Donald R. Shopland

State-specific trends in smoke-free workplace policy coverage: the current population survey tobacco use supplement, 1993 to 1999.

We examined trends in smoke-free workplace policies among all indoor workers in the United States using the National Cancer Institute’s Tobacco Use Supplement to the Census Bureau’s Current Population Survey (total n = 270,063). Smoke-free was defined as smoking not permitted in public or common areas or in work areas of a worksite. Nationally, we found that nearly 70% of the US workforce worked under a smoke-free policy in 1999. At the state level, a greater than 30-percentage-point differential existed in the proportion of workers with such policies. Although significant progress has been made to reduce worker exposure to environmental tobacco smoke on the job, we predict further progress may be difficult unless comprehensive regulations to protect all workers are implemented at the national, state, or local level.

Disparities in smoke-free workplace policies among food service workers.

Information is lacking on which groups of workers are protected from job-related environmental tobacco smoke. Data from the Census Bureau’s Current Population Survey are analyzed for trends in smoke-free workplace policies among 38 major occupations. Data are also analyzed to determine the degree of compliance with such policies. Although over three fourths of white collar workers are covered by smoke-free policies, including 90% of teachers, just 43% of the country’s 6.6 million food preparation and service occupations workers benefit from this level of protection. Compliance with workplace restrictions is not a significant human resources issue because only 3.8% of workers reported that someone violated a smoke-free policy in 1999, down from 4.9% in 1996. Protection for workers is increasing, but those in food preparation and service occupations are significantly less protected than others.

Association between home smoking restrictions and changes in smoking behaviour among employed women

Study objective: Examine trends in home smoking restrictions among employed women not living alone and assess the associations of such restrictions with smoking behaviour. Design: Multivariate logistic regression analysis of major demographic variables and household composition characteristics. Study participants: 128 024 employed female respondents to the Census Bureau’s current population survey over the 10 year period 1992 to 2002. Main results: The prevalence of smoke free homes has increased significantly over the past decade. This increase was evident across all demographic and household characteristics examined with the greatest rate of increase seen among smoking households. Nearly 90% of households consisting of all never smoking adult members reported having a smoke free home in 2001–02 compared with 22% of households consisting of all smokers. The extent of smoking restrictions in the home was the most powerful determinant of cessation of all the factors examined in the regression model. Odds of becoming a former smoker (any length) and quit for three months or more were seven to eight times greater among those women reporting their homes were smoke free compared with those whose homes permitted smoking anywhere in the home. Conclusions: Smoke free homes were associated with a highly significant increase in quitting (p<0.0001). However, at this time it is not clear what proportion of the observed effect can be attributed to living in a smoke free home. None the less, the significantly increased probability of quitting correlated with having a smoke free home found in this analysis, are substantially higher than the odds reported in most workplace studies published to date; additional studies are needed to elucidate this relation.

Do smoking ordinances protect non-smokers from environmental tobacco smoke at work?

Author(s): Pierce, JP; Shanks, TG; Pertschuk, M; Gilpin, E; Shopland, D; Johnson, M; Bal, D

Reasons smokers give for stopping smoking: do they relate to success in stopping?

Correspondence and requests for reprints to : Dr Pierce. Abstract Objective -To determine the frequency and distribution of reasons that smokers give for stopping smoking, and whether any type of reason is associated with a greater likelihood of success than any other. Design Univariate and multivariate analyses of reasons for stopping smoking by demographic characteristics, success in stopping by demographic character istics, and success in stopping by reasons for stopping (adjusting for demographic variables). Subjects 3788 current and former smokers who had stopped in the five years before the interview as part of the 1987 National Health Interview Survey (Cancer Control Supplement), a popu lation survey of non-institutionalised adults in the United States. Main outcome measures Reasons for stopping and percentage of successful quitters (abstinent for at least one year at the time of the survey). Results Respondents mentioned health reasons as a motivating factor most frequently (health reasons, 62%; social reasons, 22%; cost, 9%; lost desire, 5%). Important relations were found between demographic factors and reasons cited and between demographic factors and success in stopping. After adjustment for differences in demographic variables re lated to success in stopping, smokers citing only health, social, or cost reasons had about the same likelihood of success. However, smokers citing a combination of health and social reasons had a higher likelihood of stopping successfully than had those citing only social or cost reasons, but their likelihood of success was not increased compared with those citing only health reasons or loss of desire. Conclusion -Even though the social acceptability of smoking has been in creasingly emphasised in the campaign against smoking, the health message should continue to have a major role. Smokers who cite a social reason for stopping are more likely to stop suc cessfully if they feel that they are stop ping for their own health as well.

