate the decrease of PAI-1 levels associated with mild exercise. Overweight, FVII and PAI-1 levels were correlated and the weight reduction induced by training was related to the changes in the factors. In smokers, physical exercise was associated with a significant increase of hemostatic markers. This exercise-induced variation disappeared after 3 months of intervention in participants who stopped smoking and reappeared in those who smoked again after 6 months of intervention. This finding was not influenced by the physical training program.

Antithrombin III↗

Commentary on the hypermetabolic state and the role of oxygen in alcohol-induced liver injury.

Centrilobular hypoxia has been postulated as a mechanism for the development of hepatocellular necrosis and fibrosis in alcoholic liver disease. Chronic ethanol ingestion in rodents results in increased hepatic oxygen consumption and in a steeper fall in oxygen tension between the periportal and the pericentral area of the lobule, rendering the pericentral area susceptible to hypoxia. Hepatocellular necrosis occurs when ethanol-fed animals are exposed to low atmospheric oxygen. In man, the existence of a hypermetabolic state is more tenuous, but suggested by an increased rate of ethanol elimination after chronic ethanol consumption that has been linked to increased oxygen consumption in animals. Also, decreases in hepatic blood flow and hepatic vein oxygen tension were found in alcoholics with histological evidence of liver-cell necrosis as compared to those without necrosis. It is postulated that in man, reduction in the availability of oxygen to the liver may be caused by miscellaneous conditions such as anemia, respiratory depression or infection, cigarette-smoking, or reduction of hepatic blood flow, but the contribution of one or more of these factors remains to be proven. Trials of the effect of propylthiouracil (PTU) on alcoholic hepatitis are based on the effect of this drug in decreasing the ethanol-induced hypermetabolic state and in preventing hepatocellular necrosis in animals exposed to low atmospheric oxygen. A tentative conclusion of the two small trials that have been completed is that PTU may be beneficial in moderately ill patients with a low mortality, but not useful in severely ill patients with a high mortality.

Alcohol Dehydrogenase↗

[Smoking and attitude to smoking in Norway].

Prohibition of smoking on flights has received much public attention, and one has the impression that Norway lies ahead of other countries as regards regulation and reduction of smoking. According to a recent international comparison, quite the opposite seems to be the case. Norway has the worst figures compared with other Western countries. A local study conducted over the past ten years shows that attitudes towards smoking have changed dramatically, but there has been no change in the number of daily smokers. We suggest some ways of achieving a more smoke-free environment and reducing passive smoking.

Adult↗

Personality traits, perceived risk, and risk-reduction behaviors: a further study of smoking and radon.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p < .05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of extraversion (p < .01). Greater perceived risk predicted whether highly or moderately conscientious women quit smoking (p < .05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions.

Female↗

Reducing tobacco harm: research challenges and issues.

The emergence of potential reduced-exposure tobacco and cigarette-like products and the reduction of smoking as a treatment approach, have recently been forcing the debate and discussion about the science that is necessary to inform policies, regulation, and programs. To deal effectively with the issues evolving around tobacco harm reduction, a comprehensive and strategic research agenda must be forged, and a multi-disciplinary, collaborative approach must be taken. The goal of this article is to describe research challenges and issues related to tobacco exposure and harm reduction. Scientists from multiple disciplines and individuals from government agencies, nonprofit organizations, and tobacco control advocacy groups as well as the pharmaceutical and tobacco industries attended a two-day meeting that focused on addressing the current knowledge regarding tobacco harm reduction, identifying gaps in knowledge, and recommending research directions. Workgroups, comprising a subset of attendees, met after the conference to synthesize, discuss, and prioritize the important research frontiers. The resulting document provides guidance for scientists, grant funding agencies, industry and policy makers by identifying areas in which to invest research effort and funds to develop a science base to ensure the future health of this nation and world.

Communication↗

Alleviation of wood smoke-induced lung injury by tachykinin receptor antagonist and hydroxyl radical scavenger in guinea pigs.

