Robert McMillen

Beliefs About the Health Effects of "Thirdhand" Smoke and Home Smoking Bans

OBJECTIVE. There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans. METHODS. Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children. RESULTS. Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car. CONCLUSIONS. This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.

Use of emerging tobacco products in the United States.

This paper provides the first nationally representative estimates for use of four emerging products. Addressing the issue of land-line substitution with cell phones, we used a mixed-mode survey to obtain two representative samples of US adults. Of 3,240 eligible respondents contacted, 74% completed surveys. In the weighted analysis, 13.6% have tried at least one emerging tobacco product; 5.1% snus; 8.8% waterpipe; 0.6% dissolvable tobacco products; 1.8% electronic nicotine delivery systems (ENDS) products. Daily smokers (25.1%) and nondaily smokers (34.9%) were the most likely to have tried at least one of these products, compared to former smokers (17.2%) and never smokers (7.7%), P<.001. 18.2% of young adults 18–24 and 12.8% of those >24 have tried one of these products, P<.01. In multivariable analysis, current daily (5.5, 4.3–7.6), nondaily (6.1, 4.0–9.3), and former smoking status (2.7, 2.1–3.6) remained significant, as did young adults (2.2, 1.6–3.0); males (3.5, 2.8–4.5); higher educational attainment; some college (2.7, 1.7–4.2); college degree (2.0, 1.3–3.3). Use of these products raises concerns about nonsmokers being at risk for nicotine dependence and current smokers maintaining their dependence. Greater awareness of emerging tobacco product prevalence and the high risk demographic user groups might inform efforts to determine appropriate public health policy and regulatory action.

Child Health Care Clinicians' Use of Medications to Help Parents Quit Smoking: A National Parent Survey

Background. Smokers who use cessation medications when they attempt to quit double their likelihood of success. No prior survey has assessed the acceptability to parents of receiving smoking cessation medication prescriptions in the context of their childs primary care visits. Objective. To assess acceptability to parents of receiving smoking cessation medication prescriptions and to compare that with the reported rate of actually receiving smoking cessation medication prescriptions in the context of the childs health care visit. Methods. Data were collected through a national random-digit dial telephone survey of households from July to September 2003. The sample was weighted according to race and gender, on the basis of the 2002 US Census, to be representative of the US population. Results. Of 3990 eligible respondents contacted, 3010 (75%) completed surveys; 1027 (34%) of those were parents. Of those parents, 211 (21%) were self-identified smokers. One half would consider using a smoking cessation medication and, of those, 85% said that it would be acceptable if the childs doctor prescribed or recommended it to them. In contrast, of the 143 smoking parents who accompanied their child to the doctor, only 15% had pharmacotherapy recommended and only 8% received a prescription for a smoking cessation medication. These results did not vary according to parent age, gender, race, or child age. Conclusions. Child health care clinicians have low rates of recommending and prescribing cessation therapies that have proved effective in other settings. The recommendation or provision of cessation medications would be acceptable to the majority of parents in the context of their childs health care visit.

Assessing secondhand smoke exposure with reported measures

Non-smokers are exposed to tobacco smoke from the burning cigarette and the exhaled smoke from smokers. In spite of decades of development of approaches to assess secondhand smoke exposure (SHSe), there are still unresolved methodological issues. This manuscript summarises the scientific evidence on the use of SHSe reported measures and their methods, objectives, strengths and limitations; and discusses best practices for assessing behaviour leading to SHSe for lifetime and immediate or current SHSe. Recommendations for advancing measurement science of SHSe are provided. Behavioural measures of SHSe commonly rely on self-reports from children and adults. Most commonly, the methodology includes self, proxy and interview-based reporting styles using retrospective recall or diary-style reporting formats. The reporting method used will vary based upon the subject of interest, assessment objectives and cultural context. Appropriately implemented, reported measures of SHSe provide an accurate, timely and cost-effective method for assessing exposure time, location and quantity in a wide variety of populations.

