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Chiu YL, Lo HC, Lai CH, Hwang SL, Lin FG, Huang SJ, Jiang SH, Li SR, Tzeng YM, Fang WH, Kao S. Effectiveness of a smoking restriction policy on smoking behaviour in the military. Addict Behav 2017; 67:53-57. [PMID: 28012966 DOI: 10.1016/j.addbeh.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/29/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Yu-Lung Chiu
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | | | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Ling Hwang
- Center for General Education, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.
| | - Shu-Jia Huang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shiang-Huei Jiang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shan-Ru Li
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Mei Tzeng
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Senyeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan.
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Hahn EJ, Rayens MK, Okoli CT, Love K, Kim S. Tobacco Use Prevention and Cessation Policies in Manufacturing Facilities in the Tobacco-Growing State of Kentucky. Am J Health Promot 2016; 18:225-31. [PMID: 14748312 DOI: 10.4278/0890-1171-18.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To assess workplace tobacco use prevention and cessation policies in manufacturing facilities and explore factors associated with tobacco policies and practices in the tobacco-growing state of Kentucky. Design. Cross-sectional, descriptive, correlational design. Setting. Telephone survey of Kentucky manufacturing facilities. Subjects. A total of 437 human resource managers (77% participation rate). Measures. Telephone interviews by trained local health department staff to assess indoor and outdoor smoking policies, sale of cigarettes on company property, and provision of cessation and prevention programs. Results. Nearly seven in 10 manufacturing facilities had a written smoking policy, but only 43% banned indoor smoking. About one-fourth of companies reimbursed for cessation treatment and/or provided cessation resources. Companies with unions were more likely than those without unions to provide cessation resources but were also more likely to allow indoor smoking. Although large companies had more than two and a half times the odds as small companies to have a written smoking policy, they were more likely to allow cigarette sales on company property. Conclusion. Despite the importance of smoke-free policies in the workplace, most manufacturing facilities surveyed allowed indoor smoking and few helped smokers quit. Companies with unions were more likely to cater to their smoking employees. Manufacturing facilities provide an opportunity to protect large numbers of adult workers from the hazards of secondhand smoke and to provide quit assistance for smokers.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky College of Nursing and College of Medicine, School of Public Health, 760 Rose Street, Lexington, KY 40536-0232, USA
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Kegler MC, Escoffery C, Bundy L, Berg CJ, Haardörfer R, Yembra D, Schauer G. Pilot study results from a brief intervention to create smoke-free homes. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:951426. [PMID: 22675374 PMCID: PMC3362929 DOI: 10.1155/2012/951426] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/10/2012] [Accepted: 02/28/2012] [Indexed: 11/26/2022]
Abstract
Very few community-based intervention studies have examined how to effectively increase the adoption of smoke-free homes. A pilot study was conducted to test the feasibility, acceptability, and short-term outcomes of a brief, four-component intervention for promoting smoke-free home policies among low-income households. We recruited forty participants (20 smokers and 20 nonsmokers) to receive the intervention at two-week intervals. The design was a pretest-posttest with follow-up at two weeks after intervention. The primary outcome measure was self-reported presence of a total home smoking ban. At follow-up, 78% of participants reported having tried to establish a smoke-free rule in their home, with significantly more nonsmokers attempting a smoke-free home than smokers (P = .03). These attempts led to increased smoking restrictions, that is, going from no ban to a partial or total ban, or from a partial to a total ban, in 43% of the homes. At follow-up, 33% of the participants reported having made their home totally smoke-free. Additionally, smokers reported smoking fewer cigarettes per day. Results suggest that the intervention is promising and warrants a rigorous efficacy trial.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Ravara SB, Calheiros JM, Aguiar P, Barata LT. Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: a cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban. BMC Public Health 2011; 11:720. [PMID: 21943400 PMCID: PMC3189890 DOI: 10.1186/1471-2458-11-720] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 09/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. METHODS Questionnaire-based cross-sectional study, including all eligible staff. SAMPLE 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. RESULTS Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. CONCLUSIONS Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.
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Affiliation(s)
- Sofia B Ravara
- Health Sciences Research Centre (CICS), Faculty of Health Sciences (FCS), University of Beira Interior (UBI), Av, Infante D, Henrique, 6200-506 Covilhã, Portugal.
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Hopkins DP, Razi S, Leeks KD, Priya Kalra G, Chattopadhyay SK, Soler RE. Smokefree policies to reduce tobacco use. A systematic review. Am J Prev Med 2010; 38:S275-89. [PMID: 20117612 DOI: 10.1016/j.amepre.2009.10.029] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 08/12/2009] [Accepted: 10/27/2009] [Indexed: 10/19/2022]
Abstract
In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. A total of 57 studies were identified in the period 1976 through June 2005 that met criteria to be candidates for review; of these, 37 met study design and quality of execution criteria to qualify for final assessment. Twenty-one studies measured absolute differences in tobacco-use prevalence with a median effect of -3.4 percentage points (interquartile interval: -6.3 to -1.4 percentage points). Eleven studies measured differences in tobacco-use cessation among tobacco users exposed to a smokefree policy compared with tobacco users not exposed to a smokefree policy. The median absolute change was an increase in cessation of 6.4 percentage points (interquartile interval: 1.3 to 7.9 percentage points). The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy. Additional research is needed to more fully evaluate the total economic effects of these policies.
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Affiliation(s)
- David P Hopkins
- National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.
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Mullally BJ, Greiner BA, Allwright S, Paul G, Perry IJ. The effect of the Irish smoke-free workplace legislation on smoking among bar workers. Eur J Public Health 2009; 19:206-11. [PMID: 19307250 DOI: 10.1093/eurpub/ckp008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. METHODS A random sample of bar workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9% follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. RESULTS There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: -2.8% from 51.4% to 48.6%, P = 0.51; combined self report and cotinine: -4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in consumption of four cigarettes (95% CI 2.21-6.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5%, P = 0.06) in smoking prevalence but no significant change in consumption. CONCLUSIONS Ireland's smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.
