Dianne C. Barker

Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study

Abstract Objective: To determine the relation between extent of restrictions on smoking at home, at school, and in public places and smoking uptake and smoking prevalence among school students. Design: Cross sectional survey with merged records of extent of restrictions on smoking in public places. Setting: United States. Participants: 17 287 high school students. Main outcome measures: Five point scale of smoking uptake; 30 day smoking prevalence. Results: More restrictive arrangements on smoking at home were associated with a greater likelihood of being in an earlier stage of smoking uptake (P<0.05) and a lower 30 day prevalence (odds ratio 0.79 (95% confidence interval 0.67 to 0.91), P<0.001). These findings applied even when parents were smokers. More pervasive restrictions on smoking in public places were associated with a higher probability of being in a earlier stage of smoking uptake (P<0.05) and lower 30 day prevalence (0.91 (0.83 to 0.99), P=0.03). School smoking bans were related to a greater likelihood of being in an earlier stage of smoking uptake (0.89 (0.85 to 0.99), P<0.05) and lower prevalence (0.86 (0.77 to 0.94), P<0.001) only when the ban was strongly enforced, as measured by instances when teenagers perceived that most or all students obeyed the rule. Conclusions: These findings suggest that restrictions on smoking at home, more extensive bans on smoking in public places, and enforced bans on smoking at school may reduce teenage smoking.

Field validation of secondary commercial data sources on the retail food outlet environment in the U.S.

This study used direct field observations with interior assessments of outlets to validate food store and restaurant data from two commercial business lists conditional on classification of outlet type, including supermarkets, grocery stores, convenience stores, full-service restaurants and fast food restaurants. The study used a stratified random sample that included 274 urban census tracts across 9 counties from the Chicago Metropolitan Statistical Area (MSA) and 46 suburban and 61 rural census tracts across 13 counties from a 50-mile buffer surrounding the MSA. Results showed that agreement between the field observations and the commercial business lists for the food store and restaurant outlets was generally moderate (ranging from fair to good). However, when the listed data were validated based on an exact classification match, agreement was only fair (ranging from poor to moderate) and, in particular, poor for fast food restaurants. The study also found that agreement levels for some outlet types differed by tract characteristics. Commercial databases must be used with caution as substitutes for on the ground data collection.

Tobacco Industry Marketing at Point of Purchase After the 1998 MSA Billboard Advertising Ban

Point-of-purchase marketing has become increasingly important for the tobacco industry in the United States.1 In the wake of the 1998 master settlement agreement (MSA) that required tobacco advertising on billboards across the country to end on April 24, 1999, the point-of-purchase environment is likely to assume even greater importance in the industrys marketing efforts. One goal of the billboard advertising ban (as well as other MSA advertising and promotion restrictions) was to reduce youth exposure to cigarette advertising. However, previous research suggests that the tobacco industry is able to compensate for an inability to advertise in one medium by transferring advertising dollars to other marketing activities.2–6 Accordingly, there is concern that the MSA billboard advertising ban may merely shift tobacco advertising funding to other efforts, such as point-of-purchase marketing. In this study, we used data from a unique national sample of retailers to explore changes in the point-of-purchase environment after implementation of the billboard tobacco advertising ban.

Helping pregnant smokers quit: meeting the challenge in the next decade

Throughout the past decade, smoking has remained the single most important modifiable cause of poor pregnancy outcome in the USA. It accounts for 20% of low birth weight deliveries, 8% of preterm births, and 5% of all perinatal deaths.1 New studies have found that maternal smoking during pregnancy contributes to sudden infant death syndrome and may cause important changes in fetal brain and nervous system development.2-7 New economic estimates indicate that the direct medical costs of a complicated birth for a smoker are 66% higher than for non-smokers—reflecting the greater severity of complications and the more intensive care required.8 While quitting smoking early in pregnancy is most beneficial, important health benefits accrue from quitting at any time during the pregnancy.1 Moreover, the health hazards and health care burden to women and their family members caused by smoking do not begin or end with pregnancy. Before pregnancy, smoking increases the risk of serious medical complications for women using oral contraceptives and can impair fertility.1 After pregnancy, in addition to adversely affecting womens health, smoking exposes infants and young children to environmental tobacco smoke. This exposure is linked to SIDS, respiratory illnesses, middle ear infections, and decreased lung function.3 4 9 Currently, 27% of US children aged 6 years and under are exposed to tobacco smoke at home,10with the annual direct medical costs of parental smoking estimated at

Use of Flavored Cigarettes Among Older Adolescent and Adult Smokers: United States, 2004–2005

4.6 billion and loss of life costs estimated at

The availability of electronic cigarettes in US retail outlets, 2012: results of two national studies

8.2 billion.11 Recent national survey data indicate that the goal of reducing smoking among pregnant women from 25% in 1985 to 10% by the 2000 was not met.12 While some reduction was achieved, about 20% of US women currently smoke during pregnancy, based on the 1994, 1995, and 1996 SAMSHA national surveys (table 1). …