We recently reported that wood smoke inhalation initially (within 5 min) causes airway injury and subsequently produces both airway and parenchymal injury after a delay (within 2 h). In this study, we investigated the mediator mechanisms of this delayed smoke-induced lung injury in 126 anesthetized and artificially ventilated guinea pigs who received challenges of either air or 40 tidal breaths of wood smoke. Two hours after inhalation, wood smoke produced various injurious responses, including increases in alveolar-capillary permeability, microvascular permeabilities, and histological injury scores, in airway and parenchymal tissues. Pre-treatment given before smoke challenge with CP-96,345 [a tachykinin NK1 receptor antagonist; (2S,3S)-cis-2-(diphenylmethyl)-N-((2-methoxyphenyl)-methyl)-1-aza bicyclo(2.2.2.)-octan-3-amine], dimethylthiourea (a hydroxyl radical scavenger), or a combination of these two drugs largely alleviated both the airway and parenchymal responses, whereas pre-treatment with SR-48,968 [a tachykinin NK2 receptor antagonist; (S)-N-methyl-N(4-(4-acetylamino-4-phenylpiperidino)-2-(3,4-dichlorophenyl)-butyl)benzamide] or a combination of CP-96,344 and SR-48,965 (inactive enantiomers) failed to do so. Post-treatment given at 5 min after smoke challenge with CP-96,345 or dimethylthiourea significantly alleviated the parenchymal responses, while having no effect on the airway responses. Pre-treatment with dimethylthiourea prevented the smoke-induced reduction in airway neutral endopeptidase activity (an enzyme for tachykinin degradation). We concluded that (1) tachykinins and hydroxyl radical play important roles in producing smoke-induced delayed lung injury in guinea pigs, and both may be involved in the spread of injury from the airways to the pulmonary parenchyma, and (2) the contribution of tachykinins is mediated via the activation of tachykinin NK1 receptors, and is associated with the hydroxyl radical-induced inactivation of airway neutral endopeptidase.

Animals↗

Lessons from falling coronary heart disease mortality in the United States.

The marked decline in coronary heart disease mortality in the United States since the late 1960s is most likely due in large part to successful efforts at primary prevention, attributable in turn to improved eating habits, better control of blood pressure and a reduction in smoking. Another part of the decline can probably be explained by an improvement in prognosis. It remains to be established if there has been a reduction in morbidity as well as mortality. There are other countries which have experienced declines, though of a lesser degree, while several countries have recorded increases in coronary heart disease mortality. These downward and upward turns, in general, are likewise compatible with the theory that they are caused by corresponding favourable or unfavourable changes in life styles.

Adult↗

[Prevention: a real possibility to repress lung cancer]

In the lack of effective treatment, the role of prevention has increased in the repressing of lung cancer. Smoking being a pathogenetic factor in the development of lung cancer is an accepted fact. Because of this, primer prevention means first of all the reduction of smoking both with the help of preventing smoking and cessation. A bigger - historical - debate has developed around secunder prevention: the effective screening of lung cancer. Although it was observed that staging rate and resecability had been more advantageous in the screened group, the screening of lung cancer was declared ineffective, because mortality did not improve. The change of approach can be felt from the middle of the 90's. Nowadays the creation of a multimodal lung cancer preventional strategy is in the center of researches. The screening of risk groups can mean the solution with the aid of biomarkers, chest X-ray and spiral CT. In Hungary, with the infrastructure of existing lung-screening network the up-to-date screening of risk groups seems to have reality in the near future.

Journal Article↗

An evaluation of quantitative and qualitative assessment techniques on the impact of the SERR curriculum.

This study measured the effectiveness of a smoking risk reduction program for sixth grade students using a pretest/posttest control group design with the addition of a nonequivalent control group. Knowledge of the health consequences of smoking, decision-making, resistance-to-persuasion skills, and tobacco use were analyzed quantitatively; program implementation, participant views of the program, and program effects were analyzed qualitatively; and the quantitative data were analyzed in terms of its consistency with the qualitative data. Analysis of quantitative results revealed significant differences between groups on the smoking knowledge test, decision-making skills, and resistance-to-persuasion skills. Qualitative results not only substantiated quantitative results, but also revealed overall participant satisfaction with the program. They also indicated the need for a close working relationship between teachers, state and local health educators, reorganization of the curriculum, and relinquishing of curriculum to school districts for self-scheduling and organization. Utilization of both methods of analysis yielded a closer estimate of total program impact than if only method of analysis had been used.

Attitude to Health↗

Modifying risk of developing lung cancer by changing habits of cigarette smoking.

Data from a hospital based case-control study of lung cancer in Western Europe were used to examine changes in the risk of developing lung cancer after changes in habits of cigarette smoking. Only data for subjects who had smoked regularly at some time in their lives were included. The large size of the study population (7181 patients and 11 006 controls) permitted precise estimates of the effect of giving up smoking. Risks of developing lung cancer for people who had given up smoking 10 or more years before interview were less than half of those for people who continued to smoke. The reduction in risk was seen in men and women and in former smokers of both filter and non-filter cigarettes but varied by duration of smoking habit before giving up. The protective effect of giving up became progressively greater with shorter duration of smoking habit. The risks after not smoking for 10 years for both men and women who had previously smoked for less than 20 years were roughly the same as those for lifelong non-smokers. Reducing the number of cigarettes smoked a day or switching from non-filter to filter cigarettes also lowered the risk of developing lung cancer but not to the extent associated with giving up smoking.