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Affiliation(s)
- Bernie J Mullally
- Department of Epidemiology & Public Health, National University of Ireland, Brookfield Health Sciences Complex, Cork, Republic of Ireland.
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Serra C, Bonfill X, Pladevall Vila M, Cabezas Pena C. WITHDRAWN: Interventions for preventing tobacco smoking in public places. Cochrane Database Syst Rev 2008; 2008:CD001294. [PMID: 18646069 PMCID: PMC10734372 DOI: 10.1002/14651858.cd001294.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Environmental tobacco smoke is a health hazard. Reducing exposure to tobacco smoke in public places is a widespread public health goal. There is, however, considerable variation in the extent to which this goal has been achieved in different settings and societies. There is therefore a need to identify effective strategies for reducing tobacco consumption in public places. OBJECTIVES To evaluate the effectiveness of interventions to reduce tobacco consumption in public places. SEARCH STRATEGY We searched the Tobacco Addiction Review Group trials register, MEDLINE and EMBASE in March 2006. We handsearched a key journal and abstracts from international conferences on tobacco. We checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA We considered randomized and controlled trials, controlled and uncontrolled before-and-after studies and interrupted time series. The main outcome of interest was levels and measures of compliance with bans and restrictions. We considered strategies aimed at populations, including education campaigns, written material, non-smoking and warning signs, and comprehensive strategies. We also considered strategies aimed at individual smokers. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of each study was abstracted by one reviewer and checked by two others. Studies were combined using qualitative narrative synthesis. MAIN RESULTS Twenty of 25 studies reporting information about interventions to reduce smoking in public places met all the inclusion criteria. Three were controlled before-and-after studies and 17 were uncontrolled before-and-after studies. The most effective strategies used comprehensive, multi-component approaches to implement policies banning smoking within institutions. Less comprehensive strategies, such as posted warnings and educational material, had a moderate effect. Five studies showed that prompting individual smokers had an immediate effect, but such strategies are unlikely to be acceptable as a public health intervention. AUTHORS' CONCLUSIONS Carefully planned and resourced, multi-component strategies effectively reduced smoking within public places. Less comprehensive strategies were less effective. Most studies were done in the USA and, despite increasing evidence from Europe, there is a need to identify ways in which these strategies can be adopted and used in countries with different attitudes to tobacco use. Future studies should also consider the use of more rigorous experimental designs.
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Affiliation(s)
- Consol Serra
- Department of Health and Experimental SciencesUnit of Research in Occupational HealthPompeu Fabra UniversityDr Aiguader, 80BarcelonaSpain08003
| | - Xavier Bonfill
- Hospital de la Santa Creu i Sant PauSpanish Cochrane Centre, Department of Epidemiologyc/ Sant Antoni M. Claret, 167BarcelonaCataloniaSpain08025
| | | | - Carmen Cabezas Pena
- Health DepartmentSubdireccio General de Salut PublicaRoc Boronat 81‐9508005 BarcelonaCataloniaSpain
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Shavers VL, Fagan P, Alexander LAJ, Clayton R, Doucet J, Baezconde-Garbanati L. Workplace and home smoking restrictions and racial/ethnic variation in the prevalence and intensity of current cigarette smoking among women by poverty status, TUS-CPS 1998-1999 and 2001-2002. J Epidemiol Community Health 2007; 60 Suppl 2:34-43. [PMID: 17708009 PMCID: PMC2491893 DOI: 10.1136/jech.2006.046979] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE Recognition of the health consequences of exposure to environmental tobacco smoke has led government agencies and many employers to establish policies that restrict cigarette smoking in public and workplaces. This cross sectional study examines the association of workplace smoking policies and home smoking restrictions with current smoking among women. DESIGN Participants were employed US women ages 18-64 who were self respondents to the 1998-1999 or 2000-2001 tobacco use supplement to the current population survey supplements. Cross tabulations and multivariate logistic regression analyses examine the association of selected demographic characteristics, occupation, income, workplace and home smoking policies/restrictions with current smoking, consumption patterns, and quit attempts among women by poverty level for five race/ethnic groups. MAIN RESULTS The prevalence of either having an official workplace or home smoking policy that completely banned smoking increased with increased distance from the poverty level threshold. A complete ban on home smoking was more frequently reported by African American and Hispanic women although Hispanic women less frequently reported an official workplace smoking policy. In general, policies that permitted smoking in the work area or at home were associated with a higher prevalence of current smoking but this varied by poverty level and race/ethnicity. Home smoking policies that permitted smoking were associated with lower adjusted odds of having a least one quit attempt for nearly all poverty level categories but there was no association between having one quit attempt and workplace policies. CONCLUSION Home smoking policies were more consistently associated with a lower prevalence of current smoking irrespective of poverty status or race/ethnicity than workplace policies. These findings underscore the importance of examining tobacco control policies in multiple domains (work and home) as well as by race/ethnicity and socioeconomic position.
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Affiliation(s)
- Vickie L Shavers
- National Cancer Institute, Division of Cancer Control and Population Science, Applied Research Program, Health Service and Economics Branch, 6130 Executive Blvd, MSC-7344, EPN Room 4005, Bethesda, MD 20892-7344, USA.
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Greaves L, Johnson J, Bottorff J, Kirkland S, Jategaonkar N, McGowan M, McCullough L, Battersby L. What are the effects of tobacco policies on vulnerable populations? A better practices review. Canadian Journal of Public Health 2006. [PMID: 16967752 DOI: 10.1007/bf03405610] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies--tax and price, smoking location restrictions and sales restrictions--and examines the consequences for Aboriginal people, youth and low-income people. METHODS A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined. FINDINGS Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis. CONCLUSIONS Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review.
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Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, BC Women's Hospital, E-311 4500 Oak St., Vancouver, BC V6H 3N1.
