Carol Riker

E-Cigarettes: Promise or Peril?

Electronic cigarettes (e-cigarettes) use a heating element to vaporize nicotine and other ingredients, simulating the visual, sensory, and behavioral aspects of smoking without the combustion of tobacco. An ever-growing number of companies around the world manufacture a wide variety of e-cigarette brands, despite scant information on the safety of the ingredients for human inhalation. This article provides an overview of the history, production, and marketing of e-cigarettes, the contents of e-cigarettes and vapor, how they are used, public health concerns, and implications for nursing practice, research, and policy development.

Immediate impact of smoke-free laws on indoor air quality.

Smoke-free laws significantly impact indoor air quality. However, the temporal effects of these laws on indoor air pollution have not been determined. This paper assesses the temporal impact of one smoke-free law on indoor air quality. This quasi-experimental study compared the indoor air quality of nine hospitality venues and one bingo hall in Georgetown, Kentucky, before and after implementation of a 100% smoke-free workplace law. We made real-time measurements of particulate matter with 2.5 &mgr;m aerodynamic diameter or smaller (PM2.5). Among the nine Georgetown hospitality venues, the average indoor PM2.5 concentration was 84 &mgr;g/m3 before the law took effect. The average indoor PM2.5 concentrations in nine compliant venues significantly decreased to 18 &mgr;g/m3 one week after the law took effect. Three venues having 82 &mgr;g/m3 before the law had significantly lower levels from the first day the law was implemented, and the low level was maintained. Compliance with the law is critical to achieving clean indoor air. Indoor air pollution in the bingo hall was not reduced until the establishment decided to comply with the law. The smoke-free law showed immediate impact on indoor air quality.

Passing a smoke-free law in a pro-tobacco culture: a multiple streams approach.

This article describes a case study of the policy development and political decision-making process involved in the enactment of Lexington, Kentucky’s smoke-free law. The multiple streams framework is used to analyze the development of the law in a seemingly unlikely and challenging political environment. Proponents developed a dissemination research plan targeted at policy makers and the public to demonstrate the need for a comprehensive law. The existence of a strong coalition of health care providers and health care systems including the board of health, as well as long-standing tobacco control expertise and a strong legal team, were essential ingredients for success. A deliberate strategy to expose the tobacco industry was effective in preparing policy makers for the opponents’ policy arguments. As expected, a hospitality industry association was formed to oppose the ordinance, resulting in a legal challenge that delayed enactment of the law.

Measuring Compliance With Tobacco-Free Campus Policy

Abstract Objective: The purpose is to describe psychometric testing and feasibility of the Tobacco-Free Compliance Assessment Tool (TF-CAT) to measure tobacco-free policy compliance at a public university and medical center. The aims are to (1) investigate concurrent validity by comparing the number of cigarette butts in areas covered by the policy with those on adjacent sidewalks; (2) evaluate the interrater reliability of the TF-CAT; and (3) describe the feasibility of using the TF-CAT. Methods: Phase I was a pilot study on the health care campus. Phase II was baseline of an intervention study on the main campus. Cigarette butts and smokers were counted in hot spots. Validity was assessed using Mann-Whitney U and Geographical Information System Analysis methods. Results: There was some support for the validity and high interrater reliability. Data collectors spent 1 hour per week for 8 weeks during Phase I, and 31 hours in 1 week during Phase II. Conclusion: TF-CAT is a feasible, time-intensive method to measure tobacco-free policy compliance.

An Intervention to Increase Compliance with a Tobacco-Free University Policy:

Purpose. To test the effects of a population-based self-efficacy message card campaign on compliance with a tobacco-free campus policy. Setting. This study was conducted at a large public university in the South. Subjects. Three hundred twelve observational periods at 39 campus sites. Intervention. The message card campaign, based on the Theory of Planned Behavior, consisted of distributing approximately 6000 efficacy-enhancing cards over 3 days. The intent of the cards was to increase awareness of the policy and resources available to help individuals stop smoking or remain comfortable while on campus. Measures. Policy compliance was measured using the Tobacco-Free Compliance Assessment Tool. Field notes were used to assess campaign reaction. Analysis. Mann-Whitney U-test was conducted to compare number of cigarette butts in hot spot areas before and after the intervention. A rate ratio was also calculated using Geographic Information System (GIS) mapping software to compare cigarette butts collected per day before and after the intervention at each of the study sites. Results. The median number of cigarette butts per day after the intervention was significantly lower than before the intervention (1.9 vs. 4.7, χ2: 8.1, p = .004). Eighteen sites (66.6%) had a post-pre ratio of .11 to .75, indicating a decrease in cigarette butts per day. Conclusion. An efficacy-enhancing message card campaign shows promise in improving compliance with tobacco-free campus policies.