A National Survey of the Acceptability of Quitlines to Help Parents Quit Smoking

OBJECTIVE. Provision of telephone smoking cessation counseling can increase the rate of quitting smoking. The US Public Health Service recently helped to establish a free national quitline enrollment service. No previous surveys have assessed the acceptability to parents of enrollment in quitline counseling in the context of their childs health care visits. Therefore, the objective of this study was to assess acceptability to parents of enrollment in quitline counseling and to compare that with the reported rate of actually being enrolled in any smoking cessation counseling outside the office in the context of the childs health care visit. METHODS. Data were collected by a national random-digit-dial telephone survey of households from September to November 2004. The sample is weighted by race and gender on the basis of the current US Census to be representative of the US population. RESULTS. Of 3615 eligible respondents contacted, 3011 (83.3%) completed surveys; 958 (31.8%) who completed the survey were parents with children under the age of 18 years. Of these parents, 187 (19.7%) were self-identified smokers. Of the parents who smoked, 113 (64.2%) said that they would accept enrollment in a telephone cessation program if the childs doctor offered it to them. In contrast, of the 122 smoking parents who accompanied their child to the doctor in the past year, only 11 (9%) had any counseling recommended to them, and only 1 (0.8%) was actually enrolled. These results did not vary by parent age, gender, race, or child age. CONCLUSIONS. When interacting with parents who smoke, child health care providers have low rates of referring and enrolling parents in any services related to smoking. Enrollment in quitlines would be acceptable to the majority of parents in the context of their childs health care visit. Tobacco control efforts in the child health care setting should include implementation of office systems that can facilitate enrollment of parental smokers in telephone quitlines.

Association between clean indoor air laws and voluntary smokefree rules in homes and cars

Objectives This study examines the influence that smokefree workplaces, restaurants and bars have on the adoption of smokefree rules in homes and cars, and whether there is an association with adopting smokefree rules in homes and cars. Methods Bivariate probit models were used to jointly estimate the likelihood of living in a smokefree home and having a smokefree car as a function of law coverage and other variables. Household data were obtained from the nationally representative Social Climate Survey of Tobacco Control 2001, 2002 and 2004–2009; clean indoor air law data were from the American Nonsmokers’ Rights Foundation Tobacco Control Laws Database. Results ‘Full coverage’ and ‘partial coverage’ smokefree legislation is associated with an increased likelihood of having voluntary home and car smokefree rules compared with ‘no coverage’. The association between ‘full coverage’ and smokefree rule in homes and cars is 5% and 4%, respectively, and the association between ‘partial coverage’ and smokefree rules in homes and cars is 3% and 4%, respectively. There is a positive association between the adoption of smokefree rules in homes and cars. Conclusions Clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smokefree rules in homes and cars.

Assessing college students' autonomy over smoking with the Hooked On Nicotine Checklist

Objective, Participants, and Methods: In this study, the authors explored the psychometric properties of the Hooked on Nicotine Checklist (HONC) among 300 college students who were current smokers. The HONC is a 10-item survey instrument designed to measure diminished autonomy over smoking, a key aspect of dependence. Autonomy is diminished when symptoms present a barrier to cessation. Results: Internal consistency was high (α = .89), as was concurrent validity. Students who began smoking earlier and heavier smokers reported more symptoms than did those who started later and smoked less. After controlling for smoking frequency, the HONC was predictive of the likelihood of a failed cessation attempt, with each additional symptom doubling that likelihood. Conclusions: College health professionals could use the HONC to help new smokers recognize their symptoms of diminished autonomy. The HONC may serve as a recruiting tool for cessation programs, which could benefit such early-phase smokers.