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Sabidó M, Sunyer J, Masuet C, Masip J. Hospitalized smokers: compliance with a nonsmoking policy and its predictors. Prev Med 2006; 43:113-6. [PMID: 16630651 DOI: 10.1016/j.ypmed.2006.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 02/12/2006] [Accepted: 02/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Factors associated with compliance with smoke-free policies among hospitalized smokers are poorly described. A better understanding of these factors may improve smoking cessation during admission and in the long-term. METHODS Two cross-sectional studies were conducted in an urban teaching hospital in Spain during 2002 and 2004. We interviewed 229 admitted smokers gathering data on smoking history, admission diagnosis, belief that hospitalization is related to smoking, policy's awareness, and smoking during admission and place of smoking. RESULTS Among hospitalized patients, approximately a third were current smokers. The compliance with the nonsmoking policy in 2002 and 2004 was respectively 71.9% (IC95%: 63.9-79.9) and 60.1% (IC95%: 50.9-69.3). In the multivariate regression model, factors significantly associated with compliance were: contemplation stage, confidence in quitting after discharge, belief that current symptoms or illness were related to smoking, and mild withdrawal symptoms. CONCLUSIONS Admission in a smoke-free hospital does not guarantee that patients will refrain from smoking. Factors associated with compliance identified may be modified by tailored smoking cessation interventions. Our results might help physicians to understand inpatients' difficulties to abstain from cigarettes and enhance their efforts to take advantage of the hospitalization as a window opportunity to quit.
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Affiliation(s)
- Meritxell Sabidó
- Department of Preventive Medicine and Public Health, Hospital Universitari de Bellvitge, Crta. Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
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Harano Y, Miyawaki T, Nabiki J, Shibachi M, Adachi T, Ikeda M, Ueda F, Nakano T. Development of cookie test for the simultaneous determination of glucose intolerance, hyperinsulinemia, insulin resistance and postprandial dyslipidemia. Endocr J 2006; 53:173-80. [PMID: 16618974 DOI: 10.1507/endocrj.53.173] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A new cookie test was developed for the simultaneous evaluation of multiple risk factors such as glucose intolerance, hyperinsulinemia, insulin resistance and postprandial dyslipidemia. The cookie consisting of 75 g carbohydrate and 25 g fat is ingested and the blood samples are obtained at 0, 1 and 2 hours later. When the two carbohydrate sources, liquid glucose and test cookie, were compared as a glucose load within 3 months, the 2 hr plasma glucose levels were not statistically different, proposing the use of the same criteria at 2 hour glucose level for the diagnosis of diabetes and impaired glucose tolerance (IGT) in subjects without exocrine pancreatic dysfunction. In addition, hyperinsulinemia, insulin resistance (AUC insulin, and/or AUC insulin X AUC glucose), and postprandial hyperlipidemia (DeltaTG, Triglyceride; DeltaRLP, remnant like particles) have been simultaneously uncovered. Reactive hypoglycemia with adverse epigastric discomfort was observed in 26.3% of the control subjects with liquid glucose, while it was observed in only 1 case (5.3%) without any symptom with cookie tests. In fact, one reactive hypoglycemia out of 5 with liquid glucose turned out to be IGT with cookie test. In 64 subjects with lifestyle-related diseases, cookie test revealed hyperinsulinemia and insulin resistance in 56% respectively, postprandial hyperlipidemia in 39%, diabetes and IGT in 22-23% of each of the subjects and all showed at least one abnormal value. In contrast, in university students with exercise habit, all showed normal results with cookie test. In addition, improved insulin sensitivity over non-exercise group was obverved. In summary, the cookie test provided more informations compared with OGTT using liquid glucose and with fewer side effects. Simultaneous evaluation of glucose intolerance, hyperinsulinemia, insulin resistance, and postprandial hyperlipidemia was also possible.
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Affiliation(s)
- Yutaka Harano
- Niseikai Center for Lifestyle-Related Diseases, Mino City, Osaka, Japan
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Spurlock AY. Policy predictors of participation in adult tobacco cessation programs. Policy Polit Nurs Pract 2005; 6:296-304. [PMID: 16443984 DOI: 10.1177/1527154405283426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article examines the effect of tobacco cessation treatment factors and environmental, structural, and client factors on participation in tobacco cessation programs among adults in a tobacco growing state. A pooled time series cross-sectional research design was used to analyze the primary and secondary data collected at the population level (N = 140 Health Department Service Areas; HDSA). Results indicated that for every cessation program added, there would be an increase in participation of 4 adults per 10,000 smokers, and for every 1.00 dollar per capita spent on counteradvertising, there would be an increase in participation of 26 adults per 10,000 smokers. Local health departments need to initiate or increase counteradvertising, targeting younger adults and HDSAs with higher per capita tobacco production; enhance marketing efforts for cessation; and increase the number of cessation programs offered by HDSAs to as many as are feasible and affordable.
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Hu SC, Huang SY, Li D, Wen CP, Tsai SP. Workplace smoking policies in Taiwan and their association with employees' smoking behaviours. Eur J Public Health 2005; 15:270-5. [PMID: 15923215 DOI: 10.1093/eurpub/cki057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The implementation of worksite smoking policies has shown significant effects on reducing employees' smoking consumption and protecting non-smoking workers. However, there are no data about workplace smoking policies in Taiwan. The purpose of this study was to document the status of worksite smoking policies in Taiwan and its potential impact on employees' smoking behaviours. METHODS A two-stage investigation was conducted. The first stage was to examine the current status of workplace smoking policies and the second was to evaluate the relationship between workplace smoking policies and employees' smoking behaviours. After two follow-ups in each stage, 264 companies and 1141 employees returned their questionnaires. RESULTS Workplace smoking policies were associated with types of businesses and size of workplaces. Only approximately half of manufacturing and service companies have implemented a prohibitive smoking policy. Large facilities (>750 employees) were more likely to implement a prohibitive policy (57%). Employees in workplaces with a prohibitive policy had lower prevalence of smoking and cigarette consumption, and less exposure to passive smoking. Although most smokers agreed with banning smoking in their work environment, no difference in interest in participating in cessation programs was found. CONCLUSIONS Significant associations were found between workplace smoking policies and employees' smoking behaviours. Results of the study provide basic information for designing more refined smoking policies in the workplace in Taiwan.
