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Harris KJ, Stearns JN, Kovach RG, Harrar SW. Enforcing an outdoor smoking ban on a college campus: effects of a multicomponent approach. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2009; 58:121-126. [PMID: 19892648 DOI: 10.1080/07448480903221285] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Data on effective strategies to enforce policies banning outdoor smoking are sparse. This study tested the effects of an enforcement package implemented on a college campus. PARTICIPANTS Thirty-nine observers recorded compliance of 709 outside smokers. METHODS Smoking within 25 feet of buildings was noncompliant. The intervention included moving receptacles, marking the ground, improving signage, and distributing reinforcements and reminder cards. RESULTS The proportion of smokers complying with the ban was 33% during the baseline observation period, increased to 74% during the intervention week, and was at 54% during the follow-up. Differences across conditions was statistically significant (chi2(2, N = 709) = 6.299, p <.001). Compliance proportions varied by location in all conditions. CONCLUSIONS Enforcing an outdoor smoking ban using a multiple component package increased compliance with the nonsmoking policy on a college campus.
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Affiliation(s)
- Kari Jo Harris
- School of Public and Community Health Sciences, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, Montana 59812, USA.
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152
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Sheffer CE, Barone CP, Anders ME. Training health care providers in the treatment of tobacco use and dependence: pre- and post-training results. J Eval Clin Pract 2009; 15:607-13. [PMID: 19674215 DOI: 10.1111/j.1365-2753.2008.01058.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE Health care providers have an extended reach into the population of tobacco users. Increasing the number and variety of health care providers that deliver the evidence-based, brief interventions for tobacco use prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based treatments and more successful quit attempts. Effective training is key to increasing provider performance and proficiency in this regard. METHOD A 1-hour didactic training was delivered to 1286 health care providers (185 physicians, 359 nurses, 75 dental providers and 667 other health-related professions). Pre- and post-training tests assessed provider attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Analysis of variance was used to test for significant differences among professional groups. RESULTS Prior to training, physicians engaged in more interventions and reported more knowledge and more positive attitudes towards treating tobacco use than the other professions. Post-training, differences among physicians, nurses and dental providers were minimal. All professions reported significantly more knowledge and more positive attitudes on nearly all measures. CONCLUSIONS A large potential benefit can be garnered from a brief, targeted, 1-hour training in the brief, evidence-based interventions for treating tobacco use and dependence. Increases in perceived knowledge and positive attitudes towards treatment among the professional groups suggest that trainees will perform interventions at higher frequency post-training. Overall gains were highest for dental providers and nurses.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas University for Medical Sciences, Little Rock, AR 72205-7199, USA.
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153
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Freund M, Campbell E, Paul C, Sakrouge R, McElduff P, Walsh RA, Wiggers J, Knight J, Girgis A. Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect. Nicotine Tob Res 2009; 11:650-62. [DOI: 10.1093/ntr/ntp056] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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154
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Verdonk-Kleinjan WMI, Knibbe RA, Tan FES, Willemsen MC, de Groot HN, de Vries H. Does the workplace-smoking ban eliminate differences in risk for environmental tobacco smoke exposure at work? Health Policy 2009; 92:197-202. [PMID: 19398142 DOI: 10.1016/j.healthpol.2009.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 03/12/2009] [Accepted: 03/19/2009] [Indexed: 01/11/2023]
Abstract
OBJECTIVES A workplace-smoking ban in the Netherlands was introduced on January 1, 2004. Before the ban male and low educated employees were at higher risk for exposure to environmental tobacco smoke (ETS). Effective implementation of the ban should result not only in an overall decline of exposure, but also in the disappearance of systematic differences in exposure between subgroups of employees. METHODS Data from a Dutch continuous Internet survey were used. From July 2003 through June 2005, 200 respondents were randomly selected each week. The sample consisted of 11,291 non-smoking, working respondents, aged 16-65 years. RESULTS ETS exposure decreased among all employees and among subgroups at higher risk before the ban. However, also after the ban, males and low educated employees were still most likely to be exposed to ETS. CONCLUSIONS The workplace-smoking ban was effective in reducing ETS exposure among employees. However, after the ban still 52.2% of non-smoking workers reported to be exposed. We did not find the expected stronger effect among employees who were at higher risk. Both before and after implementation of the ban, males and lower educated employees were about two times more likely to be exposed to ETS.
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155
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Connolly GN, Carpenter CM, Travers MJ, Cummings KM, Hyland A, Mulcahy M, Clancy L. How smoke-free laws improve air quality: a global study of Irish pubs. Nicotine Tob Res 2009; 11:600-5. [PMID: 19380381 DOI: 10.1093/ntr/ntp038] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The present study examined indoor air quality in a global sample of smoke-free and smoking-permitted Irish pubs. We hypothesized that levels of respirable suspended particles, an important marker of secondhand smoke, would be significantly lower in smoke-free Irish pubs than in pubs that allowed smoking. METHODS Indoor air quality was assessed in 128 Irish pubs in 15 countries between 21 January 2004 and 10 March 2006. Air quality was evaluated using an aerosol monitor, which measures the level of fine particle (PM(2.5)) pollution in the air. A standard measurement protocol was used by data collectors across study sites. RESULTS Overall, the level of air pollution inside smoke-free Irish pubs was 93% lower than the level found in pubs where smoking was permitted. DISCUSSION Levels of indoor air pollution can be massively reduced by enacting and enforcing smoke-free policies.
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Affiliation(s)
- Gregory N Connolly
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Ave, Landmark Center, 3rd Floor East, Boston, MA 02115, USA.
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156
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Yancey AK, Cole BL, Brown R, Williams JD, Hillier A, Kline RS, Ashe M, Grier SA, Backman D, McCarthy WJ. A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising. Milbank Q 2009; 87:155-84. [PMID: 19298419 DOI: 10.1111/j.1468-0009.2009.00551.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities. METHODS Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia. FINDINGS Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities. CONCLUSIONS The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government's ability to regulate advertising, the success of limiting tobacco advertising offers lessons for reducing the marketing contribution to the obesigenicity of urban environments.
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Affiliation(s)
- Antronette K Yancey
- UCLA School of Public Health, University of California at Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
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McKinnon RA, Orleans CT, Kumanyika SK, Haire-Joshu D, Krebs-Smith SM, Finkelstein EA, Brownell KD, Thompson JW, Ballard-Barbash R. Considerations for an obesity policy research agenda. Am J Prev Med 2009; 36:351-7. [PMID: 19211215 PMCID: PMC2824162 DOI: 10.1016/j.amepre.2008.11.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/30/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
The rise in obesity levels in the U.S. in the past several decades has been dramatic, with serious implications for public health and the economy. Experiences in tobacco control and other public health initiatives have shown that public policy may be a powerful tool to effect structural change to alter population-level behavior. In 2007, the National Cancer Institute convened a meeting to discuss priorities for a research agenda to inform obesity policy. Issues considered were how to define obesity policy research, key challenges and key partners in formulating and implementing an obesity policy research agenda, criteria by which to set research priorities, and specific research needs and questions. Themes that emerged were: (1) the embryonic nature of obesity policy research, (2) the need to study "natural experiments" resulting from policy-based efforts to address the obesity epidemic, (3) the importance of research focused beyond individual-level behavior change, (4) the need for economic research across several relevant policy areas, and (5) the overall urgency of taking action in the policy arena. Moving forward, timely evaluation of natural experiments is of especially high priority. A variety of policies intended to promote healthy weight in children and adults are being implemented in communities and at the state and national levels. Although some of these policies are supported by the findings of intervention research, additional research is needed to evaluate the implementation and quantify the impact of new policies designed to address obesity.
