Cheryl Higbee

A 32-country comparison of tobacco smoke derived particle levels in indoor public places

Objective: To compare tobacco smoke-derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol. Methods: The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM2.5) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007. Results: Geometric mean PM2.5 levels were highest in Syria (372 μg/m3), Romania (366 μg/m3) and Lebanon (346 μg/m3), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 μg/m3, Uruguay at 18 μg/m3 and New Zealand at 8 μg/m3). On average, the PM2.5 levels in places where smoking was observed was 8.9 times greater (95 CI 8.0 to 10) than levels in places where smoking was not observed. Conclusions: Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.

Higher cigarette prices influence cigarette purchase patterns

Objective: To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Background: Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Methods: Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. Results: 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Conclusion: Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.

Cigarette purchase patterns in four countries and the relationship with cessation: findings from the International Tobacco Control (ITC) Four Country Survey

Background: Higher cigarette prices result in decreased cigarette consumption, but some smokers may seek lower-taxed cigarette sources. This price avoidance behaviour likely dampens the health impact of higher cigarette prices although it has not been thoroughly studied. Objective: To describe the characteristics of smokers who purchase low/untaxed cigarettes and to examine how this behaviour is associated with subsequent changes in smoking behaviours. Methods: Telephone survey data from 8930 smokers from the International Tobacco Control (ITC) Four Country Survey (ITC-4) were used to assess cigarette purchase patterns and smoking behaviours in Wave 1 conducted from October to December 2002 and subsequently followed seven months later in Wave 2. Respondents’ smoking status, attempts to quit, amount smoked, and cigarette purchase patterns were assessed in both waves. Results: Rates of purchase from a low/untaxed source at the respondents’ last cigarette purchase differed notably between countries at Wave 1, from less than 1% in Australia to 15% in the United Kingdom. In the UK, but not the other countries, this increased significantly to 20% at Wave 2. Smokers who were older, white/English speakers, had higher incomes, and had higher levels of education were more likely to report purchasing cigarettes from a low/untaxed source on their last purchase. Those who reported purchasing from a low/untaxed source on their last purchase at Wave 1 were less likely to have tried to quit smoking quit smoking by Wave 2 (relative risk 0.70, p < 0.01), while no overall significant association with smoking cessation was observed. Conclusion: Data from this study indicate that there are lower levels of making a quit attempt among purchasers of low/untaxed cigarettes compared to purchasers of full-priced cigarettes. The availability of low/untaxed cigarettes may mitigate the influence of increases in cigarette prices.

The impact of smokefree legislation in Scotland: results from the Scottish ITC Scotland/UK longitudinal surveys

BACKGROUND To evaluate how Scotlands smokefree law impacted self-reported secondhand smoke (SHS) exposure in hospitality venues, workplaces and in peoples homes. In addition, we examine changes in support for the law, pub and restaurant patronage, smoking cessation indicators and whether any observed changes varied by socioeconomic status. METHODS A quasi-experimental longitudinal telephone survey of nationally representative samples of smokers and non-smokers interviewed before the Scottish law (February to March 2006) and 1 year later after the law (March 2007) in Scotland (n = 705 smokers and n = 417 non-smokers) and the rest of the UK (n = 1027 smokers and n = 447 non-smokers) where smoking in public places was not regulated at the time. RESULTS Dramatic declines in the observance of smoking in pubs, restaurants and workplaces were found in Scotland relative to the rest of the UK. The change in the percent of smokers reporting a smokefree home and number of cigarettes smoked inside the home in the evening was comparable in Scotland and the rest of the UK. Support for smokefree policies increased to a greater extent in Scotland than in the rest of the UK. Self-reported frequency of going to pubs and restaurants was generally comparable between Scotland and the rest of the UK; however, non-smokers in Scotland were more likely to frequent pubs more often. No differences in smoking cessation indicators were observed between countries. CONCLUSION The Scottish smokefree law has been successful in decreasing secondhand smoke exposure while causing none of the hypothesized negative outcomes.

Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults

INTRODUCTION The present study reports on the prevalence of smoke-free homes, the characteristics of participants who adopted a smoke-free home policy, and the association between smoke-free homes and subsequent predictors of smoking cessation. METHODS Data are reported on 4,963 individuals who originally participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed follow-up surveys in 2001 and 2005. The relationship between home smoking policy and smoking behavior was examined with a multivariate regression model. RESULTS Among those who were smokers at the 2001 follow-up, the percentage reporting that no smoking was allowed in their home increased from 29% in 2001 to 38% in 2005. Smokers most likely to adopt smoke-free home policies between 2001 and 2005 were males, former smokers, and those who had lower levels of daily cigarette consumption (among those who continued to smoke), those with higher annual household incomes, and those with no other smokers in the household. Some 28% of smokers with smoke-free homes in 2001 reported that they had quit smoking by 2005 compared with 16% of those who allowed smoking in their homes (odds ratio [OR] = 1.7, 95% CI = 1.4-2.2), and baseline quitters with smoke-free homes also were less likely to relapse (OR = 0.6, 95% CI = 0.4-0.8). DISCUSSION Smoke-free homes are becoming more prevalent, and they are a powerful tool not only to help smokers stop smoking but also to help keep those who quit from relapsing back to smoking.

