Caroline M. Fichtenberg

Effect of smoke-free workplaces on smoking behaviour: systematic review

Abstract Objective: To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases. Design: Systematic review with a random effects meta-analysis. Study selection: 26 studies on the effects of smoke-free workplaces Setting: Workplaces in the United States, Australia, Canada, and Germany Participants: Employees in unrestricted and totally smoke-free workplaces Main outcome measures: Daily cigarette consumption (per smoker and per employee) and smoking prevalence Results: Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from

Association of the California Tobacco Control Program with Declines in Cigarette Consumption and Mortality from Heart Disease

0.76 to

Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care

3.05 (€0.78 to €3.14) in the United States and from £3.44 to £6.59 (€5.32 to €10.20) in the United Kingdom. If all workplacesbecame smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry

Advancing Social Prescribing with Implementation Science

1.7 billion and £310 million annually in lost sales. To achieve similar reductions tax per pack would have to increase to

Youth access interventions do not affect youth smoking

1.11 and £4.26 Conclusions: Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption

Reducing smoking prevalence to 10% in five years

BACKGROUND The California Tobacco Control Program, a large, aggressive antitobacco program implemented in 1989 and funded by a voter-enacted cigarette surtax, accelerated the decline in cigarette consumption and in the prevalence of smoking in California. Since the excess risk of heart disease falls rapidly after the cessation of smoking, we tested the hypothesis that this program was associated with lower rates of death from heart disease. METHODS Data on per capita cigarette consumption and age-adjusted rates of death from heart disease in California and the United States from 1980 to 1997 were fitted in multiple regression analyses. The regression analyses included the rates in the rest of the United States and variables that allowed for changes in the rates after 1988, when the tobacco-control program was approved, and after 1992, when the program was cut back. RESULTS Between 1989 and 1992, the rates of decline in per capita cigarette consumption and mortality from heart disease in California, relative to the rest of the United States, were significantly greater than the pre-1989 rates, by 2.72 packs per year per year (P = 0.001) and by 2.93 deaths per year per 100,000 population per year (P<0.001). These rates of decline were reduced (by 2.05 packs per year per year, [P=0.04], and by 1.71 deaths per year per 100,000 population per year, [P=0.031) when the program was cut back, beginning in 1992. Despite these problems, the program was associated with 33,300 fewer deaths from heart disease between 1989 and 1997 than the number that would have been expected if the earlier trend in mortality from heart disease in California relative to the rest of the United States had continued. The diminished effectiveness of the program after 1992 was associated with 8300 more deaths than would have been expected had its initial effectiveness been maintained. CONCLUSIONS A large and aggressive tobacco-control program is associated with a reduction in deaths from heart disease in the short run.

Screening for Social Determinants of Health

The social determinants of health (SDoH) are defined by the World Health Organization as the “conditions in which people are born, grow, live, work, and age.” Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and “adult diseases” such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.

Social Prescribing in the U.S. and England: Emerging Interventions to Address Patients’ Social Needs

A wealth of emerging evidence on the associations between social determinants of health (SDH) (eg, food, housing, transportation, and education) and health outcomes[1][1][⇓][2][⇓][3][⇓][4][⇓][5][⇓][6]–[7][7] has fueled a wave of experimentation around identifying and addressing patients