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158
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Levy DT, Ross H, Zaloshnja E, Shuperka R, Rusta M. The role of tobacco control policies in reducing smoking and deaths caused by smoking in an Eastern European nation: results from the Albania SimSmoke simulation model. Cent Eur J Public Health 2009; 16:189-98. [PMID: 19256288 DOI: 10.21101/cejph.a3486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Albania SimSmoke simulation model is used to examine the effects of tobacco control policies. The model is used to consider the projected trends in smoking prevalence and associated smoking-attributable deaths in the absence of new policies, and then to examine the effect of new policies that are consistent with the Framework Convention for Tobacco Control (FCTC) on these outcomes. The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases. Acomprehensive strategy to further reduce smoking rates should include a media campaign complete with programs to publicize and enforce clean air laws, a comprehensive cessation treatment program, strong health warnings, advertising bans, and youth access laws. Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps to identify important information needed for both modeling and policymaking. The effectiveness of future tobacco control policy will require proper surveillance and evaluation schemes for Albania.
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Affiliation(s)
- David T Levy
- Pacific Institute for Research and Evaluation, 11720 Beltsville Dr., Suite 900, Calverton, Maryland, 20705, USA. 20705,
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159
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Pizzi E, Di Pucchio A, Mastrobattista L, Solimini R, Pacifici R, Pichini S. A helpline telephone service for tobacco related issues: the Italian experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:900-14. [PMID: 19440421 PMCID: PMC2672391 DOI: 10.3390/ijerph6030900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 02/14/2009] [Indexed: 12/03/2022]
Abstract
Antismoking helplines have become an integral part of tobacco control efforts in many countries, including Italy. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of antismoking helplines. However, information on how these helplines operate in actual practice is not often readily available. This paper provides an overview of the Italian Antismoking Helpline, an increasingly popular telephone service for tobacco problems operating in Italy since 2000. As many states, regions and nations are contemplating various telephone programs as part of large scale anti-tobacco campaigns, this paper briefly discusses the reasons the helpline is well suited to lead the cessation component of a comprehensive tobacco control program, how it operates and how it can be used in conjunction with other tobacco control activities. The Italian Antismoking Helpline provides Italians with free services that include counselling, cessation related information, self help quit kits and current legislation information. The helpline is promoted statewide by media campaigns, health care providers, local tobacco control programs and public school system. The Helpline is centrally operated through the Istituto Superiore di Sanità and it has served over 17.000 tobacco users and others.
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Affiliation(s)
- Enrica Pizzi
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
| | - Alessandra Di Pucchio
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
| | - Luisa Mastrobattista
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
| | - Renata Solimini
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
| | - Roberta Pacifici
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
| | - Simona Pichini
- Therapeutic Research and Medicines Evaluation Department, Italian Epidemiological Observatory on Tobacco, Alcohol and Drugs of abuse, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; E-Mails:
(A.D.P.);
(L. M.);
(R.S.);
(R.P.);
(S. P.)
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160
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Vardavas CI, Connolly G, Karamanolis K, Kafatos A. Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels. Eur J Public Health 2009; 19:212-7. [PMID: 19218335 DOI: 10.1093/eurpub/ckp015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Graphical tobacco product labelling is a prominent source of health information and has an important position among tobacco control initiatives. However, little is known about its effectiveness among adolescents. With this above in mind, we aimed to research into how adolescents perceive the proposed EU graphic tobacco product warning labels as an effective means of preventing smoking initiation in comparison to the current EU text-only warning labels. METHODS Five hundred seventy four adolescents (13-18, 54% male) from Greece were privately interviewed, with the use of a digital questionnaire and randomly shown seven existing EU text-only and proposed EU graphic warning labels. Non-smoking respondents were asked to compare and rate the warnings effectiveness in regard to preventing them from smoking on a 1-5 Likert type scale. RESULTS Irrespective of the warning category shown, on all occasions, non-smoking adolescents rated the suggested EU graphic labels as more effective in preventing them from smoking in comparison to the existing EU text-only warnings. Controlling for gender, age, current smoking status and number of cigarettes smoked per month, younger adolescents were found to opt for graphic warnings more often, and also perceive graphic warning labels as a more effective means of preventing them from smoking, in comparison to their elder peers (P < 0.001). CONCLUSIONS The proposed EU graphic warning labels may play an important role in preventing of smoking initiation during the crucial years of early adolescence when smoking experimentation and early addiction usually take place.
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Johnson-Kozlow M, Hovell MF, Rovniak LS, Sirikulvadhana L, Wahlgren DR, Zakarian JM. Fidelity issues in secondhand smoking interventions for children. Nicotine Tob Res 2009; 10:1677-90. [PMID: 19023822 DOI: 10.1080/14622200802443429] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper reviews methodological and theoretical fidelity of secondhand smoking (SHS) intervention studies (n = 29) that target protection of children in their home. In 2005, interventions were evaluated in terms of treatment fidelity according to guidelines provided by Borrelli et al. of the National Institutes of Health Behavior Change Consortium. The degree of fidelity was evaluated based on the percentage of criteria met; the inter-rater reliability based on percent agreement across independent raters was 0.78. Analysis indicated that studies with higher treatment fidelity were more likely to obtain statistically significant results (p = .003) with the average fidelity rating of 0.74 for statistically significant studies vs. 0.50 for statistically non-significant studies. Higher treatment fidelity was also significantly associated with being a more recent investigation (year 2000 or later), an efficacy as compared to effectiveness trial, more intensive as compared to less intensive intervention, a trial in the U.S. as compared to foreign nations, and having a theoretical basis. After taking all other variables into account, only treatment fidelity was significantly related to study outcome (p = .052). Ratings of treatment fidelity were ranked and compared to previous rankings based on 342 behavioral change interventions; the rank-ordered correlation between previous and current ratings was 0.84, although median fidelity ratings were 0.10 points lower in the previous than in the present study (0.52 vs. 0.62; intraclass correlation = 0.79). Improvements to the treatment fidelity evaluation guidelines were suggested, including the consideration of theoretical fidelity. Enhancing methodological and theoretical fidelity will speed identification of valid theoretical precepts that will, in turn, guide effective public health prevention programs.
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162
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Hung DY, Shelley DR. Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care clinics. Health Serv Res 2009; 44:103-27. [PMID: 18783454 PMCID: PMC2669639 DOI: 10.1111/j.1475-6773.2008.00896.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. METHODS Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. PRINCIPAL FINDINGS Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04-5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69-30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). CONCLUSIONS Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components.