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Affiliation(s)
- Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
BACKGROUND The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. OBJECTIVES To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialized Register in October 2004, MEDLINE (1966 - October 2004), EMBASE (1985 - October 2004) and PsycINFO (to October 2004). We searched abstracts from international conferences on tobacco and we checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA We categorized interventions into two groups: a) Interventions aimed at the individual to promote smoking cessation and b) interventions aimed at the workplace as a whole. We applied different inclusion criteria for the different types of study. For interventions aimed at helping individuals to stop smoking, we included only randomized controlled trials allocating individuals, workplaces or companies to intervention or control conditions. For studies of smoking restrictions and bans in the workplace, we also included controlled trials with baseline and post-intervention outcomes and interrupted times series studies. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one author and checked by two others. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis. MAIN RESULTS Workplace interventions aimed at helping individuals to stop smoking included ten studies of group therapy, seven studies of individual counselling, nine studies of self-help materials and five studies of nicotine replacement therapy. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective.Workplace interventions aimed at the workforce as a whole included 14 studies of tobacco bans, two studies of social support, four studies of environmental support, five studies of incentives, and eight studies of comprehensive (multi-component) programmes. Tobacco bans decreased cigarette consumption during the working day but their effect on total consumption was less certain. We failed to detect an increase in quit rates from adding social and environmental support to these programmes. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Competitions and incentives increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting. AUTHORS' CONCLUSIONS We found: 1. Strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include advice from a health professional, individual and group counselling and pharmacological treatment to overcome nicotine addiction. Self-help interventions are less effective. All these interventions are effective whether offered in the workplace or elsewhere. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low. 2. Limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer. 3. Consistent evidence that workplace tobacco policies and bans can decrease cigarette consumption during the working day by smokers and exposure of non-smoking employees to environmental tobacco smoke at work, but conflicting evidence about whether they decrease prevalence of smoking or overall consumption of tobacco by smokers. 4. A lack of evidence that comprehensive approaches reduce the prevalence of smoking, despite the strong theoretical rationale for their use. 5. A lack of evidence about the cost-effectiveness of workplace programmes.
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Exposure to environmental tobacco smoke (ETS) and determinants of support for complete smoking bans in psychiatric settings. Tob Control 2005; 13:180-5. [PMID: 15175537 DOI: 10.1136/tc.2003.004804] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To measure environmental tobacco smoke (ETS) exposure in psychiatric settings and to assess determinants of support for complete smoking bans. DESIGN Cross sectional study SETTING Dutch psychiatric hospitals, outpatient care institutions, and sheltered home facilities. SUBJECTS A random sample of 540 treatment staff, 306 attendants/nurses, and 93 patients. MAIN OUTCOME MEASURES Self reported ETS exposure, current smoking policy, compliance with smoking policy, beliefs about smoking bans. RESULTS 87% of respondents were exposed to tobacco smoke in psychiatric institutions; 29% said that on an average day they were exposed to "a lot of smoke". Although ETS originates mainly from smoking patients, both non-compliance from patients and employees with existing bans resulted in non-smokers being exposed to ETS. Due to non-compliance, ETS exposure was quite high when there is a general smoking ban (designated areas option). Only with a complete ban was compliance good and employees sufficiently protected from ETS exposure. Psychiatrists, psychologists, physicians, attendants, and nurses were most concerned about resistance from patients, partly because of the fear of infringing on patients' freedom to smoke. CONCLUSIONS Complete smoking bans are the only way to fully protect those working in psychiatry from ETS exposure, mainly because general smoking bans are not sufficiently complied with. Communication strategies to improve compliance with complete bans are crucial to protect those working in psychiatry from ETS. Compliance could be improved by addressing the belief that the ban will effectively result in less ETS exposure and the issue of patients' freedom to smoke versus employees' right to work in a smoke-free environment.
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16
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Barbeau EM, McLellan D, Levenstein C, DeLaurier GF, Kelder G, Sorensen G. Reducing occupation-based disparities related to tobacco: roles for occupational health and organized labor. Am J Ind Med 2004; 46:170-9. [PMID: 15273970 DOI: 10.1002/ajim.20026] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. METHODS We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health. CONCLUSIONS Implications of these efforts for future research and action are discussed.
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Affiliation(s)
- Elizabeth M Barbeau
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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17
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Albertsen K, Hannerz H, Borg V, Burr H. The effect of work environment and heavy smoking on the social inequalities in smoking cessation. Public Health 2003; 117:383-8. [PMID: 14522152 DOI: 10.1016/s0033-3506(03)00103-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate social differences with regard to smoking cessation in Denmark. METHODS Social differences in smoking cessation were estimated from 3606 smokers from the Danish National Work Environment Cohort Study in 1990, 1995 and 2000. The differences were investigated using heavy smoking and four work environment factors as explanatory variables. RESULTS The odds ratio for cessation was more than twice as high in social class I compared with social class V. When heavy smoking was controlled, this explained 28% of social differences, the work-environment factors alone explained 36% of social differences, and together the factors explained 55% of social differences. CONCLUSIONS A large proportion of the social differences in smoking cessation could be explained by differences in work-environment exposures and smoking intensity.
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Affiliation(s)
- Karen Albertsen
- Department of Psychology and Sociology, National Institute of Occupational Health, Lersø Parkallé 105, Copenhagen DK-2100, Denmark.
