Nancy J. Kaufman

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.

Women and tobacco: moving from policy to action.

A gender perspective contributes to a better understanding of the epidemiological trends, social marketing strategies, economic policies, and international actions relating to women and the tobacco epidemic. Evidence is provided in this article for the negative impact of tobacco use by women and of passive smoking on the health of women and children. Use of tobacco by women is increasing and this is related to the tobacco industrys aggressive advertising, sponsorship and promotion strategies. Policy directions are proposed in this article. At all levels, a multi-pronged strategy--including changes in legislation and fiscal policies, improvements in gender-sensitive health services, and cessation programmes--should be considered. Much more gender-specific research on tobacco use is needed, particularly in developing countries. Womens empowerment and leadership should be at the centre of all tobacco control efforts and are essential for the success of national programmes and the recently introduced Framework Convention on Tobacco Control.

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

Tobacco Use and Cessation Behavior Among Adolescents Participating in Organized Sports.

4.6 billion and loss of life costs estimated at

Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies.

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). …

Changes in Adolescent Cigarette-Brand Preference, 1989 to 1996.

OBJECTIVES To examine the difference in tobacco use between adolescents who participate in organized sports and those who do not. METHODS Using a cross-sectional study design, this study uses data from a nationally representative sample of adolescents enrolled in public high schools in the United States. RESULTS Those participating in organized sports were 25% less likely to be current cigarette smokers. However, smokeless tobacco use was found to be associated with participation in organized sports. CONCLUSIONS Given the large proportion of students involved in organized sports, intervening through this venue to address tobacco use has the potential to reach significant numbers of adolescents.

Tobacco control - challenges and prospects

Supplemental Digital Content is Available in the Text. This study focuses on the existing public health workforce, with the results aiming at informing the revisions public health academic programs and standards are experiencing nationally.

E-cigarettes: policy options and legal issues amidst uncertainty.

OBJECTIVE To understand changes in cigarette-brand choice by adolescents in the context of demographic differences and advertising. METHODS Data from 3 nationally representative cross-sectional surveys of adolescents were analyzed. RESULTS Marlboro, Camel, and Newport brand cigarettes accounted for over 80% of the cigarettes usually bought by adolescents in 1989, 1993, and 1996. Between 1989 and 1996, Marlboro and Camel market shares changed little, whereas preference for Newport doubled among white and Hispanic adolescents. CONCLUSIONS Brand preference among adolescents has been steadily concentrated among 3 brands. More attention may need to be focused on mentholated brands given the increase in Newports market share.

Using Public Health Legal Counsel Effectively: Beliefs, Barriers and Opportunities for Training

The need for action to stop tobacco production and consumption is patent. At present, about 4 million people a year die of tobacco-related diseases (1). WHO epidemiologists predict that unless there is a dramatic change in present trends tobacco will be killing 8.4 million people a year by the late 2020s (2). This month the Bulletin joins the BMJ and JAMA in a global theme issue to take a look at some of the factors involved. About 1.2 billion of the people in the world who are over 15 years of age smoke. In countries where the number of young smokers is not high already, it is rising. Warren et al. (pp. 868-876) discuss the data on this now becoming available through the Global Youth Tobacco Survey. In many places tobacco consumption continues to rise despite the fact that ways to reduce it exist and are known to work. These measures include government regulations on marketing and access, price increases, counter-advertising, and treatment for dependence. They have proved to be effective, as Corrao et al. point out (pp. 884-890), failing only where they have not been wholeheartedly adopted. Now, however, they risk being thwarted by the new dangers that globalization brings: unopposed marketing through satellite television and Internet, and unprecedented opportunities for smuggling. Threats of this kind cannot be dealt with by countries acting on their own, and that is why governments and organizations have begun work on drafting the Framework Convention on Tobacco Control, as Taylor & Bettcher explain (pp. 920-929). WHO will convene the first full Intergovernmental Negotiating Committee for the convention in mid-October of this year. Much has been done nationally as well. The Masters Settlement Agreement reached in 1998 in the USA determined that the tobacco industry should pay out

Free to Grow: Translating Substance Abuse Research and Theory into Preventive Practice in a National Head Start Initiative

264 billion over a period of 25 years to 46 of the United States to compensate for tobacco-related health costs (3). This and other litigation has brought to light vast quantities of secret tobacco industry documents. As Judith Mackay (pp. 911-912) and Ong & Glantz (pp. 938-939) observe, they show how the industry had known for decades that tobacco causes death and is addictive, and had been very concerned about it. Such is the power of corporate thinking, however, that the industry found a solution: properly managed, the lethality of tobacco could be compensated for by its addictiveness, which would guarantee the fidelity of survivors and new recruits, so all would be well (for the industry). Saloojee & Dagli (pp. 902-910) explain how this sinister strategy of drawing new customers into addiction while old ones die of it is concealed by an array of attractive images which associate smoking with its opposites -- freedom, fresh air, independence, physical strength and beauty, happiness and respectability. Ernster et al. (pp. 891-901) provide fascinating information on how a previously neglected clientele, women, are drawn into the belief that smoking is glamorous. Spokespeople for the industry often argue that its aim is not to recruit new smokers but to offer existing ones a better product and win a larger piece of the market for their shareholders. …