Relative and absolute availability of healthier food and beverage alternatives across communities in the United States

Cigarettes with candy, fruit and alcohol flavors have been introduced in recent years as extensions to popular cigarette brands, raising concerns in the public health community that the enticing names, creative packaging, and intense flavorings of these products may be especially appealing to youth. This study used two national surveys to examine the prevalence of use of Camel Exotic Blends, Kool Smooth Fusion, and Salem Silver Label brands during 2004--2005 among older adolescents and young adult smokers aged 17-26 years and adult smokers aged > or =25 years. Overall use of any of these flavored brands in the past 30 days was 11.9% among smokers aged 17-26 years and 6.7% among smokers aged > or =25 years. A significant gradient in use was seen across age, with the highest rates of utilization among 17-year-old (22.8%) and 18-19-year-old smokers (21.7%) (p<.001). Uniquely flavored cigarette brands seem to be most attractive to the youngest smokers and should be prohibited.

Development and reliability testing of a food store observation form.

Background Since their introduction in 2007, electronic cigarette (‘e-cigarette’) awareness and use has grown rapidly. Little is known about variation in e-cigarette availability across areas with different levels of tobacco taxes and smoke-free air policies. This paper looks at US retail availability of e-cigarettes and factors at the store, neighbourhood and policy levels associated with it. Methods In-person store audit data collected in 2012 came from two national samples of tobacco retailers in the contiguous US. Study 1 collected data from a nationally representative sample of tobacco retailers (n=2165). Study 2 collected data from tobacco retailers located in school enrolment zones for nationally representative samples of 8th, 10th and 12th grade public school students (n=2526). Results In 2012, e-cigarette retail availability was 34% in study 1 and 31% in study 2. Tobacco, pharmacy and gas/convenience stores were more likely to sell e-cigarettes than beer/wine/liquor stores. Retail availability of e-cigarettes was more likely in neighbourhoods with higher median household income (study 1), and lower percent of African–American (studies 1 and 2) and Hispanic residents (study 2). Price of traditional cigarettes was inversely related to e-cigarette availability. Stores in states with an American Lung Association Smoke-Free Air grade of F (study 1) or D (study 2) compared with A had increased likelihood of having e-cigarettes. Conclusions Currently, e-cigarette availability appears more likely in areas with weak tax and smoke-free air policies. Given the substantial availability of e-cigarettes at tobacco retailers nationwide, states and localities should monitor the sales and marketing of e-cigarettes at point of sale (POS).

Walkable Communities and Adolescent Weight

OBJECTIVES We examined associations between the relative and absolute availability of healthier food and beverage alternatives at food stores and community racial/ethnic, socioeconomic, and urban-rural characteristics. METHODS We analyzed pooled, annual cross-sectional data collected in 2010 to 2012 from 8462 food stores in 468 communities spanning 46 US states. Relative availability was the ratio of 7 healthier products (e.g., whole-wheat bread) to less healthy counterparts (e.g., white bread); we based absolute availability on the 7 healthier products. RESULTS The mean healthier food and beverage ratio was 0.71, indicating that stores averaged 29% fewer healthier than less healthy products. Lower relative availability of healthier alternatives was associated with low-income, Black, and Hispanic communities. Small stores had the largest differences: relative availability of healthier alternatives was 0.61 and 0.60, respectively, for very low-income Black and very low-income Hispanic communities, and 0.74 for very high-income White communities. We found fewer associations between absolute availability of healthier products and community characteristics. CONCLUSIONS Policies to improve the relative availability of healthier alternatives may be needed to improve population health and reduce disparities.

Evaluation of Active Living Research Progress and Lessons in Building a New Field

OBJECTIVE To develop a reliable food store observational data collection instrument to be used for measuring product availability, pricing, and promotion. DESIGN Observational data collection. SETTING A total of 120 food stores (26 supermarkets, 34 grocery stores, 54 gas/convenience stores, and 6 mass merchandise stores) in the Chicago metropolitan statistical area. MAIN OUTCOME MEASURES Inter-rater reliability for product availability, pricing, and promotion measures on a food store observational data collection instrument. ANALYSIS Cohens kappa coefficient and proportion of overall agreement for dichotomous variables and intra-class correlation coefficient for continuous variables. RESULTS Inter-rater reliability, as measured by average kappa coefficient, was 0.84 for food and beverage product availability measures, 0.80 for interior store characteristics, and 0.70 for exterior store characteristics. For continuous measures, average intra-class correlation coefficient was 0.82 for product pricing measures; 0.90 for counts of fresh, frozen, and canned fruit and vegetable options; and 0.85 for counts of advertisements on the store exterior and property. CONCLUSIONS AND IMPLICATIONS The vast majority of measures demonstrated substantial or almost perfect agreement. Although some items may require revision, results suggest that the instrument may be used to reliably measure the food store environment.