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18
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Zhu SH, Sun J, Hawkins S, Pierce J, Cummins S. A population study of low-rate smokers: quitting history and instability over time. Health Psychol 2003; 22:245-52. [PMID: 12790251 DOI: 10.1037/0278-6133.22.3.245] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used 1 longitudinal and 2 cross-seconal population surveys to compare stability of low-rate daily smokers (less than 5 cigarettes per day) with other daily smokers and occasional smokers. Few low-rate smokers maintained consumption level; 36% retained smoking status after 20 months, compared with 82% and 44% for regular daily and occasional smokers, respectively. In a dynamic process, established smokers quit smoking and/or modified (decreased or increased) consumption. Low-rate and occasional smokers quit at higher rates than regular daily smokers (odds ratios 3:1) but were replenished by new members, many converted from regular daily smoker. The overall trend is an increasing proportion of low-consumption smokers while smoking prevalence declines. The dynamic process has implications for tobacco control efforts and for addiction theory.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093-0905, USA.
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19
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Abstract
The health hazards caused by exposure to environmental tobacco smoke (ETS) are well established. Workplace exposure to ETS is strongly influenced by the types of workplace and smoking policy-total bans on smoking have become common in many countries. Blue-collar and service workers are more likely than other types of workers to be exposed to ETS in the workplace. Smokers who are employed in workplaces with smoking bans are likely to consume fewer cigarettes per day, are more likely to be considering quitting, and quit at an increased rate compared with smokers employed in workplaces with no or weaker policies. Despite substantial progress in protecting workers from ETS, additional efforts are needed in areas that include attention to exposure among blue-collar and service workers; policies in workplaces with a limited number of employees; and studies of enforcement, effects on smoking cessation in multiple settings, and cost-effectiveness.
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Affiliation(s)
- Ross C Brownson
- Department of Community Health and Prevention Research Center, School of Public Health, Saint Louis University, St. Louis, Missouri 63108-3342, USA.
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20
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Kegler MC, Malcoe LH. Smoking restrictions in the home and car among rural Native American and white families with young children. Prev Med 2002; 35:334-42. [PMID: 12453710 DOI: 10.1006/pmed.2002.1091] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This paper examines the prevalence of household and car smoking restrictions, factors associated with these restrictions, and children's exposure to secondhand smoke in homes with varying levels of household smoking restrictions in rural Native American and White families. METHODS In-person interviews were conducted with 380 rural, low-income Native American and White parents or guardians who were the primary caregivers of children aged 1-6 in northeastern Oklahoma. RESULTS Prevalence of complete smoking bans was 49.1% in Native American homes and 42.7% in White homes. Car smoking bans were less common, with 34.9% of Native American and 39.6% of White caregivers reporting complete bans. Among nonsmoking households, the proportion of friends who smoked was associated with both car and home smoking bans. Race and education of the caregivers were also associated with car smoking bans in homes with no adult smokers. Among smokers, cigarettes smoked per day, quit attempts within the past year, and the strong belief that secondhand smoke harmed children and babies were related to household smoking bans, whereas cigarettes smoked per day and the proportion of friends who smoked were related to car smoking bans. CONCLUSIONS Despite the relatively low prevalence of smoking bans in our population, factors associated with household and car smoking bans were similar to those found in the general population.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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21
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Abstract
OBJECTIVE To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases. DESIGN Systematic review with a random effects meta-analysis. STUDY SELECTION 26 studies on the effects of smoke-free workplaces. SETTING Workplaces in the United States, Australia, Canada, and Germany. PARTICIPANTS Employees in unrestricted and totally smoke-free workplaces. MAIN OUTCOME MEASURES Daily cigarette consumption (per smoker and per employee) and smoking prevalence. RESULTS Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from $0.76 to $3.05 (0.78 euro to 3.14 euro) in the United States and from 3.44 pounds sterling to 6.59 pounds sterling (5.32 euro to 10.20 euro) in the United Kingdom. If all workplaces became smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry $1.7 billion and 310 million pounds sterling annually in lost sales. To achieve similar reductions tax per pack would have to increase to $1.11 and 4.26 pounds sterling. CONCLUSIONS Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption.
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Affiliation(s)
- Caroline M Fichtenberg
- Center for Tobacco Control Research and Education, Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
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22
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National Health Expenditure Account of Korea: Sources and Estimation Methods. HEALTH POLICY AND MANAGEMENT 2002. [DOI: 10.4332/kjhpa.2002.12.1.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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A Review for the Factors Affecting the Effects of Health Promotion Programs. HEALTH POLICY AND MANAGEMENT 2002. [DOI: 10.4332/kjhpa.2002.12.1.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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24
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Okah FA, Choi WS, Okuyemi KS, Ahluwalia JS. Effect of children on home smoking restriction by inner-city smokers. Pediatrics 2002; 109:244-9. [PMID: 11826202 DOI: 10.1542/peds.109.2.244] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The home is the site of the most significant environmental tobacco smoke (ETS) exposure for children. Surveys show that adults, including smokers, agree that smoking should be restricted in homes of smokers with children. However, in a national survey, only 12.5% of such homes are actually smoke-free. This study examined factors associated with home smoking restriction among inner-city smokers. METHODS A cross-sectional survey of 598 adult smokers who attended an inner-city community health center was conducted. RESULTS Home smoking restriction was reported by 38.2% of all smokers (95% confidence interval [CI]: 33.6%-42.8%). Univariate analysis showed smoking restriction was positively associated with presence of children and of a nonsmoking adult partner in the home, intentional limiting of smoking, stages of change, and fewer number of cigarettes smoked daily. On multivariate analysis, home smoking restriction was more likely with the presence of a child (odds ratio: 2.63; 95% CI: 1.70-4.08) and a nonsmoking adult partner (odds ratio: 2.30; 95% CI: 1.32-4.02) in the home. CONCLUSIONS The presence of children and of nonsmoking adults is associated with the practice of smoking restriction in the homes of inner-city smokers. These findings suggest that inner-city smokers are concerned about health effects of ETS on children. Health professionals should target nonsmoking adult members of households with children and smokers but no home smoking restriction and emphasize the health effects of ETS on children as a motivation for smoking parents to limit exposure and to quit smoking.
