Matthew C. Farrelly

The impact of workplace smoking bans: results from a national survey

OBJECTIVE To estimate the impact of workplace smoking restrictions on the prevalence and intensity of smoking among all indoor workers and various demographic and industry groups. DESIGN Detailed cross sectional data on worker self reported characteristics, smoking histories, and workplace smoking policies were used in multivariate statistical models to examine whether workplace smoking policies reduce cigarette consumption. After analysing the distribution of policies, four main types of workplace programme were defined: (1) 100% smoke-free environments, (2) work area bans in which smoking is allowed in some common areas, (3) bans in some but not all work and common areas, and (4) minimal or no restrictions. SETTING After environmental tobacco smoke was identified as a health hazard in the mid-1980s, workplace smoking restrictions became more prevalent. By 1993, nearly 82% of indoor workers faced some restriction on workplace smoking and 47% worked in 100% smoke-free environments. PARTICIPANTS The database included a nationally representative sample from the tobacco use supplements to the September 1992, January 1993, and May 1993 Current Population Surveys of 97 882 indoor workers who were not self employed. MAIN OUTCOME MEASURES Prevalence of smoking and number of cigarettes smoked daily by smokers. RESULTS Having a 100% smoke-free workplace reduced smoking prevalence by 6 percentage points and average daily consumption among smokers by 14% relative to workers subject to minimal or no restrictions. The impact of work area bans was lessened by allowing smoking in some common areas. Smoke-free policies reduced smoking for all demographic groups and in nearly all industries. CONCLUSIONS Requiring all workplaces to be smoke free would reduce smoking prevalence by 10%. Workplace bans have their greatest impact on groups with the highest rates of smoking.

Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban

OBJECTIVES Reductions in exposure to environmental tobacco smoke have been shown to attenuate the risk of cardiovascular disease. We examined whether the 2003 implementation of a comprehensive smoking ban in New York State was associated with reduced hospital admissions for acute myocardial infarction and stroke, beyond the effect of moderate, local and statewide smoking restrictions, and independent of secular trends. METHODS We analyzed trends in county-level, age-adjusted, monthly hospital admission rates for acute myocardial infarction and stroke from 1995 to 2004 to identify any association between admission rates and implementation of the smoking ban. We used regression models to adjust for the effects of pre-existing smoking restrictions, seasonal trends in admissions, differences across counties, and secular trends. RESULTS In 2004, there were 3813 fewer hospital admissions for acute myocardial infarction than would have been expected in the absence of the comprehensive smoking ban. Direct health care cost savings of

Changes in hospitality workers’ exposure to secondhand smoke following the implementation of New York’s smoke-free law

56 million were realized in 2004. There was no reduction in the number of admissions for stroke. CONCLUSIONS Hospital admission rates for acute myocardial infarction were reduced by 8% as a result of a comprehensive smoking ban in New York State after we controlled for other relevant factors. Comprehensive smoking bans constitute a simple, effective intervention to substantially improve the publics health.

The impact of tobacco control program expenditures on aggregate cigarette sales: 1981–2000

Objective: To assess the impact on hospitality workers’ exposure to secondhand smoke of New York’s smoke-free law that prohibits smoking in all places of employment, including restaurants, bars, and bowling facilities. Design: Pre-post longitudinal follow up design. Settings: Restaurants, bars, and bowling facilities in New York State. Subjects: At baseline, 104 non-smoking workers in restaurants, bars, and bowling facilities were recruited with newspaper ads, flyers, and radio announcements. Of these, 68 completed a telephone survey and provided at least one saliva cotinine specimen at baseline. At three, six, and 12 month follow up studies, 47, 38, and 32 workers from the baseline sample of 68 completed a telephone survey and provided at least one saliva cotinine specimen. Intervention: The smoke-free law went into effect 24 July 2003. Main outcome measures: Self reported sensory and respiratory symptoms and exposure to secondhand smoke; self administered saliva cotinine specimens. Analyses were limited to subjects in all four study periods who completed a telephone survey and provided at least one saliva cotinine specimen. Results: All analyses were limited to participants who completed both an interview and a saliva specimen for all waves of data collection (n  =  30) and who had cotinine concentrations ⩽ 15 ng/ml (n  =  24). Hours of exposure to secondhand smoke in hospitality jobs decreased from 12.1 hours (95% confidence interval (CI) 8.0 to 16.3 hours) to 0.2 hours (95% CI −0.1 to 0.5 hours) (p < 0.01) and saliva cotinine concentration decreased from 3.6 ng/ml (95% CI 2.6 to 4.7 ng/ml) to 0.8 ng/ml (95% CI 0.4 to 1.2 ng/ml) (p < 0.01) from baseline to the 12 month follow up. The prevalence of workers reporting sensory symptoms declined from 88% (95% CI 66% to 96%) to 38% (95% CI 20% to 59%) (p < 0.01); there was no change in the overall prevalence of upper respiratory symptoms (p < 0.16). Conclusion: New York’s smoke-free law had its intended effect of protecting hospitality workers from exposure to secondhand smoke within three months of implementation. One year after implementation, the results suggest continued compliance with the law.