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Affiliation(s)
- Dorothy Y Hung
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, Suite 548, New York, NY 10032, USA.
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163
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McNabola A, Gill LW. The control of environmental tobacco smoke: a policy review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:741-58. [PMID: 19440413 PMCID: PMC2672352 DOI: 10.3390/ijerph6020741] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 02/14/2009] [Indexed: 11/16/2022]
Abstract
According to World Health Organisation figures, 30% of all cancer deaths, 20% of all coronary heart diseases and strokes and 80% of all chronic obstructive pulmonary disease are caused by cigarette smoking. Environmental Tobacco Smoke (ETS) exposure has also been shown to be associated with disease and premature death in non-smokers. In response to this environmental health issue, several countries have brought about a smoking ban policy in public places and in the workplace. Countries such as the U.S., France, Italy, Ireland, Malta, the Netherlands, Sweden, Scotland, Spain, and England have all introduced policies aimed at reducing the population exposure to ETS. Several investigations have monitored the effectiveness of these smoking ban policies in terms of ETS concentrations, human health and smoking prevalence, while others have also investigated a number of alternatives to smoking ban policy measures. This paper reviews the state of the art in research, carried out in the field of ETS, smoking bans and Tobacco Control to date and highlights the need for future research in the area.
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Affiliation(s)
- Aonghus McNabola
- Department of Civil, Structural and Environmental Engineering, University of Dublin, Trinity College, Ireland; E-Mail:
| | - Laurence William Gill
- Department of Civil, Structural and Environmental Engineering, University of Dublin, Trinity College, Ireland; E-Mail:
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164
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Hudmon KS, Corelli RL. ASHP Therapeutic Position Statement on the Cessation of Tobacco Use. Am J Health Syst Pharm 2009. [DOI: 10.2146/ajhp070303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Karen Suchanek Hudmon
- Karen Suchanek Hudmon, Dr.P.H., M.S., is Associate Professor, Department of Pharmacy Practice, Purdue University School of Pharmacy and Pharmaceutical Sciencs, West Lafayette, IN
| | - Robin L. Corelli
- Robin L. Corelli, PharmD., is Professor of Clinical Pharmacy, Department. of Clinical Pharmacy, University of California San Francisco, San Francisco
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165
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Graham AL, Milner P, Saul JE, Pfaff L. Online advertising as a public health and recruitment tool: comparison of different media campaigns to increase demand for smoking cessation interventions. J Med Internet Res 2008; 10:e50. [PMID: 19073542 PMCID: PMC2630839 DOI: 10.2196/jmir.1001] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 04/24/2008] [Accepted: 08/19/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To improve the overall impact (reach x efficacy) of cessation treatments and to reduce the population prevalence of smoking, innovative strategies are needed that increase consumer demand for and use of cessation treatments. Given that 12 million people search for smoking cessation information each year, online advertising may represent a cost-efficient approach to reach and recruit online smokers to treatment. Online ads can be implemented in many forms, and surveys consistently show that consumers are receptive. Few studies have examined the potential of online advertising to recruit smokers to cessation treatments. OBJECTIVE The aims of the study were to (1) demonstrate the feasibility of online advertising as a strategy to increase consumer demand for cessation treatments, (2) illustrate the tools that can be used to track and evaluate the impact of online advertising on treatment utilization, and (3) highlight some of the methodological challenges and future directions for researchers. METHODS An observational design was used to examine the impact of online advertising compared to traditional recruitment approaches (billboards, television and radio ads, outdoor advertising, direct mail, and physician detailing) on several dependent variables: (1) number of individuals who enrolled in Web- or telephone-based cessation treatment, (2) the demographic, smoking, and treatment utilization characteristics of smokers recruited to treatment, and (3) the cost to enroll smokers. Several creative approaches to online ads (banner ads, paid search) were tested on national and local websites and search engines. The comparison group was comprised of individuals who registered for Web-based cessation treatment in response to traditional advertising during the same time period. RESULTS A total of 130,214 individuals responded to advertising during the study period: 23,923 (18.4%) responded to traditional recruitment approaches and 106,291 (81.6%) to online ads. Of those who clicked on an online ad, 9655 (9.1%) registered for cessation treatment: 6.8% (n = 7268) for Web only, 1.1% (n = 1119) for phone only, and 1.2% (n = 1268) for Web and phone. Compared to traditional recruitment approaches, online ads recruited a higher percentage of males, young adults, racial/ethnic minorities, those with a high school education or less, and dependent smokers. Cost-effectiveness analyses compare favorably to traditional recruitment strategies, with costs as low as US $5-$8 per enrolled smoker. CONCLUSIONS Developing and evaluating new ways to increase consumer demand for evidence-based cessation services is critical to cost-efficiently reduce population smoking prevalence. Results suggest that online advertising is a promising approach to recruit smokers to Web- and telephone-based cessation interventions. The enrollment rate of 9.1% exceeds most studies of traditional recruitment approaches. The powerful targeting capabilities of online advertising present new opportunities to reach subgroups of smokers who may not respond to other forms of advertising. Online advertising also provides unique evaluation opportunities and challenges to determine rigorously its impact and value.
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Affiliation(s)
- Amanda L Graham
- The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, NW, Washington, DC 20036, USA.
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166
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Amodei N, Lamb RJ. Over-the-counter nicotine replacement therapy: can its impact on smoking cessation be enhanced? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2008; 22:472-85. [PMID: 19071972 PMCID: PMC3577424 DOI: 10.1037/0893-164x.22.4.472] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nicotine replacement therapies (NRTs) are efficacious smoking-cessation aids. However, only minimal increases in smoking cessation followed NRTs being made available over-the-counter (OTC), which presumably made these treatments more readily available. To better understand why the United States did not experience improvements in smoking cessation following the OTC availability of NRTs, it is useful to review factors that determine NRT's impact on smoking cessation and how these factors played out with the introduction of OTC NRT. The authors contend that for NRTs to have a greater impact on public health, increases are needed in the number of individuals making a quit attempt, the proportion using NRTs in a quit attempt, and the effectiveness of each quit attempt. Even small increases in the impact of OTC NRTs could yield significant benefits in terms of morbidity and mortality. The remainder of this article provides examples of interventions designed to target each of the aforementioned factors individually as well as examples of interventions that link increased cessation attempts, increased NRT reach, and increased NRT efficacy in order to synergistically enhance the impact of OTC NRTs.
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Affiliation(s)
- Nancy Amodei
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, USA.