Integrating Supply and Demand Reduction Strategies for Drug Abuse Prevention

Historically, demand and supply reduction approaches to the prevention and control of tobacco, alcohol, and other drug abuse have been treated as independent efforts in the United States, vying for public attention and funding. Separate reviews of research suggest that the more effective components of each approach can reduce potential drug use by 20% to 40% for 3 years and sometimes longer. Review of theories relevant to behavior change suggest that integrating the two approaches could increase this proportion to 40% to 50% for longer periods by synergistically affecting community anti-drug use norms and compliance. This article briefly reviews demand and supply reduction approaches to drug abuse prevention and presents hypothetical models of change in drug use behavior based on program and policy interventions that are introduced sequentially into communities.

Tobacco manufacturers’ defence against plaintiffs’ claims of cancer causation: throwing mud at the wall and hoping some of it will stick

Background: In the late 1990s and the early part of this decade, the major US cigarette manufacturers admitted, to varying degrees, that smoking causes cancer and other diseases. Objective: To examine how tobacco manufacturers have defended themselves against charges that their products caused cancer in plaintiffs in 34 personal injury lawsuits, all but one of which were litigated between the years 1986 and 2003. Methods: Defence opening and closing statements, trial testimony, and depositions for these cases were obtained from the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta/). All available defence-related transcripts from these cases were reviewed and a content analysis was conducted to identify common themes in the defendants’ arguments. Results: After review of the transcripts, defendants’ arguments were grouped into seven categories: (1) there is no scientific proof that cigarette smoking causes lung cancer; (2) the plaintiff did not have lung cancer as claimed; (3) the plaintiff had a type of lung cancer not associated with cigarette smoking; (4) the plaintiff had cancer that may have been associated with cigarette smoking or smokeless tobacco use, but tobacco products were not to blame in this particular case; (5) the plaintiff had cancer that may have been associated with cigarette smoking, but the defendant’s cigarette brands were not to blame; (6) the defendant’s cigarettes (or smokeless tobacco) may have played a role in the plaintiff’s illness/death, but other risk factors were present that negate or mitigate the defendant’s responsibility; and (7) the defendant’s cigarettes may have been a factor in the plaintiff’s illness/death, but the plaintiff knew of the health risks and exercised free will in choosing to smoke and declining to quit. Use of the argument that smoking is not a proven cause of lung cancer declined in frequency during and after the period when tobacco companies began to publicly admit that smoking causes disease. Corresponding increases occurred over time in the use of other arguments (namely, presence of other risk factors and “free will”). Conclusions: Despite the vast body of literature showing that cigarette smoking causes cancer, and despite tobacco companies’ recent admissions that smoking causes cancer, defendants used numerous arguments in these cases to deny that their products had caused cancer in plaintiffs. The cigarette companies, through their public admissions and courtroom arguments, seem to be saying, “Yes, smoking causes lung cancer, but not in people who sue us”.

Public health approaches to tobacco use prevention and cessation in the U.S.

Tobacco has a long history of use in the U.S., and its serious health effects have been well-documented during the past half century, U.S. efforts to control tobacco use and tobacco-related morbidity and mortality have been reasonably successful over the past 25 years, during which time there has been a 34 percent reduction in adult smoking. Nevertheless, tobacco use remains a significant public health problem in the U.S., with more than 430,000 tobacco-related deaths per year and over one-fourth of the population continuing to smoke. Many organizations are involved in tobacco use control activities, the most broadly focused of which is the National Cancer Institute (NCI). As an example of the type of program needed to address the problem of tobacco use on a national scale, the NCIs public health research plan and activities are described and its emphasis on a data-based decision matrix in its approach to tobacco and cancer control research and applications of research is discussed. Finally, future approaches to tobacco use control in the U.S. are suggested.