Ross M. Kauffman

Tobacco policy in American prisons, 2007

Objective: To examine current tobacco policy in US prisons and explore changes in prison tobacco policies over time. Data source: Telephone survey of the 52 US departments of correction. Main outcome measures: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids. Participants: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information. Results: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies; however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period. Conclusion: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.

Tobacco use by male prisoners under an indoor smoking ban.

INTRODUCTION Most correctional facilities have implemented tobacco restrictions in an effort to reduce costs and improve prisoner health, but little has been done to evaluate the impact of these policy changes. Patterns of tobacco use among prisoners were explored to determine the impact of incarceration in a facility with an indoor smoking ban on tobacco use behaviors. METHODS Recently incarcerated male inmates (n = 200) were surveyed about their tobacco use prior to and during incarceration. RESULTS Tobacco use was prevalent prior to arrest (77.5%) and increased during incarceration (81.0%). Though the number of cigarette smokers increased during imprisonment, per-capita cigarette consumption declined by 7.1 cigarettes/day (p < .001). Despite widespread tobacco use, most participants recognized that smoking is a cause of lung cancer (96.0%) and heart disease (75.4%) and that it can be addicting (97.5%). Most tobacco users (70.0%) reported a desire to quit, with 63.0% saying they intended to try quitting in the next year. CONCLUSIONS Indoor smoking bans do not promote cessation in prisons but may reduce the amount of tobacco consumed. Though smoking is commonplace in prisons, most prisoners recognize the risks involved and wish to quit. This creates an ideal setting for intervention. Evidence-based cessation assistance should be made freely available to all incarcerated smokers.

Tobacco Use among the Amish in Holmes County, Ohio.

PURPOSE The objective of this study was to estimate tobacco use prevalence among the Amish in Holmes County, Ohio, using both self-report and a biochemical marker of nicotine exposure. METHODS Amish adults (n=134) were interviewed as part of a lifestyle study. Self-reported tobacco use was measured using standardized questions, and cotinine was measured from a saliva sample. The prevalence of smoking, total tobacco use, and misclassification were estimated separately by gender, and then compared to 2 non-Amish groups. One group was selected from 2 counties contained within the Holmes County Amish settlement (n=154) and the other was representative of non-Hispanic whites in the United States (n=4,099). FINDINGS No Amish women reported current tobacco use and only 2 reported former use. This was significantly different (P<.0001) from the patterns observed among non-Amish in the settlement counties (15.7%) and US white (23.3%) women. The prevalence of tobacco use among Amish men was 17.6% and this was significantly lower than estimates from non-Amish in the settlement counties (38.8%, P=.04) and US white (32.2%, P=.005) men. No Amish women and only 2 Amish men underreported tobacco use and misclassification was similar in the comparison groups. CONCLUSIONS Tobacco use is significantly lower among adults in the largest Amish settlement in the world compared to their non-Amish neighbors in Appalachia Ohio and US whites. A strength of this study is that self report was verified with a marker of nicotine, a critical measure to include in any study conducted in a group that stigmatizes tobacco use.

Factors associated with smokeless tobacco cessation in an Appalachian population

Identifying factors associated with successful tobacco quit attempts may help in the development and targeting of effective cessation strategies. This paper aims to describe factors associated with smokeless tobacco (ST) cessation and compares the results to findings in the smoking cessation literature. Prospective data on 116 men aged 19 to 70 and participating in a ST cessation program were used to examine correlates of successful ST cessation at 1-year post-intervention. Controlling for age, level of education (p=0.002) and daily coffee consumption (p=0.005) had significant independent associations with successful cessation. No ST use variables were significant predictors of cessation success. In a multivariable logistic regression model three factors were significantly associated with cessation: education (p=0.010), coffee consumption (p=0.019), and age (p=0.029). Factors associated with successful ST cessation in this sample are consistent with predictors of smoking cessation reported in the literature. Based on its widespread use and the strength of its association with successful quitting, the role of caffeine consumption in ST cessation merits further study.

Patient Education Cards for Skin Cancer Detection and Treatment

Over 1.3 million cases of skin cancer occur annually in the USA, but no uniform or evidence-based screening guidelines exist. During a 1-year intervention, a patient education tool was distributed to patients. Billing records were utilized to compare detection and treatment rates for cancerous and precancerous skin lesions during the intervention to a historical control. No significant change in detection rates was demonstrated (RR = 1.0, p = 0.88). However, the number of procedures performed for malignant and pre-malignant skin lesions increased significantly (RR = 2.4, p < 0.0001). The patient education tool created clinically significant behavioral change at a low monetary and time cost.