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167
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Telephone quitlines to help surgical patients quit smoking patient and provider attitudes. Am J Prev Med 2008; 35:S486-93. [PMID: 19012843 DOI: 10.1016/j.amepre.2008.08.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/06/2008] [Accepted: 08/19/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND The scheduling of elective surgery provides an excellent opportunity for cigarette smoking-cessation interventions. Abstinence from smoking may improve immediate surgical outcomes, and the surgical period represents a teachable moment for modifying smoking behavior. However, a variety of barriers to intervention exist. This qualitative, formative research identified themes to guide the development of a brief intervention used by the providers of surgical services to promote the use of telephone quitlines. METHODS Structured interviews were conducted in 2007 with 19 cigarette smokers either scheduled for or recently receiving surgery at Mayo Clinic, Rochester MN and ten providers of surgical services (anesthesiologists and surgeons). RESULTS Prominent patient themes included interest in quitting smoking around the time of surgery, a view of physicians having an important role in their cessation attempts, and a profound lack of knowledge regarding telephone quitline services. Patients were also poorly informed regarding the immediate benefits of quitting to surgical outcomes. Prominent provider themes included a similar ignorance of quitline services and a lack of time to deliver interventions. Although providers expressed interest in referring to quitlines if this could be easily accomplished, they were willing to spend only a limited amount of time learning how to intervene. CONCLUSIONS Both surgical patients and providers are potentially receptive to a quitline-based smoking-cessation intervention in the peri-operative period, but significant barriers exist.
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168
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Affiliation(s)
- Katherine Frohlich
- Department of Social and Preventive Medicine, University of Montréal, Montréal, Que.
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169
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Shelley D, Fahs M, Yerneni R, Das D, Nguyen N, Hung D, Burton D, Chin M, Chang MD, Cummings KM. Effectiveness of tobacco control among Chinese Americans: a comparative analysis of policy approaches versus community-based programs. Prev Med 2008; 47:530-6. [PMID: 18687355 PMCID: PMC2643380 DOI: 10.1016/j.ypmed.2008.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population. METHODS A pre-post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18-74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions. RESULTS From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community. CONCLUSION City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.
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Affiliation(s)
- Donna Shelley
- New York University College of Densitry, 423 East 23rd Street, New York, NY 10010, USA.
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170
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Lee JM, Chen SH, Chen HF, Jeng HYJ. Price sensitivity and smoking smuggled cigarettes. Eur J Public Health 2008; 19:23-7. [DOI: 10.1093/eurpub/ckn115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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171
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Campbell SL, Lee L, Haugland C, Helgerson SD, Harwell TS. Tobacco quitline use: enhancing benefit and increasing abstinence. Am J Prev Med 2008; 35:386-8. [PMID: 18675528 DOI: 10.1016/j.amepre.2008.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 06/03/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study sought to evaluate the impact on the quitline utilization and abstinence rates of increasing a free nicotine-replacement therapy (NRT) benefit from 4 weeks to 6 weeks. METHODS Intake data were utilized to assess the number of callers to the quitline during the time period in which 4 weeks of free NRT was provided (January-November 2006) and the time period of the enhanced NRT benefit (December 2006-June 2007). Abstinence rates at 3 and 6 months were calculated for people utilizing the quitline program during both time periods. RESULTS The mean number of intake calls to the quitline increased from 397 (range 326-509) prior to the enhanced NRT benefit to 712 (range 592-1227) during the 6-week NRT benefit period. The 6-month tobacco abstinence rates were significantly higher among people receiving the 6-week NRT benefit compared to those receiving the 4-week benefit (OR=1.51; 95% CI=1.07, 1.66). CONCLUSIONS The findings suggest that the promotion of an expanded NRT benefit can increase quitline utilization and abstinence rates.
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Affiliation(s)
- Stacy L Campbell
- Montana Department of Public Health and Human Services, Tobacco Use Prevention Section, Helena, Montana 59620-2951, USA
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172
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Effect of a large increase in cigarette tax on cigarette consumption: an empirical analysis of cross-sectional survey data. Public Health 2008; 122:1061-7. [DOI: 10.1016/j.puhe.2007.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 08/26/2007] [Accepted: 12/21/2007] [Indexed: 11/15/2022]
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173
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Hurley SF, Matthews JP, Guymer RH. Cost-effectiveness of smoking cessation to prevent age-related macular degeneration. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:18. [PMID: 18783631 PMCID: PMC2562365 DOI: 10.1186/1478-7547-6-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 09/11/2008] [Indexed: 11/10/2022] Open
Abstract
Background Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk. Methods We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year. Results If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective. Conclusion Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.
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Affiliation(s)
- Susan F Hurley
- Bainbridge Consultants, 222/299 Queen St, Melbourne, VIC 3000, Australia.
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174
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Niederdeppe J, Kuang X, Crock B, Skelton A. Media campaigns to promote smoking cessation among socioeconomically disadvantaged populations: what do we know, what do we need to learn, and what should we do now? Soc Sci Med 2008; 67:1343-55. [PMID: 18691793 DOI: 10.1016/j.socscimed.2008.06.037] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Indexed: 11/25/2022]
Abstract
Little is known about whether media campaigns are effective strategies to promote smoking cessation among socioeconomically disadvantaged populations or whether media campaigns may unintentionally maintain or widen disparities in smoking cessation by socioeconomic status (SES). This paper presents a systematic review of the literature on the effectiveness of media campaigns to promote smoking cessation among low SES populations in the USA and countries with comparable political systems and demographic profiles such as Canada, Australia and Western European nations. We reviewed 29 articles, summarizing results from 18 studies, which made explicit statistical comparisons of media campaign effectiveness by SES, and 21 articles, summarizing results from 13 studies, which assessed the effectiveness of media campaigns targeted specifically to low SES populations. We find that there is considerable evidence that media campaigns to promote smoking cessation are often less effective, sometimes equally effective, and rarely more effective among socioeconomically disadvantaged populations relative to more advantaged populations. Disparities in the effectiveness of media campaigns between SES groups may occur at any of three stages: differences in meaningful exposure, differences in motivational response, or differences in opportunity to sustain long-term cessation. There remains a need to conduct research that examines the effectiveness of media campaigns by SES; these studies should employ research designs that are sensitive to various ways that SES differences in smoking cessation media effects might occur.
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Affiliation(s)
- Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY 14853-4203, United States.
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175
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Hahn EJ, Rayens MK, Butler KM, Zhang M, Durbin E, Steinke D. Smoke-free laws and adult smoking prevalence. Prev Med 2008; 47:206-9. [PMID: 18519154 DOI: 10.1016/j.ypmed.2008.04.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 04/14/2008] [Accepted: 04/20/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether the adult smoking rate changed in Lexington-Fayette County, Kentucky, following the enactment of a smoke-free public places ordinance. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data from 2001-2005 were used to test whether smoking rates changed in Fayette County from the pre- to post-law period, relative to the change in 30 Kentucky counties with similar demographics. The sample consisted of 10,413 BRFSS respondents: 7139 pre-law (40 months) and 3274 post-law (20 months). RESULTS There was a 31.9% decline in adult smoking in Fayette County (25.7% pre-law to 17.5% post-law). In the group of 30 Control counties, the rate was 28.4% pre-law and 27.6% post-law. Controlling for seasonality, time trend, age, gender, ethnicity, education, marital status, and income, there was a significant Time (pre- vs. post-law) by Group (Fayette vs. Controls) interaction. There were an estimated 16,500 fewer smokers in Fayette County during post-law compared to pre-law. CONCLUSION There was a significant effect of smoke-free legislation on adult smoking rates.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky, College of Nursing, 760 Rose Street, Lexington, KY 40536-0232, USA.