Europe↗

Format and quitting instructions as factors influencing the impact of a self-administered quit smoking program.

This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by-day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self-help booklets were developed for comparison in this study. Each varied on a combination of the two study factors, but were similar in content, length, style, and readability. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigarette smokers who called a stop smoking hotline in Buffalo, New York seeking information on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects reported of being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self-management skills were no more effective than the control booklet (6 month non-smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting.

Adolescent↗

Why the tobacco industry fears the passive smoking issue.

The tobacco industry has identified the passive smoking issue as the single most important problem confronting its economic future. During the 1980s, the industry has been engaged in an elaborate and expensive international campaign seeking to refute the evidence against passive smoking's effects on health and to position the issue as one essentially concerned with civil liberties and smokers' "rights." There are three main reasons for the industry's concern: first, the passive smoking issue allows a widening of the definition of smoking beyond its discussion as a personal habit, legitimizing it as a social problem; second, successful cases of litigation against employers by workers with histories of chronic exposure to environmental tobacco smoke have created an industrial climate of concern leading to workplace smoking restrictions and bans, and third, the proliferation of smoking restrictions reduces smoking opportunities and thus reduces total cigarette consumption and hence financial returns to the industry. Based on the results of a large Australian study of a workplace smoking ban, an estimated 654.88 million cigarettes with a retail value of $A6,549 thousand would be forgone annually in Australia alone if 50 percent of white-collar worksites were to ban smoking. Finally, the passive smoking issue can be considered a Trojan horse to its less discussed effects: the reduced morbidity and mortality likely to result in smokers from the significant reductions in smoking frequency that occur with the proliferation of smoking restrictions introduced in the name of concern for the health of nonsmokers.

Commerce↗

The causes and prevention of cancer: gaining perspective.

Epidemiological studies have identified several factors that are likely to have a major effect on reducing rates of cancer: reduction of smoking, increased consumption of fruits and vegetables, and control of infections. Other factors include avoidance of intense sun exposure, increased physical activity, and reduced consumption of alcohol and possibly red meat. Risks of many types of cancer can already be reduced, and the potential for further reductions is great. In the United States, cancer death rates for all cancers combined are decreasing, if lung cancer (90% of which is due to smoking), is excluded from the analysis. We review the research on causes of cancer and show why much cancer is preventable. The idea that traces of synthetic chemicals, such as DDT, are major contributors to human cancer is not supported by the evidence, yet public concern and resource allocation for reduction of chemical pollution are very high, in part because standard risk assessment uses linear extrapolation from limited data in high-dose animal cancer tests. These tests are done at the maximum tolerated dose (MTD) and are typically misinterpreted to mean that low doses of synthetic chemicals and industrial pollutants are relevant to human cancer. About half the chemicals tested, whether synthetic or natural, are carcinogenic to rodents at such high doses. Almost all chemicals in the human diet are natural. For example, 99.99% of the pesticides we eat are naturally present in plants to ward off insects and other predators. Half of the natural pesticides that have been tested at the MTD are rodent carcinogens. Cooking food produces large numbers of natural dietary chemicals. Roasted coffee, for example, contains more than 1000 chemicals: of 27 tested, 19 are rodent carcinogens. Increasing evidence supports the idea that the high frequency of positive results in rodent bioassays is due to testing at the MTD, which frequently can cause chronic cell killing and consequent cell replacement-a risk factor for cancer that can be limited to high doses. Because default risk assessments use linear extrapolation, which ignores effects of the high dose itself, low-dose risks are often exaggerated.

Aging↗

Contingent reinforcement for reduced carbon monoxide levels in methadone maintenance patients.

Five cigarette smoking methadone maintenance patients (MMP) participated in a within-subjects (A-B-A-B) study involving repeated application of carbon monoxide (CO)-contingent payments for reductions in smoke intake. To replicate and extend findings from an earlier study in non-drug-abusing smokers (Stitzer & Bigelow, 1982), we used the same contingent reinforcement procedure that involved the delivery of a monetary payment ($5) for CO readings which were 50% or less than the average value of readings obtained during the prior noncontingency period. Although four of the five subjects earned the contingent payment on at least three of the eight occasions, the overall effect of the intervention on CO level was nonsignificant. Daily smoking records revealed significantly lower rates during the first contingency intervention for the group as a whole. Significant correlations between CO and the time interval since smoking prior to CO measurement were found. The rather modest intervention effects suggest that important parameters be considered when designing contingency management procedures to reduce cigarette smoking in this difficult population of drug abusers.

Breath Tests↗