Sarah Adkins

Are age of smoking initiation and purchasing patterns associated with menthol smoking

AIMS The purpose of this study was to examine the relationship between age of cigarette smoking initiation and cigarette purchasing patterns on menthol smoking among current smokers. DESIGN Secondary analyses were conducted using logistic regression with balanced replicated weights. SETTING Data from the 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey (CPS), collected by the National Cancer Institute, the Centers for Disease Control and Prevention and the Census Bureau, formed the basis for this investigation. PARTICIPANTS A total of 66,145 current smokers who participated in the TUS CPS administration in 2003 and 2006/07 were examined. MEASUREMENTS Demographic characteristics (gender, race/ethnicity, age, education and income), smoking frequency, purchase type (pack, carton, or both), age of initiation and menthol cigarette use were assessed. FINDINGS One-quarter of the sample smoked menthol cigarettes; most purchased their cigarettes by the pack when rather than by the carton; average age of cigarette smoking initiation was 18 years; and females, ethnic/racial minorities and younger participants were more likely to smoke menthol cigarettes compared with males, whites or older respondents. Other demographic factors associated with menthol cigarette use among current smokers included a high school education (the prevalence of menthol use among this cohort was greater than either those with less education or those with more). The multivariate logistic model only marginally revealed that age of smoking initiation predicted menthol smoking: findings are suggestive that the longer the delay of initiation the more likely that an individual smoked menthol cigarettes [odds ratio (OR) = 1.01; 95% confidence interval (CI): 1.00-1.01]. In addition, relative to those who purchased cigarettes by the pack, smokers who purchased cigarettes by the carton were less (OR = 0.86; 95% CI: 0.81-0.91) likely to be menthol smokers. CONCLUSIONS Menthol smokers in the United States are more likely to be female, younger, from ethnic minority groups, and to have a high school education. The findings that menthol smokers in the U.S. tend to start smoking later than smokers of other types of cigarettes are suggestive only and require further study.

Farm Elders Define Health as the Ability to Work

Thirty percent of Americas 2.2 million farms are operated by individuals older than 65 years. This study examined how older farmers define health and determined whether demographic characteristics, farm work, and physical and mental health status predict health definition. Data were collected via telephone and mailed surveys during the baseline wave of data collection in a longitudinal study of family farmers residing in two southern states (n = 1,288). Nearly 42% defined health as the “ability to work” compared to a physical health-related definition. Predictors of defining health as the ability to work included being White, performing more farm tasks in the past week, taking prescription medications daily, and having minimal health-related limitations to farm work. Health behaviors are centered on the individuals perception of health. Understanding the defining attributes of health can support better approaches to health care and health promotion, particularly among rural subcultures such as farmers, whose identity is rooted in their work.

Fewer Hospitalizations for Chronic Obstructive Pulmonary Disease in Communities With Smoke-Free Public Policies

OBJECTIVES We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). METHODS We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. RESULTS Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban-rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate-weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. CONCLUSIONS Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs.

Rural Print Media Portrayal of Secondhand Smoke and Smoke-Free Policy

The purpose of this article is to describe how the print media portrays secondhand smoke and smoke-free policy in rural communities. Baseline print media clips from an ongoing 5-year study of smoke-free policy development in 40 rural communities were analyzed. The authors hypothesized that community population size would be positively associated with media favorability toward smoke-free policy. Conversely, pounds of tobacco produced and adult smoking prevalence would be negatively associated with media favorability. There was a positive correlation between population size and percentage of articles favorable toward smoke-free policy. The authors did not find a correlation between adult smoking or tobacco produced and media favorability toward smoke-free policy, but we did find a positive relationship between tobacco produced and percentage of pro-tobacco articles and a negative relationship between adult smoking prevalence and percentage of articles about health/comfort. Implications for targeting pro-health media in rural communities as well as policy-based initiatives for tobacco control are discussed.

Changes in smoking behaviours following a smokefree legislation in parks and on beaches: an observational study

Objective To examine the effect of an outdoor smokefree law in parks and on beaches on observed smoking in selected venues. Methods The study involved repeated observations in selected parks and beaches in Vancouver, British Columbia, Canada. The main outcome measure was changes in observed smoking rates in selected venues from prelaw to 12 months postlaw. Results No venue was 100% smokefree at the 12-month postlaw observation time point. There was a significant decrease in observed smoking rates in all venues from prelaw to 12-month postlaw (prelaw mean smoking rate=20.5 vs 12-month mean smoking rate=4.7, p=0.04). In stratified analysis by venue, the differences between the prelaw and 12-month smoking rates decreased significantly in parks (prelaw mean smoking rate=37.1 vs 12-month mean smoking rate=6.5, p=0.01) but not in beaches (prelaw mean smoking rate=2.9 vs 12-month mean smoking rate=1.0, p=0.1). Conclusions Smokefree policies in outdoor recreational venues have the potential to decrease smoking in these venues. The effectiveness of such policies may differ by the type and usage of the venue; for instance, compliance may be better in venues that are used more often and have enforcement. Future studies may further explore factors that limit and foster the enforcement of such policies in parks and beaches.

Political Climate and Smoke-Free Laws in Rural Kentucky Communities

The purpose was to determine factors associated with rural communities’ political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials’ perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.

A Controlled Community‐Based Trial to Promote Smoke‐Free Policy in Rural Communities

PURPOSE Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities. METHODS A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years. FINDINGS Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties. CONCLUSIONS The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities.

Smoke-free homes, strength of smoke-free law, and children in the home.

INTRODUCTION Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics. METHODS An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law. RESULTS Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers. CONCLUSIONS Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.

Therapeutic Conversations Intervention in Pediatrics: Are They of Benefit for Families of Children with Asthma?

This article reports a quasiexperimental family level intervention study to measure effectiveness of a theory-based family therapeutic conversation intervention (FAM-TC) for families of children with asthma on perceived family support and asthma-related quality of life (QOL). Perceived family support increased significantly for mothers in the experimental group. The children of the parents in the experimental group reported significantly lower problems with asthma treatment on the treatment problems subscale of the asthma QOL scale after the intervention. These results highlight the benefit of therapeutic conversations for families of children and adolescent with asthma to support or enhance QOL.

A Short Online Community Readiness Survey for Smoke-Free Policy

INTRODUCTION Rural residents in the United States are more likely to use tobacco, have less access to tobacco control resources and efforts, and are more highly exposed to secondhand smoke than their urban counterparts. The purpose was to design and pilot test a shortened, self-administered online survey (Community Readiness Survey-Short form [CRS-S]) to assess community readiness for smoke-free policy in rural communities. The Community Readiness Survey-Long form (CRS-L) is a 30- to 90-min telephone-administered survey. The Community Readiness Model can guide the design of programs and policy interventions to reduce health risks. METHODS 160 key informants from Wave 3 of a 5-year community-based randomized controlled trial set in Kentucky completed the CRS-L; 61 of approximately 140-284 items were significantly related to the relevant readiness dimension subscores and selected for inclusion. The online CRS-S was created with these items using Qualtrics software; 43 smoke-free advocates who had completed the CRS-L during Wave 4 were invited to participate. Correlations between the CRS-S and the CRS-L on overall readiness and the dimension scores were calculated. Readiness scores were correlated with existence of public policy and voluntary smoke-free policies to assess convergent validity. RESULTS The correlation between the overall CRS-S and CRS-L scores was relatively strong (.82), and there is evidence to support convergent validity. Most respondents completed the CRS-S in less than 15 min and preferred this format. CONCLUSIONS The CRS-S is a valid and less time- and resource-intensive method to assess readiness for smoke-free policy in rural communities.