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176
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Pell JP, Haw S, Cobbe S, Newby DE, Pell ACH, Fischbacher C, McConnachie A, Pringle S, Murdoch D, Dunn F, Oldroyd K, Macintyre P, O'Rourke B, Borland W. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008; 359:482-91. [PMID: 18669427 DOI: 10.1056/nejmsa0706740] [Citation(s) in RCA: 281] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both. METHODS Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million. RESULTS Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684--a 17% reduction (95% confidence interval, 16 to 18)--as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test). CONCLUSIONS The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.
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177
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Biener L, Wakefield M, Shiner CM, Siegel M. How broadcast volume and emotional content affect youth recall of anti-tobacco advertising. Am J Prev Med 2008; 35:14-9. [PMID: 18482819 PMCID: PMC2464355 DOI: 10.1016/j.amepre.2008.03.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 01/16/2008] [Accepted: 03/11/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Televised anti-tobacco advertising has been shown to be effective for discouraging smoking initiation; however, purchasing broadcasting time is very costly. This study investigated the relative impact of the broadcast volume (media weight) and the emotional content of an ad as predictors of advertising recall. METHODS The data come from a random-digit-dialed survey conducted in 2001 and 2002 of 3863 youth aged 12-17. Media weight was based on commercial TV ratings data. The emotional intensity of advertisements was derived from the ratings made by independent youth judges. RESULTS Data analyses were conducted between 2005 and 2007. Results indicated that media weight was a significant predictor of recall, but the emotional content of the ad was an even stronger predictor. Also, ads low in emotional intensity required more media weight than those high in emotional intensity to achieve the same amount of increase in recall. CONCLUSIONS This study extends prior research that highlights the importance of emotional intensity for effective anti-tobacco advertising. It also indicates that, relative to unemotional advertisements, emotionally arousing advertisements require fewer broadcasts to achieve the same level of recall, and hence are likely to be less costly to a public health campaign.
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Affiliation(s)
- Lois Biener
- Center for Survey Research University of Massachusetts Boston, Boston, Massachusetts 02125, USA.
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178
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Baron RC, Rimer BK, Breslow RA, Coates RJ, Kerner J, Melillo S, Habarta N, Kalra GP, Chattopadhyay S, Wilson KM, Lee NC, Mullen PD, Coughlin SS, Briss PA. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review. Am J Prev Med 2008; 35:S34-55. [PMID: 18541187 DOI: 10.1016/j.amepre.2008.04.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 02/05/2008] [Accepted: 04/10/2008] [Indexed: 11/25/2022]
Abstract
Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.
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Affiliation(s)
- Roy C Baron
- Community Guide Branch, National Center for Health Marketing, CDC, Atlanta, Georgia, USA
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179
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Breslow RA, Rimer BK, Baron RC, Coates RJ, Kerner J, Wilson KM, Lee NC, Mullen PD, Coughlin SS, Briss PA. Introducing the community guide's reviews of evidence on interventions to increase screening for breast, cervical, and colorectal cancers. Am J Prev Med 2008; 35:S14-20. [PMID: 18541183 DOI: 10.1016/j.amepre.2008.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 02/05/2008] [Accepted: 04/10/2008] [Indexed: 11/30/2022]
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180
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Verdonk-Kleinjan WMI, Knibbe RA, Bieleman B, de Groot HN, de Vries H. The tobacco sales ban and tobacco purchases by adolescents: a general population study in The Netherlands. Eur J Public Health 2008; 18:498-503. [PMID: 18579576 DOI: 10.1093/eurpub/ckn054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The study aimed to assess the effect of the introduction on 1 January 2003 of a legal tobacco sales ban in The Netherlands on tobacco purchases by smoking and non-smoking adolescents aged <16 years. METHODS Two cross-sectional surveys were conducted among adolescents aged 13 through 15 years, one at end 1999 (n = 4751) and the other at end 2003 (n = 13 298). RESULTS The percentage of adolescents buying tobacco decreased significantly from 26.3% in 1999 to 10.8% in 2003 (P < 0.001). Further analysis showed that, after the ban, the proportion of smokers among buyers almost tripled [Odds Ratio (OR) = 2.9], while the likelihood of non-smokers buying tobacco decreased strongly (OR = 0.17). A difference in the pattern of purchasing tobacco also emerged after the ban. In 2003, the proportion of smokers buying at least weekly in commercial outlets was larger than in 1999. For non-smokers there was no difference between 1999 and 2003 in the proportion buying weekly. The variety of commercial outlets in which purchases were made increased among both smoking and non-smoking purchasers of tobacco. CONCLUSIONS Implementation of the 2003 tobacco sales ban has had the (intended) effect of lowering tobacco purchases among adolescents. This was mainly due to the decrease in the likelihood of buying tobacco among those who regard themselves as a non-smoker. The decrease in buying tobacco is associated with a decrease in prevalence of smoking. The sales ban has probably contributed to a stronger decrease in prevalence of smoking.
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181
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Andreeva VA, Sakuma KLK. Adapting smoking cessation programming to the Bulgarian context. Eval Health Prof 2008; 31:290-6. [PMID: 18559883 DOI: 10.1177/0163278708320149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tobacco control efforts are among Bulgaria's leading health priorities, although enforcement of policies translated from other regions is challenging due to the high national smoking prevalence, especially among health professionals and school personnel. This article reviews the sociocultural and economic background relevant to health policy change and smoking cessation initiatives. Recommendations are made for effective Bulgarian tobacco control.
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182
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Abstract
Over the past quarter century, primarily as a result of scientific discovery, citizen advocacy, and legislative action, comprehensive clean indoor air laws have spread rapidly throughout the world. Laws that establish completely smoke-free indoor environments have many relative advantages including being low cost, safe, effective, and easy to implement. The diffusion of these laws has been associated with a dramatic and rapid reduction in population levels of serum cotinine among nonsmokers and has also contributed to a reduction in overall cigarette consumption among smokers, with no adverse economic impact, except to the tobacco industry. Currently, nearly half of the U.S. population lives in jurisdictions with some combination of completely smoke-free workplaces, restaurants, or bars. The diffusion of clean indoor air laws is spreading rapidly throughout the world, stimulated by the first global health treaty, the Framework Convention on Tobacco Control.
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Affiliation(s)
- Michael P Eriksen
- Institute of Public Health, Georgia State University, Atlanta, GA 30302, USA.
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183
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Curry SJ, Keller PA, Orleans CT, Fiore MC. The role of health care systems in increased tobacco cessation. Annu Rev Public Health 2008; 29:411-28. [PMID: 18173387 DOI: 10.1146/annurev.publhealth.29.020907.090934] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health care delivery systems are critical components of tobacco cessation efforts. This review summarizes recent evidence in support of the health care system recommendations in the 2000 U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence. Measurable progress in addressing tobacco use through the health care system is summarized, including accountabilities for addressing tobacco in national health care reporting systems, increases in reported advice to quit smoking from health care providers, and wider availability of insurance coverage for tobacco cessation treatments. Despite progress, significant gaps remain between what is possible and what is done by health care systems to impact tobacco cessation. A four-point public policy agenda is outlined to help close these gaps.
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Affiliation(s)
- Susan J Curry
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA.
