Chizimuzo T.C. Okoli

Effects of a smoke-free law on hair nicotine and respiratory symptoms of restaurant and bar workers

Objective: Bar and restaurant workers’ exposure to secondhand smoke (SHS) was compared before and 3 and 6 months after implementation of a smoke-free ordinance. Methods: Hair nicotine, self-reported exposure to SHS, and respiratory symptoms were assessed on 105 smoking and nonsmoking workers from randomly selected establishments in Lexington, Kentucky. Thirty-eight percent were current smokers with more than half smoking 10 or fewer cigarettes per day. Workers provided a hair sample at baseline and at the 3-month interview. Results: There was a significant decline in hair nicotine 3 months postlaw when controlling for cigarettes smoked per day. Bar workers showed a significantly larger decline in hair nicotine compared with restaurant workers. The only significant decline in SHS exposure was in the workplace and other public places. Regardless of smoking status, respiratory symptoms declined significantly postlaw. Conclusions: Hospitality workers demonstrated significant declines in hair nicotine and respiratory symptoms after the law. Comprehensive smoke-free laws can provide the greatest protection to bar workers who are the most vulnerable to SHS exposure at work.

Nicotine dependence symptoms among young never-smokers exposed to secondhand tobacco smoke

BACKGROUND To extend previous observations that secondhand tobacco smoke (SHS) is associated with nicotine markers in children, we investigated if SHS exposure is associated with self-reports of nicotine dependence (ND) symptoms among young never-smokers. METHOD Data on number of persons who smoke inside the home, number of days exposed to SHS in a motor vehicle in the past week, number of parents, siblings, and friends who smoke, and ND symptoms, were collected from 10-12 year-old students in self-report questionnaires. The association between SHS and ND symptoms among young never-smokers was assessed in logistic regression models. RESULTS Sixty-nine of 1488 never-smokers (5%) reported one or more ND symptom. After controlling for sibling and peer smoking, and susceptibility to initiating smoking, exposure to SHS in a motor vehicle was independently associated with ND symptoms (OR, 95% CI=1.2, 1.0-1.4). The OR for number of persons who smoke inside the home was 1.1 (0.9-1.4). CONCLUSION SHS exposure in motor vehicles may be associated with ND symptoms among young never-smokers. If replicated, this finding provides support for interventions that promote non-smoking in motor vehicles.

Partner Support for Smoking Cessation During Pregnancy: A Systematic Review

INTRODUCTION Pregnancy is a key time to leverage receptivity to smoking reduction or cessation in both pregnant women and their partners. A partners smoking status and support for the pregnant/postpartum womans efforts to reduce or quit smoking may impact her smoking behavior. METHODS A systematic literature review of interventions to enhance partner support for pregnant/postpartum womens smoking reduction or cessation and cessation treatments for the partners themselves identified 855 unique references, which were examined for relevance, yielding 9 intervention studies. RESULTS This narrative review analyzed a range of interventions including mass media campaigns, ultrasound scans, video, self-help manuals, counselling, and nicotine replacement therapies (NRTs) aimed at pregnant women and/or their partners. One randomized controlled trial (RCT) showed significant results for an intervention, which included a partner-targeted component in which pregnant women received health counselling, video and printed information, while partners received a booklet explaining the importance of quitting together. Three studies (1 RCT cluster, 1 pre-post test, 1 RCT) demonstrated no effect in improving smoking cessation among pregnant women. Two RCTs included free NRTs, telephone counselling, and multiple contacts as components of effective intervention for male partners, but impact on overall quit rates may not be sustainable postpartum. Seven studies (4 pre-post test, 2 RCT, 1 RCT cluster) found no effect of the intervention on partner smoking cessation. CONCLUSIONS Despite the importance of partner smoking, there are very few effective smoking cessation interventions for pregnant/postpartum women that include or target male partners, suggesting the need for further intervention development and research to establish the utility of this approach.