Public support for raising the age of sale for tobacco to 21 in the United States

Objectives The vast majority of tobacco users began before the age of 21. Raising the tobacco sales age to 21 has the potential to reduce tobacco use initiation and progression to regular smoking. Our objective was to assess the level of public support nationally for ‘Tobacco 21’ initiatives in the USA. Methods The Social Climate Survey of Tobacco Control, a cross-sectional dual-frame survey representing national probability samples of adults was administered in 2013. Respondents were asked to state their agreement level with, ‘The age to buy tobacco should be raised to 21.’ Results Of 3245 respondents, 70.5% support raising the age to buy tobacco to 21. The majority of adults in every demographic and smoking status category supported raising the tobacco sales age to 21. In multivariable analyses, support was highest among never smokers, females, African-Americans and older adults. Conclusions This national study demonstrates broad public support for raising the sales age of tobacco to 21 and will help facilitate wide dissemination of initiatives to increase the legal purchase age at national, state and local levels. Increasing public awareness about the susceptibility and rapid addiction of youth to nicotine may further increase public support for raising the tobacco sale age to 21.

Consumer perceptions of the sale of tobacco products in pharmacies and grocery stores among U.S. adults

BackgroundPharmacy-based tobacco sales are a rapidly increasing segment of the U.S. retail tobacco market. Growing evidence links easy access to tobacco retail outlets such as pharmacies to increased tobacco use. This mixed-mode survey was the first to employ a nationally representative sample of consumers (n = 3057) to explore their opinions on sale of tobacco products in pharmacies and grocery stores.ResultsThe majority reported that sale of tobacco products should be either ‘allowed if products hidden from view’ (29.9%, 25.6%) or ‘not allowed at all’ (24.0%, 31.3%) in grocery stores and pharmacies, respectively. Significantly fewer smokers, compared to non-smokers, reported agreement on point-of-sale restrictions on sales of tobacco products (grocery stores: 27.1% vs. 59.6%, p < .01; pharmacy: 32.8% vs. 62.0%, p < .01). Opinions also varied significantly by demographic characteristics and factors such as presence of a child in the household and urban/rural location of residence.ConclusionsOverall, a majority of consumers surveyed either supported banning sales of tobacco in grocery stores and pharmacies or allowing sales only if the products are hidden from direct view. Both policy changes would represent a departure from the status quo. Consistent with the views of practicing pharmacists and professional pharmacy organizations, consumers are also largely supportive of more restrictive policies.

The Co-Occurrence of Maternal Depressive Symptoms and Smoking in a National Survey of Mothers

CONTEXT Both maternal smoking and depression are common and can adversely impact child health and functioning, yet few studies have explored their co-occurrence among mothers. OBJECTIVE To determine the prevalence and associations of depression and smoking among mothers in the United States. DESIGN Random-digit-dial national telephone survey of 1530 households conducted in 2002. Respondents were asked about their sociodemographic characteristics, smoking status, and their childrens receipt of Medicaid. A validated 3-item depression screen was administered. Bivariate and multiple regression analyses for maternal smoking and a positive depression screen were performed. SETTING National sample. PARTICIPANTS Seven hundred two mothers with children aged less than 19 years living in their homes. RESULTS The response rate was 61%. Among mothers, 24.3% were smokers, 24.4% had a positive depression screen, 8.1% had both, and 40.6% were smokers and/or had a positive depression screen. All rates were greater among mothers whose children receive Medicaid (37.6%, 47.5%, 20.6%, and 64.5%) than those whose children do not receive Medicaid (21.1%, 19.0%, 4.8%, and 35.3%) (P < .001) for each. In multivariate analyses, maternal smoking was independently associated with a 70% increased risk of depressive symptoms (odds radio, 1.7; 95% confidence interval, 1.1-2.6). CONCLUSIONS This study highlights both the frequency and the co-occurrence of maternal smoking and maternal depressive symptoms, two negative influences on childrens health and development, as well as their increased prevalence among mothers whose children receive Medicaid, thereby highlighting the economic disparities associated with both. These findings have significant implications for our nations children, health care clinicians, and health care payers.