Deborah J. Hennrikus

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses.

Occasional smoking in a Minnesota working population.

OBJECTIVES This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.

Worksite intervention for weight control: a review of the literature.

Purpose. Published research on worksite weight-control programs is reviewed with the objective of assessing success in (1) reaching populations in need, (2) achieving sustained weight loss, and (3) improving employee health and productivity. Search method. Reviewed are 44 data-based articles published between 1968 and 1994. The initial search was part of a larger review on the health impact of worksite health promotion programs conducted by Centers for Disease Control and described in the introduction to this issue. We supplemented the resulting list with articles found in a search of our own reference files. Important findings. Methodologically the literature is relatively weak, consisting largely of uncontrolled case studies. Worksite interventions appear to be successful in reaching large numbers of people: the median participation rate among overweight employees was 39% in the six studies that provided this type of information. Worksite programs produced reasonable short-term weight loss: typically 1 to 2 pounds per week. Long-term weight loss, reductions in sitewide obesity prevalence, and health or productivity benefits have yet to be demonstrated. Major conclusions. Recommendations for future research include improved methods, more attention to recruitment and secondary outcomes, more direct comparison of different programs, and more creative use of worksites as environments and social units in designing programs.

The RealU online cessation intervention for college smokers : A randomized controlled trial

OBJECTIVES To determine the efficacy of providing online cessation intervention for college smokers. METHODS This is a two-group randomized controlled trial. The intervention group received

Effectiveness of a smoking cessation program for peripheral artery disease patients: a randomized controlled trial.

10 weekly incentives to visit an online college life magazine that provided personalized smoking cessation messages and peer email support. Evaluation assessments occurred at baseline and 8, 20, and 30 weeks after enrollment. The primary outcome is self-reported 30-day abstinence at week 30. Carbon monoxide (CO) breath testing was performed for participants reporting 30-day abstinence at week 30. RESULTS Five-hundred and seventeen college smokers at the University of Minnesota were enrolled via internet health screening (control=260, intervention=257) in the fall of 2004. Intervention participants completed an average of 18.9 (SD 2.5) of 20 weekly website visits over the course of the study. The rate of 30-day abstinence at week 30 was higher for the intervention compared to the control group (41% vs. 23%, p<0.001). CO testing showed low rates of under-reporting. There was no difference in self-reported 6-month prolonged abstinence measured at week 30. CONCLUSION Providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention.

Smoking Status, Dietary Intake, and Physical Activity in a Sample of Working Adults

OBJECTIVES This study tested the effectiveness of a smoking cessation program designed for patients with peripheral artery disease (PAD). BACKGROUND Tobacco use is the leading risk factor for PAD incidence and progression and for ischemic events. Tobacco cessation reduces PAD-related morbidity and mortality, yet few prospective clinical trials have evaluated smoking cessation interventions in PAD patients. METHODS We recruited outpatients with lower extremity PAD identified from medical records as cigarette smokers. Participants were randomly assigned to an intensive tailored PAD-specific counseling intervention or a minimal intervention. Participants completed surveys at baseline and at 3- and 6-month follow-up. Reported 7-day point prevalent smoking abstinence was confirmed by cotinine or carbon monoxide assessment. RESULTS In all, 687 outpatients were identified as probable smokers with lower extremity PAD; 232 met study eligibility requirements; and 124 (53% of eligible) enrolled. Participants were receptive to counselor contact: the median number of sessions was 8.5 (range 0 to 18). Participants randomly assigned to the intensive intervention group were significantly more likely to be confirmed abstinent at 6-month follow-up: 21.3% versus 6.8% in the minimal intervention group (chi-square = 5.21, p = 0.023). CONCLUSIONS Many long-term smokers with PAD are willing to initiate a serious quit attempt and to engage in an intensive smoking cessation program. Intensive intervention for tobacco dependence is a more effective smoking cessation intervention than minimal care. Studies should be conducted to examine the long-term effectiveness of intensive smoking cessation programs in this population to examine the effect of this intervention on clinical outcomes related to PAD.

The SUCCESS Project: The Effect of Program Format and Incentives on Participation and Cessation in Worksite Smoking Cessation Programs

The present study examined differences in dietary intake and physical activity by smoking status in a sample of 3,250 working adults. Cross-sectionally, current smokers consumed alcohol, dairy products, meat, eggs, and french fries more frequently, and engaged in leisure time physical activity less frequently, than former or never smokers. Over 2 years, current smokers increased their intake of meat, soft drinks, eggs, and total calories from high fat and high calorie foods compared to never to former smokers. Smokers who quit during the 2-year observation period increased their frequency of sweets consumption. Dietary and physical activity variables appear to be weak predictors of postcessation weight change. Implications for studies of chronic disease etiology and mechanisms of postcessation weight gain are discussed.

4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol and its Glucuronides in the Urine of Infants Exposed to Environmental Tobacco Smoke

OBJECTIVES This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. METHODS Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation. RESULTS A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates. CONCLUSIONS Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites.

Predictors of quitting in hospitalized smokers

Biomarkers of carcinogen uptake could provide important information pertinent to the question of exposure to environmental tobacco smoke (ETS) in childhood and cancer development later in life. Previous studies have focused on exposures before birth and during childhood, but carcinogen uptake from ETS in infants has not been reported. Exposures in infants could be higher than in children or adults because of their proximity to parents who smoke. Therefore, we quantified 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides (total NNAL) in the urine of 144 infants, ages 3 to 12 months, who lived in homes with parents who smoked. Total NNAL is an accepted biomarker of uptake of the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. Cotinine and its glucuronide (total cotinine) and nicotine and its glucuronide (total nicotine) were also quantified. Total NNAL was detectable in 67 of 144 infants (46.5%). Mean levels of total NNAL in the 144 infants were 0.083 ± 0.200 pmol/mL, whereas those of total cotinine and total nicotine were 0.133 ± 0.190 and 0.069 ± 0.102 nmol/mL, respectively. The number of cigarettes smoked per week in the home or car by any family member when the infant was present was significantly higher (P < 0.0001) when NNAL was detected than when it was not (76.0 ± 88.1 versus 27.1 ± 38.2). The mean level of NNAL detected in the urine of these infants was higher than in most other field studies of ETS exposure. The results of this study show substantial uptake of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in infants exposed to ETS and support the concept that persistent ETS exposure in childhood could be related to cancer later in life. (Cancer Epidemiol Biomarkers Prev 2006;15(5):988–92)