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Affiliation(s)
- Felix A Okah
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, Kansas 66160, USA.
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25
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Abstract
Tobacco smoking is the largest preventable risk factor for morbidity and mortality in industrialized countries. WHO estimates that tobacco will become the largest single health problem by 2020, causing an estimated 8.4 million deaths annually. Tobacco has central importance in the etiology of cancers of the lung, head and neck, urinary tract, and pancreas. Reducing the number of young people who take up smoking and helping those who have started to smoke to quit the habit are the key ways of preventing these cancers. Tobacco- or nicotine-dependence is a common, chronic, relapsing medical condition. Studies of twins have implicated genetic factors in most of the differences in vulnerability to tobacco smoke and in the persistence of the smoking phenotype. The available interventions for reducing tobacco use and treatment for nicotine dependence offer public health officials and clinicians the greatest single opportunity for disease prevention. Five medications -- nicotine chewing gum, nicotine patches, nicotine inhalers, nicotine nasal sprays and bupropion -- and behavioural therapy appear to be both effective and safe: they double the quitting rates and are associated with a dropout rate due to adverse events of less than 5%.
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Affiliation(s)
- H Vainio
- International Agency for Research on Cancer, Lyon, France
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26
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Skyrme-Jones RA, Gribbin B. Hypoglycaemia and electrocardiographic changes in a subject with diabetes mellitus. Intern Med J 2001; 31:368-70. [PMID: 11529593 DOI: 10.1046/j.1445-5994.2001.00069.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woollery TA, Harris KW. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001; 20:16-66. [PMID: 11173215 DOI: 10.1016/s0749-3797(00)00297-x] [Citation(s) in RCA: 324] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.
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Affiliation(s)
- D P Hopkins
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Norman GJ, Ribisl KM, Howard-Pitney B, Howard KA, Unger JB. The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors. Am J Health Promot 2000; 15:81-8. [PMID: 11194699 DOI: 10.4278/0890-1171-15.2.81] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING Random telephone interviews within 18 California counties. SUBJECTS A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.
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Affiliation(s)
- G J Norman
- Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, 1000 Welch Road, Palo Alto, CA 94304-1825, USA
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29
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Emmons KM, Thompson B, McLerran D, Sorensen G, Linnan L, Basen-Engquist K, Biener L. The relationship between organizational characteristics and the adoption of workplace smoking policies. HEALTH EDUCATION & BEHAVIOR 2000; 27:483-501. [PMID: 10929755 DOI: 10.1177/109019810002700410] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Organizational-level variables that are hypothesized to influence the level of smoking policy restrictions and the prevalence of smoking control activities were tested in a sample of 1 14 worksites that participated in the Working Well Trial, a national trial of worksite health promotion. Predictors related to more restrictive policies included smaller size, larger percentage of white-collar workers, larger number of complaints about environmental tobacco smoke, less complexity, more formalization, and having a CEO who valued health and employees' well-being. The number of smoking control activities offered in a worksite was predicted by having a larger blue-collar workforce, a higher percentage of female employees, higher levels of workforce stability, and a CEO who valued health and employees' well-being. Efforts to identify predictors of companies' adoption and implementation of workplace-based policies and interventions are an important part of tobacco control efforts and will enhance future intervention and research efforts.
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Affiliation(s)
- K M Emmons
- Dana-Farber Cancer Institute, Division of Community-Based Research, and Harvard School of Public Health, Boston, MA 02115, USA.
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30
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Heller SR, Robinson RT. Hypoglycaemia and associated hypokalaemia in diabetes: mechanisms, clinical implications and prevention. Diabetes Obes Metab 2000; 2:75-82. [PMID: 11220527 DOI: 10.1046/j.1463-1326.2000.00050.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S R Heller
- Division of Clinical Sciences, University of Sheffield, UK.
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31
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Serra C, Cabezas C, Bonfill X, Pladevall-Vila M. Interventions for preventing tobacco smoking in public places. Cochrane Database Syst Rev 2000:CD001294. [PMID: 10908490 DOI: 10.1002/14651858.cd001294] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Environmental tobacco smoke is a health hazard. Reducing exposure to tobacco smoke in public places is a widespread public health goal. There is, however, considerable variation in the extent to which this goal has been achieved in different settings and societies. There is therefore a need to identify effective strategies for reducing tobacco consumption in public places. OBJECTIVES To evaluate the effectiveness of interventions to reduce tobacco consumption in public places. SEARCH STRATEGY We searched the Tobacco Addiction Review Group trials register, Medline, EMBASE, HEALTHSTAR, PAIS, and CDP File (National Centre for Chronic Disease Prevention and Health Promotion, CDC) "Smoking and Health database". We handsearched a key journal and abstracts from international conferences on tobacco. We checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA We considered randomized and controlled trials, controlled before and after studies and interrupted time series, and uncontrolled before and after studies. We considered strategies aimed at populations, including education campaigns, written material, non-smoking and warning signs, and comprehensive strategies. We also considered strategies aimed at individual smokers. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by two others. Studies were combined using qualitative narrative synthesis. MAIN RESULTS Eleven of 22 studies reporting information about interventions to reduce smoking in public places met all the inclusion criteria. All included studies were uncontrolled before and after studies. The most effective strategies used comprehensive, multicomponent approaches to implement policies banning smoking within institutions. Less comprehensive strategies, such as posted warnings and educational material had a moderate effect. Five studies showed that prompting individual smokers had an immediate effect, but such strategies are unlikely to be acceptable as a public health intervention. REVIEWER'S CONCLUSIONS Carefully planned and resourced, multicomponent strategies effectively reduced smoking within public places. Less comprehensive strategies were less effective. All the studies used relatively weak experimental designs. Most studies were done in the USA, and there is a need to identify ways in which these strategies can be adopted and used in countries with different attitudes to tobacco use. Future studies should also consider the use of more rigorous experimental designs.