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184
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Main C, Thomas S, Ogilvie D, Stirk L, Petticrew M, Whitehead M, Sowden A. Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews. BMC Public Health 2008; 8:178. [PMID: 18505545 PMCID: PMC2412872 DOI: 10.1186/1471-2458-8-178] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 05/27/2008] [Indexed: 11/13/2022] Open
Abstract
Background With smoking increasingly confined to lower socio-economic groups, the tobacco control community has been urged to identify which population-level tobacco control interventions work in order to help tackle smoking-related health inequalities. Systematic reviews have a crucial role to play in this task. This overview was therefore carried out in order to (i) summarise the evidence from existing systematic reviews of population-level tobacco control interventions, and (ii) assess the need for a new systematic review of primary studies, with the aim of assessing the differential effects of such interventions. Methods Systematic review methods were used to evaluate existing systematic reviews that assessed a population-level tobacco control intervention and which reported characteristics of included participants in terms of at least one socio-demographic or socio-economic factor. Results Nineteen systematic reviews were included. Four reviews assessed interventions aimed at the population level alone, whilst fifteen included at least one primary study that examined this type of intervention. Four reviews assessed youth access restrictions, one assessed the effects of increasing the unit price of tobacco, and six assessed smoking bans or restrictions. Of the eight remaining reviews, six assessed multi-component community based interventions, in which the population-level interventions were part of a wider tobacco control programme, and two assessed the impact of smoking bans or restrictions in reducing exposure to environmental tobacco smoke. We found tentative evidence that the effect of increasing the unit price of tobacco products may vary between ethnic and socio-economic groups, and between males and females. However, differences in the context and the results of different reviews made it difficult to draw any firm conclusions. Few identified reviews explicitly attempted to examine differences in intervention effects between socio-demographic groups. Therefore on the basis of these reviews the potential for smoking bans, and youth access restrictions to decrease social inequalities in smoking remains unknown. Conclusion There is preliminary evidence that increases in the unit price of tobacco may have the potential to reduce smoking related health inequalities. There is a need for equity effects to be explicitly evaluated in future systematic reviews and in primary research assessing the effects of population tobacco control interventions.
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Affiliation(s)
- Caroline Main
- Peninsula Technology Assessment Group, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK.
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185
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Cokkinides VE, Halpern MT, Barbeau EM, Ward E, Thun MJ. Racial and ethnic disparities in smoking-cessation interventions: analysis of the 2005 National Health Interview Survey. Am J Prev Med 2008; 34:404-12. [PMID: 18407007 DOI: 10.1016/j.amepre.2008.02.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 01/07/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent national surveys document racial and ethnic disparities in receipt of smoking-cessation advice. This study updates and expands prior analyses using survey data for 2005, and evaluates the association between smokers' race and ethnicity and three separate measures of healthcare-encounter-based tobacco interventions: screening, smoking-cessation advice, and use of smoking-cessation aids. METHODS Analyses are based on 4756 smokers (aged 18 and older) reporting a healthcare encounter within the past year who participated in the 2005 National Health Interview Survey (NHIS). Multivariate-adjusted OR and 95% CI for receipt of tobacco interventions in non-Hispanic black and Hispanic smokers were compared to those of non-Hispanic white smokers, adjusted for smokers' characteristics (sociodemographics, health status, and healthcare-utilization factors, and smoking-related characteristics). Analyses were done in 2006. RESULTS Results show that compared to white smokers, black and Hispanic smokers had significantly lower odds of (1) being asked about tobacco use (AOR=0.70 and AOR=0.69, respectively); (2) being advised to quit (AOR=0.72 and AOR=0.64, respectively); or (3) having used tobacco-cessation aids during the past year in a quit attempt (AOR=0.60 and AOR=0.59, respectively). Compared to 2000 NHIS published data, the prevalence of receipt of advice to quit from a healthcare provider increased from 52.9% in 2000 to 61.2% in 2005, with increases across racial and ethnic groups. CONCLUSIONS Despite progress in smokers' being advised to quit during healthcare encounters in the past 5 years, black and Hispanic smokers continue to be less likely than whites to receive and use tobacco-cessation interventions, even after control for socioeconomic and healthcare factors. Further actions are needed to understand and eliminate this disparity.
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Affiliation(s)
- Vilma E Cokkinides
- Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30303-1002, USA.
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186
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Gross B, Brose L, Schumann A, Ulbricht S, Meyer C, Völzke H, Rumpf HJ, John U. Reasons for not using smoking cessation aids. BMC Public Health 2008; 8:129. [PMID: 18430206 PMCID: PMC2386812 DOI: 10.1186/1471-2458-8-129] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 04/22/2008] [Indexed: 12/05/2022] Open
Abstract
Background Few smokers use effective smoking cessation aids (SCA) when trying to stop smoking. Little is known why available SCA are used insufficiently. We therefore investigated the reasons for not using SCA and examined related demographic, smoking behaviour, and motivational variables. Methods Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used SCA and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use. The questionnaire comprised two subscales: "Social and environmental barriers" and "SCA unnecessary." Results The most endorsed reasons for non-use of SCA were the belief to be able to quit on one's own (55.2%), the belief that help is not necessary (40.1%), and the belief that smoking does not constitute a big problem in one's life (36.5%). One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much. Smokers intending to quit agreed stronger to both subscales and smokers with lower education agreed stronger to the subscale "Social and environmental barriers". Conclusion Main reasons for non-use of SCA are being overly self-confident and the perception that SCA are not helpful. Future interventions to increase the use of SCA should address these reasons in all smokers.
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Affiliation(s)
- Beatrice Gross
- Institute for Epidemiology and Social Medicine, Ernst-Moritz-Arndt-University Greifswald, Germany.
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187
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Sandford A. Trends in smoking among adolescents and young adults in the United Kingdom. HEALTH EDUCATION 2008. [DOI: 10.1108/09654280810867097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Niederdeppe J, Fiore MC, Baker TB, Smith SS. Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations. Am J Public Health 2008; 98:916-24. [PMID: 18381998 DOI: 10.2105/ajph.2007.117499] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether the impact of televised smoking cessation ads differed by a population's education and income. METHODS We used longitudinal data from the Wisconsin Behavioral Health Survey, a statewide sample of 452 adult smokers who were interviewed in 2003 to 2004 and followed up 1 year later. Logistic regression was used to assess whether baseline recall of secondhand smoke ads and "keep trying to quit" ads was associated with quit attempts and smoking abstinence at 1 year. Interaction terms were used to assess whether these associations differed by the smokers' education and income levels. RESULTS Overall, neither keep-trying-to-quit nor secondhand smoke ad recall was associated with quit attempts or smoking abstinence. Keep-trying-to-quit ads were significantly more effective in promoting quit attempts among higher-versus lower-educated populations. No differences were observed for secondhand smoke ads by the smokers' education or income levels. CONCLUSIONS Some media campaign messages appear less effective in promoting quit attempts among less-educated populations compared with those who have more education. There is a need to develop media campaigns that are more effective with less-educated smokers.