Perceptions about cigarette smoking and risks among college students

The objective of the present study was to describe how college students perceive the risks of cigarette smoking and addiction to nicotine. Data came from a self-administered survey of 1,020 college students enrolled in two 4-year liberal arts colleges in the United States. The survey was conducted in the fall of 2001. Smokers and nonsmokers differed markedly in their perceptions about the health risks associated with short-term exposure to smoking. College students in this sample who smoked did not fully comprehend the risks associated with smoking. Smokers were half as likely as nonsmokers to believe that there are health risks from smoking only on weekends or a couple of days a week. Anti-tobacco messages for young adult smokers need to communicate more effectively the concept that each cigarette they smoke is doing them damage.

Access to Low-Taxed Cigarettes Deters Smoking Cessation Attempts

We examined whether smokers who purchased low-taxed cigarettes from American Indian reservations had lower quit attempt and cessation rates than did smokers who purchased cigarettes from full-price outlets. Smokers who bought cigarettes from American Indian reservations were half as likely to make a quit attempt and had a nonsignificant trend toward lower cessation rates (20% vs 10%) compared with those who bought full-priced cigarettes. Interventions that reduce price differentials are suggested to maximize the public health benefit of cigarette excise taxes.

Secondhand smoke and particulate matter exposure in the home

With the increasing normative trend of clean indoor air laws prohibiting smoking in public places such as worksites and restaurants, the home is becoming the primary source of secondhand smoke (SHS) exposure. However, little empirical data indicate how SHS is distributed throughout homes and whether smoking in segregated areas offers protection. This project studied real-time data on levels of SHS in 9 homes in which smoking was permitted and in 3 smoke-free homes. Active sampling monitors were used to assess levels of PM(2.5), a marker for SHS, over a 3-day period. In smoking homes, one monitor was placed in the primary smoking area and another in a distal location, where smoking generally did not occur. Participants logged smoking and other activities that could affect air quality. In smoking homes, without assuming normality, the mean PM(2.5) level for the primary smoking areas was statistically significantly higher than that for distal areas (84 and 63 microg/m3, respectively). Both levels far surpassed the U.S. Environmental Protection Agencys annual standard of 15 microg/m3 for outdoor air quality. By contrast, the smoke-free home mean was 9 microg/m3, similar to outdoor air quality. These results suggest that the air in smoking homes was several times more polluted than that in smoke-free homes, regardless of where the measurements were taken, meaning that efforts to confine smoking to only part of the home offer no protection for people anywhere inside the home. Household members can be protected by implementing a smoke-free home policy.

Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: Findings from the International Tobacco Control Policy Evaluation Project

INTRODUCTION On 26 March 2006, Scotland implemented a smoke-free policy prohibiting smoking in indoor public venues, including bars and pubs. Drinking and smoking are highly associated behaviors, so we evaluated whether the regulations would decrease drinking behavior among smokers in public venues. We further assessed whether this effect would be more pronounced in heavier drinkers and whether decreases in drinking behavior in pubs would be offset by increased drinking in the home. METHODS Participants (N = 1,059) were adult smokers and nonsmokers from Scotland and from the rest of the United Kingdom, which did not have comprehensive smoke-free policies during the study period. Data were collected using a random-digit-dialed telephone survey from February to March 2006, just prior to the policy implementation in Scotland. Follow-up surveys were conducted in March 2007. Using baseline data, we categorized participants as abstainers, moderate drinkers, or heavy drinkers. RESULTS Overall, results demonstrated that drinking behavior did not change significantly in Scotland compared with the rest of the United Kingdom following implementation of the smoke-free policy in Scotland. However, planned comparisons examining mean changes in drinks consumed in pubs or bars following the legislation demonstrated that the smoke-free legislation was associated with reduced drinking behavior in pubs and bars among moderate- and heavy-drinking smokers in Scotland. These moderate- and heavy-drinking Scottish smokers also reduced their pub attendance following policy implementation. DISCUSSION The smoke-free Scottish law did not increase drinking in the home. These findings suggest that smoke-free policies may have additional public health benefits for those at greater risk for alcohol-related health problems.

Perceived Effectiveness of Tobacco Countermarketing Advertisements among Young Adults.

OBJECTIVES To measure relative effectiveness of tobacco countermarketing advertisements by category and emotive execution style among young adults. METHODS Participants (n=1011) from 2 US 4-year colleges, one southern and one northern were surveyed before and after viewing advertisements in one of 3 categories: social norms, health consequences, or tobacco industry manipulation and with 4 emotive execution styles: drama, testimonial (negative emotive) and humor, sarcasm (positive). RESULTS Health consequences and negative emotive advertisements were rated significantly most persuasive. CONCLUSIONS This is the first study to support the effectiveness of tobacco countermarketing advertisements emphasizing the negative emotive health consequences of smoking among young adults.