A systematic review of the Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence

The Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence (DSM-ND) are based on the proposition that dependence is a syndrome that can be diagnosed only when a minimum of 3 of the 7 proscribed features are present. The DSM-ND criteria are an accepted research measure, but the validity of these criteria has not been subjected to a systematic evaluation. To systematically review evidence of validity and reliability for the DSM-ND criteria, a literature search was conducted of 16 national and international databases. Each article with original data was independently reviewed by two or more reviewers. In total, 380 potentially relevant articles were examined and 169 were reviewed in depth. The DSM-ND criteria have seen wide use in research settings, but sensitivity and specificity are well below the accepted standards for clinical applications. Predictive validity is generally poor. The 7 DSM-ND criteria are regarded as having face validity, but no data support a 3-symptom ND diagnostic threshold, or a 4-symptom withdrawal syndrome threshold. The DSM incorrectly states that daily smoking is a prerequisite for withdrawal symptoms. The DSM shows poor to modest concurrence with all other measures of nicotine dependence, smoking behaviors and biological measures of tobacco use. The data support the DSM-ND criteria as a valid measure of nicotine dependence severity for research applications. However, the data do not support the central premise of a 3-symptom diagnostic threshold, and no data establish that the DSM-ND criteria provide an accurate diagnosis of nicotine dependence.

Smoking cessation programs targeted to women: a systematic review.

The authors of this systematic review aimed to examine tobacco interventions developed to meet the needs of women, to identify sex- and gender-specific components, and to evaluate their effects on smoking cessation in women. The authors searched electronic databases in the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EBSCO, PsychINFO, CINHAL, and EMBASE; the search was not restricted by publication date. Data was extracted from published peer-reviewed articles on participants, setting, treatment models, interventions, length of follow-up, and outcomes. The main outcome variable was abstinence from smoking. A total of 39 studies were identified. In efficacy studies, therapists addressed weight concerns and non-pharmacological aspects of smoking, taught mood/stress management strategies, and scheduled the quit date to be timed to the menstrual cycle. In effectiveness studies, therapists were peer counselors, provided telephone counseling, and/or distributed gendered booklets, videos, and posters. Among efficacy studies, interventions addressing weight gain/concerns showed the most promising results. If medication can support smoking cessation in women and how it interacts with non-pharmacological treatment also warrant further research. For effectiveness studies, the available evidence suggests that smoking should be addressed in low-income women accessing public health clinics. Further attention should be devoted to identifying new settings for providing smoking cessation interventions to women from disadvantaged groups. Women-specific tobacco programs help women stop smoking, although they appear to produce similar abstinence rates as non-sex/gender specific programs. Offering interventions for women specifically may reduce barriers to treatment entry and better meet individual preferences of smokers. Developing approaches that fully account for the multiple challenges treatment-seeking women face is still an area of research.

Smoking cessation interventions among individuals in methadone maintenance: A brief review

BACKGROUND Individuals in methadone maintenance treatment are motivated to quit smoking and are interested in smoking cessation treatment. However, few studies have assessed the efficacy of smoking cessation treatment for individuals undergoing methadone maintenance. The purpose of this article is to review interventions for tobacco use cessation among individuals in methadone maintenance with a particular emphasis on the components of such interventions and their effect on smoking cessation/reduction and drug use. METHODS A comprehensive search of six databases in June 2008 retrieved 584 research studies, which addressed smoking cessation interventions among individuals in substance use treatment. Of the retrieved articles, eight studies addressed smoking cessation among individuals undergoing methadone maintenance treatment. These studies were examined for effect of intervention on smoking cessation/reduction, gender differences in treatment outcomes, and the effect of the smoking cessation intervention on substance use behaviors. RESULTS Few studies demonstrated successful smoking abstinence among individuals in methadone maintenance treatment. Most interventions were associated with significant smoking reduction from baseline. Few studies assessed differences between men and women in smoking cessation treatment outcome. Smoking cessation treatment was not associated with increased substance use. CONCLUSIONS To date, interventions among individuals in methadone treatment have been largely unsuccessful in achieving sustained smoking abstinence. However, smoking cessation treatment does not worsen substance use. Future studies are necessary to determine intervention designs and components that can enhance smoking cessation among individuals in methadone maintenance.