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Affiliation(s)
- Jeff Niederdeppe
- Robert Wood Johnson Foundation Health and Society Scholar, Department of Population Health Sciences, University of Wisconsin, Room 707, WARF Building, 610 Walnut St, Madison, WI 53726-2397, USA.
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Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs 2008; 1:176-84. [PMID: 17163895 DOI: 10.1111/j.1524-475x.2004.04006.x] [Citation(s) in RCA: 1312] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several groups have outlined methodologies for systematic literature reviews of the effectiveness of interventions. The Effective Public Health Practice Project (EPHPP) began in 1998. Its mandate is to provide research evidence to guide and support the Ontario Ministry of Health in outlining minimum requirements for public health services in the province. Also, the project is expected to disseminate the results provincially, nationally, and internationally. Most of the reviews are relevant to public health nursing practice. AIMS This article describes four issues related to the systematic literature reviews of the effectiveness of public health nursing interventions: (1) the process of systematically reviewing the literature, (2) the development of a quality assessment instrument, (3) the results of the EPHPP to date, and (4) some results of the dissemination strategies used. METHODS The eight steps of the systematic review process including question formulation, searching and retrieving the literature, establishing relevance criteria, assessing studies for relevance, assessing relevant studies for methodological quality, data extraction and synthesis, writing the report, and dissemination are outlined. Also, the development and assessment of content and construct validity and intrarater reliability of the quality assessment questionnaire used in the process are described. RESULTS More than 20 systematic reviews have been completed. Content validity was ascertained by the use of a number of experts to review the questionnaire during its development. Construct validity was demonstrated through comparisons with another highly rated instrument. Intrarater reliability was established using Cohen's Kappa. Dissemination strategies used appear to be effective in that professionals report being aware of the reviews and using them in program planning/policymaking decisions. CONCLUSIONS The EPHPP has demonstrated the ability to adapt the most current methods of systematic literature reviews of effectiveness to questions related to public health nursing. Other positive outcomes from the process include the development of a critical mass of public health researchers and practitioners who can actively participate in the process, and the work on dissemination has been successful in attracting external funds. A program of research in this area is being developed.
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Affiliation(s)
- B H Thomas
- McMaster University School of Nursing, Hamilton Public Health and Community Services, Ontario, Canada.
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190
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Abstract
PURPOSE The purpose of this study was to discover public health decision makers' preferences for content, format, and channels for receiving research knowledge, so as to begin development of a comprehensive national public health knowledge transfer strategy. A preliminary knowledge transfer strategy developed in part from the views expressed by public health decision makers in an earlier study (Dobbins et al. 2002b) was used as a foundation on which to base discussions. The research team believes strongly that consultation with potential users is crucial to ensure the conduct of relevant and timely research as well as the development of an effective knowledge transfer strategy. METHODS Nine focus groups of five to seven participants were held in seven Canadian cities. Participants included medical officers of health, public health managers and directors, health promotion mangers, and health policymakers at provincial and federal levels. A semi-structured, open-ended interview guide was used to facilitate the discussion. The focus groups were audiotaped, and results were analyzed independently by two members of the research team who then developed key themes through a consensus process. RESULTS Generally, participants spoke positively about the knowledge transfer strategy to which they were exposed. In addition, they supported the development of a registry of reviews evaluating the effectiveness of public health interventions rated by methodological quality of the evidence, with a summary statement of the reviews highlighting the results along with specific implications for practice. Participants also indicated they wanted to receive personalized updates of new reviews in their area of interest. Finally, the results highlighted a significant challenge related to knowledge management indicating opportunities for ongoing professional development and training. CONCLUSIONS These findings were used to create an online registry of reviews evaluating the effectiveness of public health and health promotion interventions. The registry is one component of a comprehensive national public health knowledge transfer strategy.
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Affiliation(s)
- M Dobbins
- McMaster University, School of Nursing, Hamilton, Ontario, Canada.
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191
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Abstract
BACKGROUND Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. OBJECTIVES To assess the effectiveness of mass media interventions in reducing smoking among adults. SEARCH STRATEGY The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in March 2007. SELECTION CRITERIA Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker. DATA COLLECTION AND ANALYSIS Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of included studies and are presented narratively and in table form. MAIN RESULTS Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined. AUTHORS' CONCLUSIONS There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign, while another (California) showed positive results only during the period of adequate funding and implementation. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.
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Affiliation(s)
- M Bala
- Jagiellonian University Medical College, 2nd Department of Internal Medicine, 8 Skawinska St, Krakow, Poland, 31-066.
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192
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Dietz NA, Delva J, Woolley ME, Russello L. The reach of a youth-oriented anti-tobacco media campaign on adult smokers. Drug Alcohol Depend 2008; 93:180-4. [PMID: 17964081 DOI: 10.1016/j.drugalcdep.2007.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 08/02/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND It remains unclear whether youth-targeted anti-tobacco media campaigns reach adults. We examined the reach of the youth-oriented Florida "truth" campaign to (a) determine the extent to which adult smokers were aware of the campaign and (b) test if that awareness was associated with an intention to quit smoking in the next 30 days. METHODS Data included 781 adult smokers who in 2001 participated in a 20-min telephone survey designed to examine the effects of the "truth" campaign in Florida. Participants were asked numerous questions aimed at measuring their awareness of the campaign and about their tobacco use. RESULTS Awareness of the campaign was mixed with 21% confirming the "truth" campaign theme, 45% the "truth" logo, 62% "truth" advertising events, and 68% the "truth" advertising theme. Awareness of industry manipulation was the only variable significantly associated with smokers' intentions to quit (OR=1.66; 95% CI=1.34-2.05) in the multivariate model. CONCLUSIONS The "truth" anti-tobacco campaign targeted 12-17 year olds in an effort to prevent them from starting to smoke. Despite the awareness, the campaign did not have the "unintended consequence" of influencing adults' intentions to smoke. To change the behavior of adults it is not sufficient to have a youth-focused program.
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Affiliation(s)
- Noella A Dietz
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Department of Epidemiology and Public Health, Miami, FL 33101, USA
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193
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Farrelly MC, Pechacek TF, Thomas KY, Nelson D. The impact of tobacco control programs on adult smoking. Am J Public Health 2008; 98:304-9. [PMID: 18172148 DOI: 10.2105/ajph.2006.106377] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Matthew C Farrelly
- Division of Public Health and Environment, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA.