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Affiliation(s)
- C Serra
- Spanish Cochrane Centre, Institut Universitari Fundació Parc Taulí, Parc Taulí s/n, Sabadell, Barcelona, Spain, 08208.
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Biener L, Nyman AL. Effect of workplace smoking policies on smoking cessation: results of a longitudinal study. J Occup Environ Med 1999; 41:1121-7. [PMID: 10609233 DOI: 10.1097/00043764-199912000-00017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies of worksite smoking bans often find that they fail to increase the rate of smoking cessation. To see whether duration of exposure to restrictive policies was an important element, we surveyed workers by phone to examine the effect of being continuously employed at a smokefree worksite for 3 years. Results showed that worksite policy was unrelated to smoking cessation. However, 12% of respondents at smokefree worksites reported that smoking had taken place in their work area, and over 20% reported at least 2 hours of worksite environmental tobacco smoke (ETS) exposure during the prior week. When minimal ETS exposure is used as an indicator of an effectively enforced smoking ban, logistic regression demonstrates that continuous employment at such a worksite strongly predicts smoking cessation. Failure to demonstrate a significant impact of worksite smoking bans on cessation in this and other studies may be due to poor enforcement of smoking policies.
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Affiliation(s)
- L Biener
- Center for Survey Research, University of Massachusetts, Boston 02125, USA.
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Etter JF, Ronchi A, Perneger T. Short-term impact of a university based smoke free campaign. J Epidemiol Community Health 1999; 53:710-5. [PMID: 10656100 PMCID: PMC1756808 DOI: 10.1136/jech.53.11.710] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the impact of a smoke free programme implemented at the University of Geneva, Switzerland, in 1996. This programme included a prohibition to smoke in university buildings everywhere except in limited areas, and a smoking cessation counselling service. METHODS Surveys were conducted before and four months after the programme was implemented, in representative samples of programme participants (n = 833) and university members not exposed to the programme (n = 1023). RESULTS In retrospective assessments, participants reported being less bothered by environmental tobacco smoke after programme implementation, but no between group difference was detected in prospective assessments. Relationships between smokers and non-smokers improved moderately in the intervention group and remained unchanged in the comparison group (between group p = 0.001). Proportions of smokers who attempted to quit smoking in the past four months increased from 2.0% to 3.8% in the intervention group and remained unchanged at 3.5% in the comparison group (between group difference: p = 0.048). No impact on smoking prevalence (25%) was detected. The programme was appreciated by university members, although some of its modalities were criticised. CONCLUSION A regulation prohibiting smoking everywhere but in limited areas of university buildings was acceptable and reduced the perception of bother by environmental tobacco smoke. It did not, however, influence smoking habits or attitudes toward smoking.
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Affiliation(s)
- J F Etter
- Institute of Social and Preventive Medicine, University of Geneva, Switzerland
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34
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Harris ND, Heller SR. Sudden death in young patients with Type 1 diabetes: a consequence of disease, treatment or both? Diabet Med 1999; 16:623-5. [PMID: 10477205 DOI: 10.1046/j.1464-5491.1999.00046.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chapman S, Borland R, Scollo M, Brownson RC, Dominello A, Woodward S. The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States. Am J Public Health 1999; 89:1018-23. [PMID: 10394309 PMCID: PMC1508862 DOI: 10.2105/ajph.89.7.1018] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.
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Affiliation(s)
- S Chapman
- Department of Public Health and Community Medicine, University of Sydney, Australia.
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Abstract
OBJECTIVE To describe the prevalence of cigarette smoking and its association with other risk factors for chronic diseases among active workers of communication and data processing centers of a Bank. METHODS Cross-sectional study in a simple random sample of 647 active workers of the bank. The data were collected in the work environment, through self-administered questionnaires. RESULTS The prevalence of cigarette smoking was 29.5% (95% Confidence Interval (CI): 27.5%-31.5%), 31.1% (95% CI: 26.2%-35.8%) among men and 27.8% (95% CI: 22.6%-32.9%) among women. On average, males started smoking at the age of 17.6 years and women at the age of 19.4. High prevalence of heavy smokers was observed among men and women (53% and 42%, respectively, smoked more than 20 cigarettes per day). Smokers were older, more likely to be divorced, separated and widowed, to have high blood pressure, to drink alcoholic beverages more often, and to exercise less often than to non-smokers. Those who gave up smoking were older, drank more alcoholic beverages, and were more often overweight. CONCLUSION The considerable frequency of smoking and other risk factors for chronic diseases among those workers may be an indication of the need for new strategies for health interventions. Opportunities for preventive actions, which are more effective and less costly, may have been lost.
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Affiliation(s)
- R H Griep
- Departamento de Enfermagem em Saúde Pública, Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro, Brasil
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37
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Abstract
PURPOSE To summarize and provide a critical review of worksite health promotion program evaluations published between 1968 and 1994 that addressed the health impact of worksite smoking cessation programs and smoking policies. METHODS A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 53 smoking cessation program evaluation reports, of which 41 covered worksite single-topic cessation programs. Nine additional reports were located through manual search of citations from published reports and reviews. These 50 reports covered 52 original data-based studies of cessation programs. The search produced 19 reports for tobacco policy evaluations, of which 12 addressed health impact. An additional 17 reports were located by the authors. These 29 reports covered 29 studies of policy impact. SUMMARY OF IMPORTANT FINDINGS Smoking cessation group programs were found to be more effective than minimal treatment programs, although less intensive treatment, when combined with high participation rates, can influence the total population. Tobacco policies were found to reduce cigarette consumption at work and worksite environmental tobacco smoke (ETS) exposure. CONCLUSIONS The literature is rated suggestive for group and incentive interventions; indicative for minimal interventions, competitions, and medical interventions; and acceptable for the testing of incremental effects. Because of the lack of experimental control, the smoking policy literature is rated as weak, although there is strong consistency in results for reduced cigarette consumption and decreased exposure to ETS at work.