The compensating behavior of smokers: taxes, tar, and nicotine.

Since the 1998 Master Settlement Agreement (MSA) between states and the tobacco industry, states have unprecedented resources for programs to reduce tobacco use. Decisions concerning the use of these funds will, in part, be based on the experiences of states with existing programs. We examine the experiences of several states that have adopted comprehensive tobacco control programs. We also report estimates from econometric analyses of the impact of tobacco control expenditures on aggregate tobacco use in all states and in selected states with comprehensive programs for the period from 1981 through 2000. Our analyses clearly show that increases in funding for state tobacco control programs reduce tobacco use.

Youth tobacco prevention mass media campaigns: past, present, and future directions

Using data from the 1979 and 1987 National Health Interview Survey (NHIS), we test whether smokers alter their smoking habits in the face of higher taxes. Smokers in high-tax states are more likely to smoke cigarettes higher in tar and nicotine. Although taxes reduce the number of cigarettes consumed per day among remaining smokers, total daily tar and nicotine intake is unaffected. Young smokers, aged 18-24, are much more responsive to changes in taxes than are older smokers, and their total daily tar and nicotine intake actually increases after a tax hike. We illustrate that tax-induced compensating behavior may eliminate some health benefits generated by reduced smoking participation. A more appropriate tax might be based on the tar and nicotine content of cigarettes.

The Impact of Tobacco Control Programs on Adult Smoking

This paper focuses on countermarketing efforts aimed at curbing youth smoking. We review the literature on the effectiveness of tobacco countermarketing campaigns, characterise current state and national campaign approaches, present findings from qualitative approaches and laboratory experiments that explore a variety of messages (for example, health consequences, industry manipulation), and discuss newer, non-traditional approaches to countermarketing. In conclusion, we outline research needed to fill gaps in our existing knowledge and discuss future directions in tobacco countermarketing aimed at youth.

State Tobacco Control Spending and Youth Smoking

OBJECTIVES We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking. METHODS We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding. RESULTS From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003. CONCLUSIONS State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.

Response by Adults to Increases in Cigarette Prices by Sociodemographic Characteristics

OBJECTIVE We examined the relationship between state-level tobacco control expenditures and youth smoking prevalence and cigarette consumption. METHODS We estimated a 2-part model of cigarette demand using data from the 1991 through 2000 nationally representative surveys of 8th-, 10th-, and 12th-grade students as part of the Monitoring the Future project. RESULTS We found that real per capita expenditures on tobacco control had a negative and significant impact on youth smoking prevalence and on the average number of cigarettes smoked by smokers. CONCLUSIONS Had states represented by the Monitoring the Future sample and the District of Columbia spent the minimum amount of money recommended by the Centers for Disease Control and Prevention, the prevalence of smoking among youths would have been between 3.3% and 13.5% lower than the rate we observed over this period.

The Influence of the National truth® Campaign on Smoking Initiation

Cigarette excise taxes are widely viewed by health economists as an effective tool to reduce cigarette consumption. However, those opposed to increasing cigarette excise taxes often state that the taxes unfairly target certain segments of the population, notably the poor and minorities. Some of this opposition may have been fueled by a lack of understanding of how the tax will affect the health and welfare of various demographic groups of interest. This article provides guidance to policy makers by estimating price elasticities among adults by gender, income, age, and race or ethnicity. Women, adults with income at or below the median income, young adults, African-Americans, and Hispanics are most responsive to cigarette price increases. For example, adults with income at or below the median are more than four times as price-responsive as those with income above the median.