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194
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Lipton R, Banerjee A, Levy D, Manzanilla N, Cochrane M. The spatial distribution of underage tobacco sales in Los Angeles. Subst Use Misuse 2008; 43:1594-614. [PMID: 18752162 DOI: 10.1080/10826080802241110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Underage tobacco sales is considered a serious public health problem in Los Angeles. Anecdotally, rates have been thought to be quite high. In this paper, using spatial statistical techniques, we describe underage tobacco sales, identifying areas with high levels of sales and hot spots controlling for sociodemographic measures. METHODS Six hundred eighty-nine tobacco outlets were investigated throughout the city of Los Angeles in 2001. We consider the factors that explain vendor location of illegal sales of tobacco to underage youth and focus on those areas with especially high rates of illegal sales when controlling for other independent measures. Using data from the census, the LA City Attorney's Office, and public records on school locations in Los Angeles, we employ general least-squares (GLS) estimators in order to avoid biased estimates. MAIN OUTCOME MEASURE vendor location of underage tobacco compliance checks, violators, and nonviolators. RESULTS Underage tobacco sales in Los Angeles were very high (33.5%) for the entire city in 2001. In many zip codes this rate is considerably higher (60%-100%). When conducting spatial modeling, lower income and ethnicity were strongly associated with increases in underage tobacco sales. Hotspot areas of underage tobacco sales also had much lower mean family income and a much higher percentage of foreign born and greater population density. CONCLUSIONS Spatial techniques were used to better identify areas where vendors sell tobacco to underage youth. Lower income areas were much more likely to both have higher rates of underage tobacco sales and to be a hot spot for such sales. Population density is also significantly associated with underage tobacco sales. The study's limitations are noted.
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Affiliation(s)
- Robert Lipton
- Prevention Research Center (PRC), Berkeley, California 94704, USA.
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195
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Broder KR, Cohn AC, Schwartz B, Klein JD, Fisher MM, Fishbein DB, Mijalski C, Burstein GR, Vernon-Smiley ME, McCauley MM, Wibbelsman CJ. Adolescent immunizations and other clinical preventive services: a needle and a hook? Pediatrics 2008; 121 Suppl 1:S25-34. [PMID: 18174318 DOI: 10.1542/peds.2007-1115d] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.
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Affiliation(s)
- Karen R Broder
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Meyer MG, Toborg MA, Denham SA, Mande MJ. Cultural perspectives concerning adolescent use of tobacco and alcohol in the Appalachian mountain region. J Rural Health 2008; 24:67-74. [PMID: 18257873 PMCID: PMC2409582 DOI: 10.1111/j.1748-0361.2008.00139.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Appalachia has high rates of tobacco use and related health problems, and despite significant impediments to alcohol use, alcohol abuse is common. Adolescents are exposed to sophisticated tobacco and alcohol advertising. Prevention messages, therefore, should reflect research concerning culturally influenced attitudes toward tobacco and alcohol use. METHODS With 4 grants from the National Institutes of Health, 34 focus groups occurred between 1999 and 2003 in 17 rural Appalachian jurisdictions in 7 states. These jurisdictions ranged between 4 and 8 on the Rural-Urban Continuum Codes of the Economic Research Service of the US Department of Agriculture. Of the focus groups, 25 sought the perspectives of women in Appalachia, and 9, opinions of adolescents. FINDINGS The family represented the key context where residents of Appalachia learn about tobacco and alcohol use. Experimentation with tobacco and alcohol frequently commenced by early adolescence and initially occurred in the context of the family home. Reasons to abstain from tobacco and alcohol included a variety of reasons related to family circumstances. Adults generally displayed a greater degree of tolerance for adolescent alcohol use than tobacco use. Tobacco growing represents an economic mainstay in many communities, a fact that contributes to the acceptance of its use, and many coal miners use smokeless tobacco since they cannot light up in the mines. The production and distribution of homemade alcohol was not a significant issue in alcohol use in the mountains even though it appeared not to have entirely disappeared. CONCLUSIONS Though cultural factors support tobacco and alcohol use in Appalachia, risk awareness is common. Messages tailored to cultural themes may decrease prevalence.
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Rothemich SF, Woolf SH, Johnson RE, Burgett AE, Flores SK, Marsland DW, Ahluwalia JS. Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study. Ann Fam Med 2008; 6:60-8. [PMID: 18195316 PMCID: PMC2203392 DOI: 10.1370/afm.750] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 05/15/2007] [Accepted: 06/04/2007] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling. METHODS This study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identification system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion. RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P=.04). There was no significant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P=.18). CONCLUSIONS The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.
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Affiliation(s)
- Stephen F Rothemich
- Department of Family Medicine, Virginia Commonwealth University, Richmond, VA 23298-0251, USA.
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Woods SS, Haskins AE. Increasing reach of quitline services in a US state with comprehensive tobacco treatment. Tob Control 2007; 16 Suppl 1:i33-6. [PMID: 18048629 DOI: 10.1136/tc.2007.019935] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The population reach of tobacco quitlines is an important measure of treatment seeking and penetration of services. Maine offers an opportunity to examine temporal changes in quitline reach and referral sources in the context of a comprehensive tobacco treatment programme. The impact of a $1.00 cigarette tax increase is also examined. METHODS This is a descriptive analysis of Maine Tobacco Helpline call volume September 2001 to December 2006. Annual reach was estimated using a cross sectional state surveillance survey. Weekly call volume was examined during 2005, a year of marked changes in tobacco taxes and quitline resources. Referral patterns were analysed yearly. RESULTS Maine's Tobacco Helpline observed more than a threefold increase in population reach during a four year interval, from 1.9% to over 6% per year. Calls increased substantially in 2005, concurrent with added hours of operation and a rise in the cigarette tax. Over time, callers increasingly reported hearing about the quitline from health professionals, from 10% in 2001 to 38% in 2006. CONCLUSIONS Tobacco treatment programmes offering free nicotine therapy and professional medical education can drive quitline utilisation over time. Call volume can also be affected by quitline operational and policy changes that promote the reduction of tobacco use.
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Schillo BA, Wendling A, Saul J, Luxenberg MG, Lachter R, Christenson M, An LC. Expanding access to nicotine replacement therapy through Minnesota's QUITLINE partnership. Tob Control 2007; 16 Suppl 1:i37-41. [PMID: 18048630 DOI: 10.1136/tc.2007.020180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Partnerships can expand the reach and effectiveness of quitlines while conserving limited tobacco control dollars. OBJECTIVE To describe how the addition of free nicotine replacement therapy (NRT) to the "QUITPLAN Helpline" in Minnesota influenced triage and transfer to health plan quitlines and how efforts taken to re-establish balance in the partnership expanded population based access to NRT. METHODS NRT provision began in September 2002. Call volumes, transfer rates and ClearWay Minnesota dollars spent serving health plan members were examined from May 2001 through November 2005. The process by which health plan quitlines began providing NRT as a result of the addition of NRT to the QUITPLAN Helpline in September 2002 was explored through interviews with health plan representatives. RESULTS Following the addition of NRT to the QUITPLAN Helpline, the percentage of health plan members transferred to their health plans decreased because callers were resisting transfer to their health plans for telephone counselling that did not include NRT. Transfer rates eventually returned to pre-NRT levels following sequential implementation of scripting changes, transfer requirements and collection of health plan identification numbers. These changes reduced ClearWay Minnesota dollars spent on providing services to insured Minnesotans. Through the partnership, all Minnesotans currently have access to both telephone counselling and NRT either at no or low cost. CONCLUSIONS Minnesota's partnership has effectively expanded access to NRT through quitlines. The increased use of partnerships for providing quitline services may be effective in broadening population access while conserving limited tobacco control dollars for those without cessation benefits.
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Abstract
Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption.
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Affiliation(s)
- C M Anderson
- University of California, San Diego, La Jolla, CA 92093-0905, USA.
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