Adam O. Goldstein

Relationship between high school student smoking and recognition of cigarette advertisements

We report the results of a study examining the level of advertisement recognition and tobacco experimentation in a group of U.S. high school students. Students who smoked as few as one cigarette per week were found to identify a preferred cigarette brand. One brand of cigarettes accounted for 76% of all preferred brands. A dose-response relationship was found between smoking level and cigarette advertisement recognition, with regular smokers recognizing 61.6% of advertisements, compared with only 33.2% for nonsmokers. These data have potential implications for youth smoking prevention programs. Future research is needed to explain this association and to establish whether cigarette advertising and adolescent smoking are causally related.

Hospital nurse counseling of patients who smoke.

Smoking-related diseases comprise a large portion of hospital admissions. This paper reports the attitudes and behaviors of a group of hospital-based nurses toward counseling patients on smoking cessation. The majority of nurses do not counsel patients who smoke. Counseling practices vary with the smoking status of the nurse. Barriers to increased nursing participation in counseling efforts include the lack of counseling training and physician failure to utilize nurses in this role.

Political ideology and tobacco control

“More powerful than vested interests, more subtle than science, political ideology has, in the end, the greatest influence on disease prevention policy.” Sylvia Noble Tesh1 It is widely acknowledged that strong tobacco control policies are a crucial part of a comprehensive approach to reduce the health and economic impacts of tobacco use.2 Legislators, commissioners, and city councillors ultimately determine what policies are enacted and maintained. Yet, we know relatively little about the factors that influence elected officials to support or oppose these policies. Political scientists who traditionally study legislator voting behaviour often include measures of ideology in their analyses. However, health researchers have generally neglected political ideology in their studies of legislative outcomes related to tobacco control. Political ideology includes assumptions about whether the ultimate responsibility for health lies with the individual or with society, and whether the government has a right, or even a responsibility, to regulate individual behaviour and commercial activity to protect and promote the public good. The ideological arguments that most often come into play in discussions of public health policies tend to pit the duty of government to intervene to protect the health of its citizens against the right of individuals to make their own choices.3 Ideological arguments abound in debates about health issues, many of which are not new. Twenty years ago, Beauchamp wrote about the “growing tensions between the goals of protecting the public health and individual liberty”.4 About the same time, Baker described how ideological arguments regarding personal liberty were put forth to oppose mandating the use of motorcycle helmets and had been used for decades to delay milk pasteurisation.5 Arguments against fluoridation of public water supplies span five decades, with a prominent objection being the violation of individual rights.6-8 Of course, arguments in favour of …

Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices, North Carolina, 2013

Introduction Electronic cigarettes (e-cigarettes) are not currently approved or recommended by the Food and Drug Administration (FDA) or various medical organizations; yet, they appear to play a substantial role in tobacco users’ cessation attempts. This study reports on a physician survey that measured beliefs, attitudes, and behavior related to e-cigarettes and smoking cessation. To our knowledge this is the first study to measure attitudes toward e-cigarettes among physicians treating adult smokers. Methods Using a direct marketing company, a random sample of 787 North Carolina physicians were contacted in 2013 through email, with 413 opening the email and 128 responding (response rate = 31%). Physicians’ attitudes towards e-cigarettes were measured through a series of close-ended questions. Recommending e-cigarettes to patients served as the outcome variable for a logistic regression analysis. Results Two thirds (67%) of the surveyed physicians indicated e-cigarettes are a helpful aid for smoking cessation, and 35% recommended them to their patients. Physicians were more likely to recommend e-cigarettes when their patients asked about them or when the physician believed e-cigarettes were safer than smoking standard cigarettes. Conclusions Many North Carolina physicians are having conversations about e-cigarettes with their patients, and some are recommending them. Future FDA regulation of e-cigarettes may help provide evidence-based guidance to physicians about e-cigarettes and will help ensure that patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.