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Affiliation(s)
- M P Eriksen
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Northrup DA, Ashley MJ, Ferrence R. The Ontario ban on smoking on school property: perceived impact on smoking. Canadian Journal of Public Health 1998. [PMID: 9735512 DOI: 10.1007/bf03403921] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the impact of the November 1994 ban on smoking on school property in Ontario. Telephone interviews were conducted at the end of the 1995-96 school year with 213 high school administrators. Almost all high schools (96%) prohibit smoking on school property. Although some smoking still occurs on school property, the location of smoking by students has changed, giving rise to perceptions of both benefits and risks, as well as varying complaints from parents, students, neighbours, and nearby businesses. Most of the problems arising from the ban are viewed as minor. Local conditions, particularly the geographic environment of the school, appear to be important determinants of complaints and problems. While sizeable minorities of school administrators felt the ban had favourable effects, the majority perceived little effect on either smoking behaviour or attitudes towards smoking.
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Affiliation(s)
- D A Northrup
- Institute for Social Research, York University, Toronto, ON.
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Holman CD, Corti B, Donovan RJ, Jalleh G. Association of the health-promoting workplace with trade unionism and other industrial factors. Am J Health Promot 1998; 12:325-34. [PMID: 10181142 DOI: 10.4278/0890-1171-12.5.325] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The study examines associations of five healthy workplace attributes with trade unionism and nine other industrial and sociodemographic factors. The aims were to illustrate the measurement of workplace health promotion indicators in Western Australia and to identify associations leading to a better understanding of determinants of the healthy workplace. DESIGN Personal and telephone cross-sectional surveys were performed using population-based sampling frames. The overall response rate was 72%. SETTING Workplaces in Western Australia. SUBJECTS Random samples of household respondents aged 16 to 69 years in 1992 (n = 1310) and 1994 (n = 1113). MEASURES Measures of association between healthy workplace attributes and trade unionism were adjusted for workplace location, size, sector, and industrial classification. RESULTS Trade unionism was strongly associated with healthy catering practices (adjusted OR 2.05; 95% CI 1.30 to 3.23), sun protection practices (2.66; 1.69 to 4.17), disability access (1.47; 1.10 to 1.95), and worksite health promotion programs (2.56; 2.07 to 3.17). A weak and nonsignificant association was observed with restrictive smoking policies (1.21; .95 to 1.55). Generally, healthy workplace attributes were reported less often by respondents working in rural locations, in the private sector, and at small worksites. There was no consistent relationship with sociodemographic factors, including an index of social disadvantage, but members of blue-collar occupations experienced a low prevalence of restrictive smoking policies. CONCLUSIONS The study raises the hypothesis, but cannot confirm, that trade unions could provide a means for employees to pursue the creation of a health-promoting workplace. Small business represents an excellent target for health promotion activities.
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Affiliation(s)
- C D Holman
- Department of Public Health, University of Western Australia
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Terborg JR. Health Psychology in the United States: A Critique and Selective Review. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 1998. [DOI: 10.1111/j.1464-0597.1998.tb00021.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brenner H, Born J, Novak P, Wanek V. Smoking behavior and attitude toward smoking regulations and passive smoking in the workplace. A study among 974 employees in the German metal industry. Prev Med 1997; 26:138-43. [PMID: 9010909 DOI: 10.1006/pmed.1996.9981] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Smoking regulations at the workplace have been found to be acceptable and effective in many studies conducted in the United States. There is limited knowledge, however, on acceptance and effects of smoking regulations in European countries, particularly among blue collar employees. METHODS We conducted a survey on smoking behaviour and attitude toward smoking regulations and passive smoking in a South German metal company. A self-administered questionnaire was mailed to 1,500 predominantly blue collar employees of whom 974 participated in the study (response rate 64.9%). RESULTS About 30% of the employees were not allowed to smoke at their immediate work area. Among them, about 95% of both smokers and nonsmokers agreed with this smoking policy. More than 60% of nonsmoking blue collar workers were bothered by passive smoking at work whether or not smoking was allowed at their immediate work area. In contrast, the proportion of nonsmoking white collar employees who were bothered by passive smoking varied from 52% if smoking was allowed at their immediate work area to 18% if smoking was not allowed. Prevalence of active smoking and average amount of smoking among active smokers were considerably lower among employees who were not allowed to smoke at work than among other employees. These differences were partly due to confounding by occupation, however, which was strongly related to both smoking habits and smoking policy. CONCLUSIONS Our results, which confirm and extend previous findings, give further support to the acceptability and potential effectiveness of smoking regulations at the workplace. Particular efforts should be devoted to limit both active and passive smoking among blue collar employees.
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Affiliation(s)
- H Brenner
- Department of Epidemiology, University of Ulm, Germany
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Brownson RC, Eriksen MP, Davis RM, Warner KE. Environmental tobacco smoke: health effects and policies to reduce exposure. Annu Rev Public Health 1997; 18:163-85. [PMID: 9143716 DOI: 10.1146/annurev.publhealth.18.1.163] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The health hazards due to exposure to environmental tobacco smoke (ETS) are increasingly established. ETS contains thousands of chemicals including 43 known carcinogens. Known health effects of ETS exposure are lung cancer in nonsmokers, childhood disorders such as bronchitis, and perhaps, heart disease. Workplace exposure to ETS is widespread and is influenced strongly by the type of smoking policy in the workplace. To decrease ETS exposure, efforts to restrict public smoking have proliferated over the past decade. These restrictions have emanated from government as well as voluntary measures by various private industries. Bans on public smoking are effective in reducing nonsmokers' exposure to ETS. Workplace smoking bans also influence the intensity of smoking among employees and may increase quit smoking rates. In addition to the health benefits from smoke-free workplaces, there are likely cost savings to employers who implement such policies.
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Affiliation(s)
- R C Brownson
- Department of Community Health and Prevention Research Center, School of Public Health, St. Louis University, Missouri 63108-3342, USA
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Abstract
OBJECTIVES This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.
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Affiliation(s)
- D J Hennrikus
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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