Economic effect of a smoke-free law in a tobacco-growing community

Objective: To determine whether Lexington, Kentucky’s smoke-free law affected employment and business closures in restaurants and bars. On 27 April 2004, Lexington-Fayette County implemented a comprehensive ordinance prohibiting smoking in all public buildings, including bars and restaurants. Lexington is located in a major tobacco-growing state that has the highest smoking rate in the US and was the first Kentucky community to become smoke-free. Design: A fixed-effects time series design to estimate the effect of the smoke-free law on employment and ordinary least squares to estimate the effect on business openings and closings. Subjects and settings: All restaurants and bars in Lexington-Fayette County, Kentucky and the six contiguous counties. Main outcome measures: ES-202 employment data from the Kentucky Workforce Cabinet; Business opening/closings data from the Lexington-Fayette County Health Department, Environmental Division. Results: A positive and significant relationship was observed between the smoke-free legislation and restaurant employment, but no significant relationship was observed with bar employment. No relationship was observed between the law’s implementation and employment in contiguous counties nor between the smoke-free law and business openings or closures in alcohol-serving and or non-alcohol-serving businesses. Conclusions: No important economic harm stemmed from the smoke-free legislation over the period studied, despite the fact that Lexington is located in a tobacco-producing state with higher-than-average smoking rates.

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.

Adolescents' self-defined tobacco use status, marijuana use, and tobacco dependence.

AIMS To examine differences in tobacco use and dependence between adolescents who are and are not marijuana users. DESIGN Cross-sectional analysis of existing survey data. PARTICIPANTS Data were obtained from 7440 adolescents who completed the British Columbia Youth Survey of Smoking and Health II (BCYSOSH-II), a school based survey conducted in 2004. MEASURES Responses to demographic, current smoking, alcohol use, self-defined tobacco and marijuana use status questions, perceived physical and mental addiction to tobacco, modified-Fagerstrom Tolerance Questionnaire (M-FTQ), and the Dimensions of Tobacco Dependence Scale (DTDS) were obtained. FINDINGS Marijuana users were 5.9 times more likely to be current tobacco smokers and reported higher levels of perceived addiction to tobacco as compared with marijuana non-users. After controlling for demographics, life-time tobacco use, and alcohol use, marijuana use was associated with the nicotine dependent and sensory dimensions of tobacco dependence. CONCLUSIONS Adolescents who concurrently use tobacco and marijuana may be more tobacco dependent than are marijuana non-users. Concurrent use of marijuana may be a factor associated with tobacco dependence among a sub-group of concomitant drug-using adolescents.

Secondhand Tobacco Smoke Exposure, Nicotine Dependence, and Smoking Cessation

OBJECTIVE To explore the association among the number of sources of secondhand tobacco smoke (SHS) exposure, nicotine dependence (ND), and smoking cessation. DESIGN A secondary analysis of cross-sectional data. Responses for the main study were obtained in 2001 from a controlled trial of the Quit and Win Tobacco Free Contest in Kentucky. SAMPLE 822 current smokers. MEASUREMENTS Demographic variables (age, gender, educational status, income, and ethnicity) the number of sources of SHS exposure, smoking frequency, length of abstinence from smoking, age of smoking initiation, smoking cessation attempts, intentions to quit smoking, and ND. RESULTS The number of sources of SHS exposure was associated with higher ND and smoking frequency, and related to low intentions and attempts to quit smoking. The number of sources of SHS exposure contributed to 11% of the variance in the final ND model, after accounting for control and potential mediating variables. CONCLUSIONS The number of sources of SHS exposure may be an important factor influencing ND and intentions and attempts to quit smoking. Further studies are needed to explore the association between SHS exposure and ND among smokers to guide treatment and policy development.