National Cancer Institute Conference on Treating Tobacco Dependence at Cancer Centers

The National Cancer Institute cancer centers possess the credibility to help smokers quit. With the greater life expectancies forecast for patients with cancer, addressing smoking at cancer centers has taken on greater importance.

Statewide diffusion of 100% tobacco-free college and university policies

Objectives As smoking among college students reached new highs in the 1990s, most interventions for college student smoking prevention focused on individual student knowledge, attitudes and beliefs. No published studies report on statewide movements to accelerate the adoption of tobacco-free policies on college campuses. The results of the first 4 years of the North Carolina Tobacco-Free Colleges Initiative are presented. Methods The North Carolina Health and Wellness Trust Fund developed a multilevel intervention to accelerate the diffusion of tobacco-free policies on college campuses, including funding campus coordinators and coalitions to tailor activities to the campus environment at 64 colleges. Evaluators tracked process and policy outcomes as well as the diffusion of policy adoption from January 2006–December 2009. Results Prior to the initiative, only one small, private college campus in North Carolina was tobacco-free. By 4 years into the initiative, 33 colleges and community colleges, representing more than 159 300 students, have adopted comprehensive tobacco-free policies to protect students, faculty, staff and visitors. Participating campuses also adopted 68 policies restricting smoking in certain areas and limiting industry activity. Conclusions Tobacco-free policy adoption on college campuses can be accelerated with a multilevel statewide intervention.

Smoking As a Vital Sign: Prompts to Ask and Assess Increase Cessation Counseling

Background: Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers’ attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: “Current smoker?” and “Plan to quit?” Methods: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. Results: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P < .001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P < .005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P = .41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P < .001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095–0.456). Conclusions: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

The North Carolina Youth Empowerment Study (NC YES): A Participatory Research Study Examining the Impact of Youth Empowerment for Tobacco Use Prevention

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.

Barring intervention? Lesbian and gay bars as an underutilized venue for tobacco interventions.

INTRODUCTION Lesbian, gay, bisexual, and transgender (LGBT) communities are at high risk for tobacco use. While LGBT communities have historically considered bars to be safe places to socialize and congregate, these spaces are often tobacco-friendly environments and may have potential as sites for much needed intervention. INTERVENTIONS IN BARS Only a few public health interventions have attempted to work through bars and clubs to decrease tobacco use in the LGBT populations. Evidence from HIV prevention suggests some potential interventions in bars, and the tobacco industry has worked extensively (and successfully) to utilize bars in marketing efforts. CONCLUSIONS Lesbian and gay bars are underutilized in tobacco control, suggesting missed avenues for chronic disease prevention programs. Researchers and communities should continue to recognize the importance of clean indoor air laws covering bars and develop additional strategies for reaching LGBT populations with disparities.

Safe babies: a qualitative analysis of the determinants of postpartum smoke-free and relapse states.

This qualitative study explores smoking cessation during pregnancy and the factors that contribute to remaining smoke-free and relapsing. Ninety-four women attending prenatal clinics in central North Carolina who had quit smoking before 30 weeks gestation were enrolled in an observational study that included a face-to-face interview at 4 months postpartum. Results were analyzed for common themes in the two groups: those who remained smoke-free and those who had relapsed. Fetal health motivated pregnant women to quit smoking, while stress, socializing with smokers, cravings, and easy access to cigarettes tempted women to smoke. Women who remained smoke-free postpartum overcame temptations by continuing to acknowledge the health benefits of not smoking and having a strong internal belief system, significant social support, negative experiences with renewed exposure to cigarettes, and concrete strategies for dealing with temptations. For women who relapsed postpartum, factors having the greatest influence on relapse included easy access to cigarettes, lack of social and financial support, insufficient resources for coping with the challenges of childrearing, physical addiction, reliance on cigarettes as a primary form of stress management, and feelings of regret, shame, or low self-esteem. Recommendations for relapse prevention include assessing women who quit during pregnancy for low or high risk of relapse and offering comprehensive interventions and case management for those at higher risk to address the physical, mental, behavioral, and social contexts leading to relapse.