Rural Print Media Portrayal of Secondhand Smoke and Smoke-Free Policy

The purpose of this article is to describe how the print media portrays secondhand smoke and smoke-free policy in rural communities. Baseline print media clips from an ongoing 5-year study of smoke-free policy development in 40 rural communities were analyzed. The authors hypothesized that community population size would be positively associated with media favorability toward smoke-free policy. Conversely, pounds of tobacco produced and adult smoking prevalence would be negatively associated with media favorability. There was a positive correlation between population size and percentage of articles favorable toward smoke-free policy. The authors did not find a correlation between adult smoking or tobacco produced and media favorability toward smoke-free policy, but we did find a positive relationship between tobacco produced and percentage of pro-tobacco articles and a negative relationship between adult smoking prevalence and percentage of articles about health/comfort. Implications for targeting pro-health media in rural communities as well as policy-based initiatives for tobacco control are discussed.

Secondhand Smoke Exposure in a Rural High School.

Although federal law requires all public schools to be smoke free, lack of compliance with the smoke-free policy is commonly reported. The aims of this study were to describe the indoor fine-particle (PM2.5) air pollution in a rural high school and surrounding public venues. This cross-sectional, nonexperimental study was conducted in Monroe County, Kentucky (population of 11,756). Fine-particle concentrations were measured in the high school and 5 public venues using spectrometers. Because of illegal student smoking, PM2.5 concentrations were 19 times higher in the boys’ student restroom than the National Ambient Air Quality Standard for outdoor air (670 vs. 35 μg/m3). The staff restrooms adjacent to the student restroom where staff did not smoke also showed high PM2.5 levels. Average indoor air pollution in the public venues was 158 μg/m3. Strict enforcement of smoke-free school policy and cessation resources are needed to reduce secondhand smoke exposure. Collaborative school-community campaigns involving parents, students, mass media, and community organizations may be effective in reducing the harm caused by tobacco. Implications for school nurses are discussed.

Outdoor tobacco smoke exposure at the perimeter of a tobacco-free university

There are few studies measuring exposure to outdoor tobacco smoke (OTS). Tobacco users often gather at the boundaries of tobacco-free campuses, resulting in unintended consequences. The objective of this study was to measure exposure levels from OTS on sidewalks bordering a tobacco-free university campus. Data were collected while walking along a sidewalk adjacent to a medium traffic road between May and August 2011. Monitoring occurred during “background,” “stop,” and “walk-through” conditions at and near hot spot area to measure fine particulate matter (<2.5 μm; PM2.5) from OTS using a portable aerosol monitor. The average PM2.5 levels during stop and walk-through conditions were significantly higher than during background conditions. PM2.5 peak occurrence rate and magnitude of peak concentration were significantly different depending on smoking occurrence. The peak occurrence rate during the stop condition was 10.4 times higher than during the background condition, and 3.1 times higher than during the walk-through condition. Average peak PM2.5 concentrations during the stop condition were 48.7% higher than during the background condition. In conclusion, individuals could be exposed to high levels of PM2.5 when stopping or even passing by smokers outdoors at the perimeter of tobacco-free campuses. The design and implementation of tobacco-free campus policies need to take into account the unintended consequences of OTS exposure at the boundaries. Implications: In this study, outdoor tobacco smoke (OTS) exposure was measured at the perimeter of tobacco-free campus. OTS exposure could be determined by peak analysis. Peak occurrence rate and peak concentration for OTS exposure were identified by using peak analysis. People could be exposed to high levels of PM2.5 when standing or even passing by smokers at the perimeter of tobacco-free campus. OTS exposure measurement in other outdoor locations with smokers is needed to support outdoor smoking regulation.

Enforcement of Tobacco Purchase, Use, and Possession Laws in Four Kentucky Communities

This case study examined the implementation and enforcement of the purchase, use, and possession (PUP) laws for tobacco in four Kentucky communities. Purposive and snowball sampling were used to identify 44 adult key informants. Qualitative, semistructured phone interviews assessed knowledge about PUP laws, enforcement, effects of the laws on teen tobacco use, and perceptions about the laws. Seven themes were identified: enforcement not a priority, unaware of enforcement authority, spotty enforcement, other sources of tobacco, minimum penalties, confusion about compliance checks, and schools as de facto enforcers. One community went beyond the statutory requirements of the law and created more stringent penalties for violating the use and possession law, and it also had low illegal sales rates. These laws may be more effective if they are enforced strictly with a meaningful penalty and a clear enforcement strategy.

Creating Effective Media Messaging for Rural Smoke‐free Policy

OBJECTIVES Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents. DESIGN AND SAMPLE Qualitative methods design. Thirty-nine rural adults recruited by community partners. MEASURES Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy. RESULTS Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials. CONCLUSIONS Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS.