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Herrick C, Bell K. The social life of natural experiments in epidemiology and public health. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:276-294. [PMID: 37596959 DOI: 10.1111/1467-9566.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Over the twentieth century, the concept of the natural experiment has become increasingly prominent across a variety of disciplines, albeit most consequentially in epidemiology and public health. Drawing on an analysis of the scientific and medical literature, we explore the social life of the natural experiment, tracing its changing use, meaning and uptake to better understand the work done by the concept. We demonstrate how the natural experiment became central to the identity of post-war epidemiology as the discipline professionalised, turned its attention to the prevention of chronic disease and took centre stage in the field of public health. We then turn to its growing significance amid the rise of evidence-based medicine, and the new meanings natural experiments came to take on in the context of concerns about policy and evidence. Finally, we turn to the newest iteration of the natural experiment in the COVID-19 era, which saw an explosion of studies drawing on the term, albeit in ways that reveal more about the underlying politics of health than the method itself. Throughout, we illustrate that the concept of the natural experiment has always been fundamentally social and political and tied to disciplinary claims-making about evidence and what should count as such.
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Affiliation(s)
- Clare Herrick
- Department of Geography, King's College London, London, UK
| | - Kirsten Bell
- Department of Global Health and Social Medicine, King's College London, London, UK
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Face Mask Exemptions, Respiratory Patients, and COVID-19 in Spain. Data From the 2021 ITC EUREST-PLUS Spain Survey. OPEN RESPIRATORY ARCHIVES 2023; 5. [PMID: 37497255 PMCID: PMC9554315 DOI: 10.1016/j.opresp.2022.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Huckle T, Callinan S, Pham C, Chaiyasong S, Parker K, Casswell S. Harmful drinking occurs in private homes in some high- and middle-income alcohol markets: Data from the International Alcohol Control Study. Drug Alcohol Rev 2020; 39:616-623. [PMID: 32805071 DOI: 10.1111/dar.13137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe how for some high- and middle-income countries, the total volume of alcohol, including volume consumed in harmful drinking occasions, is distributed across drinking locations in each country. METHODS Population surveys of drinkers were conducted as part of the International Alcohol Control Study in New Zealand, Australia, Vietnam and Thailand. Consumption data were collected using a beverage- and location-specific measure that also allows for the measurement of unrecorded alcohol. RESULTS In the high-income countries, the percentage of absolute alcohol consumed in harmful drinking occasions was 44% in New Zealand and 51% in Australia. In the middle-income countries, the proportions were 55% in Vietnam and 66% in Thailand. The vast majority of alcohol was consumed in private homes (67% or above in all four countries). Private homes were also the location where the highest percentage of alcohol was consumed in harmful drinking occasions (range 33% in New Zealand to 44% in Vietnam). Unrecorded/untaxed alcohol was of considerable importance for heavier drinking occasions in private homes in Vietnam. Bars and nightclubs were more likely locations for harmful drinking in the high-income countries relative to the middle-income countries. CONCLUSIONS As the majority of alcohol consumed in each country, including in harmful drinking occasions, was consumed in private homes, these findings make take-away alcohol a focus for alcohol policy including trading hour and pricing policies. Unrecorded alcohol was also of considerable importance in Vietnam, highlighting the importance of the policy responses being developed to address unrecorded alcohol.
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Affiliation(s)
- Taisia Huckle
- Shore and Whairki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cuong Pham
- Centre for Injury Policy and Prevention Research, Hanoi University of Public Health, Hanoi, Vietnam
| | - Surasak Chaiyasong
- Social Pharmacy Research Unit and PhD Program in Pharmacy, Faculty of Pharmacy, Mahasarakham University, Maha Sarakham, Thailand
| | - Karl Parker
- Shore and Whairki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Sally Casswell
- Shore and Whairki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Fong GT, Thompson ME, Boudreau C, Bécuwe N, Driezen P, Agar TK, Quah ACK, Zatoński WA, Przewoźniak K, Mons U, Demjén T, Tountas Y, Trofor AC, Fernández E, McNeill A, Willemsen M, Vardavas CI. The Conceptual Model and Methods of Wave 1 (2016) of the EUREST-PLUS ITC 6 European Countries Survey. Tob Induc Dis 2018; 16:A3. [PMID: 31516459 PMCID: PMC6659555 DOI: 10.18332/tid/99881] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022] Open
Abstract
Population-level interventions represent the only real approach for combatting the tobacco epidemic. There is thus great importance in conducting rigorous evaluation studies of tobacco control policies and regulations such as those arising from the WHO Framework Convention on Tobacco Control (FCTC) and the European Union's 2014 Tobacco Products Directive (TPD). The ITC 6 European Countries Survey, a component of the Horizon 2020 Project entitled European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease (EUREST-PLUS), was created to evaluate and impact of the TPD in six EU Member States: Germany, Greece, Hungary, Poland, Romania, and Spain. In each country, a cohort survey of a representative national sample of 1000 smokers was conducted. This paper describes the conceptual model, methodology, and initial survey statistics of Wave 1 of the ITC 6E Survey, which was conducted June-September 2016. The ITC 6E Survey's conceptual model, methodology, and survey instrument, were based on the broader 29-country ITC Project cohort studies, which have been conducted since 2002. The commonality of methods and measures allow a strong potential for cross-country comparisons between the 6 EU countries of the ITC 6E Project and 3 other EU countries (England, France, The Netherlands) in the ITC Project, as well as the broader set of ITC countries outside the EU.
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Affiliation(s)
- Geoffrey T. Fong
- University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | | | | | | | | | | | | | - Witold A. Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO) and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Ann McNeill
- Addictions Department, King’s College London, London, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, King’s College London, London, United Kingdom
| | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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Casswell S. International Alcohol Control Study: Analyses from the first wave. Drug Alcohol Rev 2018; 37 Suppl 2:S4-S9. [PMID: 29635798 PMCID: PMC6120559 DOI: 10.1111/dar.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sally Casswell
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
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Prevalence and Social Determinants of Smoking in 15 Countries from North Africa, Central and Western Asia, Latin America and Caribbean: Secondary Data Analyses of Demographic and Health Surveys. PLoS One 2015; 10:e0130104. [PMID: 26131888 PMCID: PMC4488463 DOI: 10.1371/journal.pone.0130104] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/15/2015] [Indexed: 11/24/2022] Open
Abstract
Background Article 20 of the World Health Organisation Framework Convention on Tobacco Control calls for a cross-country surveillance of tobacco use through population-based surveys. We aimed to provide country-level prevalence estimates for current smoking and current smokeless tobacco use and to assess social determinants of smoking. Methods Data from Demographic and Health Surveys done between 2005 and 2012, among men and women from nine North African, Central and West Asian countries and six Latin American and Caribbean countries were analyzed. Weighted country-level prevalence rates were estimated for ‘current smoking’ and ‘current use of smokeless tobacco (SLT) products’ among men and women. In each country, social determinants of smoking among men and women were assessed by binary logistic regression analyses by including men's and women's sampling weights to account for the complex survey design. Findings Prevalence of smoking among men was higher than 40% in Armenia (63.1%), Moldova (51.1%), Ukraine (52%), Azerbaijan (49.8 %), Kyrgyz Republic (44.3 %) and Albania (42.52%) but the prevalence of smoking among women was less than 10% in most countries except Ukraine (14.81%) and Jordan (17.96%). The prevalence of smokeless tobacco use among men and women was less than 5% in all countries except among men in the Kyrgyz Republic (10.6 %). Smoking was associated with older age, lower education and poverty among men and higher education and higher wealth among women. Smoking among both men and women was associated with unskilled work, living in urban areas and being single. Conclusion Smoking among men was very high in Central and West Asian countries. Social pattern of smoking among women that was different from men in education and wealth should be considered while formulating tobacco control policies in some Central and West Asian countries.
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Aboaziza E, Eissenberg T. Waterpipe tobacco smoking: what is the evidence that it supports nicotine/tobacco dependence? Tob Control 2015; 24 Suppl 1:i44-i53. [PMID: 25492935 PMCID: PMC4345797 DOI: 10.1136/tobaccocontrol-2014-051910] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/20/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Waterpipe tobacco smoking (WTS) involves passing tobacco smoke through water prior to inhalation, and has spread worldwide. This spread becomes a public health concern if it is associated with tobacco-caused disease and if WTS supports tobacco/nicotine dependence. A growing literature demonstrates that WTS is associated with disability, disease and death. This narrative review examines if WTS supports nicotine/tobacco dependence, and is intended to help guide tobacco control efforts worldwide. DATA SOURCES PUBMED search using: (("waterpipe" or "narghile" or "arghile" or "shisha" or "goza" or "narkeela" or "hookah" or "hubble bubble")) AND ("dependence" or "addiction"). STUDY SELECTION Excluded were articles not in English, without original data, and that were not topic-related. Thirty-two articles were included with others identified by inspecting reference lists and other sources. DATA SYNTHESIS WTS and the delivery of the dependence-producing drug nicotine were examined, and then the extent to which the articles addressed WTS-induced nicotine/dependence explicitly, as well as implicitly with reference to criteria for dependence outlined by the WHO. CONCLUSIONS WTS supports nicotine/tobacco dependence because it is associated with nicotine delivery, and because some smokers experience withdrawal when they abstain from waterpipe, alter their behaviour in order to access a waterpipe and have difficulty quitting, even when motivated to do so. There is a strong need to support research investigating measurement of WTS-induced tobacco dependence, to inform the public of the risks of WTS, which include dependence, disability, disease and death, and to include WTS in the same public health policies that address tobacco cigarettes.
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Affiliation(s)
- Eiman Aboaziza
- Center for Clinical and Translational Research and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
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Jawad M, El Kadi L, Mugharbil S, Nakkash R. Waterpipe tobacco smoking legislation and policy enactment: a global analysis. Tob Control 2014; 24 Suppl 1:i60-i65. [PMID: 25550418 PMCID: PMC4345984 DOI: 10.1136/tobaccocontrol-2014-051911] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE (1) To review how current global tobacco control policies address regulation of waterpipe tobacco smoking (WTS). (2) To identify features associated with enactment and enforcement of WTS legislation. DATA SOURCES (1) Legislations compiled by Tobacco Control Laws (www.tobaccocontrollaws.org). (2) Weekly news articles by 'Google Alerts' (www.google.com/alerts) from July 2013 to August 2014. STUDY SELECTION (1) Countries containing legislative reviews, written by legal experts, were included. Countries prohibiting tobacco sales were excluded. (2) News articles discussing aspects of the WHO FCTC were included. News articles related to electronic-waterpipe, crime, smuggling, opinion pieces or brief mentions of WTS were excluded. DATA ABSTRACTION (1) Two reviewers independently abstracted the definition of "tobacco product" and/or "smoking". Four tobacco control domains (smokefree law, misleading descriptors, health warning labels and advertising/promotion/sponsorship) were assigned one of four categories based on the degree to which WTS had specific legislation. (2) Two investigators independently assigned at least one theme and associated subtheme to each news article. DATA SYNTHESIS (1) Reviewed legislations of 62 countries showed that most do not address WTS regulation but instead rely on generic tobacco/smoking definitions to cover all tobacco products. Where WTS was specifically addressed, no additional legislative guidance accounted for the unique way it is smoked, except for in one country specifying health warnings on waterpipe apparatuses (2) News articles mainly reported on noncompliance with public smoking bans, especially in India, Pakistan and the UK. CONCLUSIONS A regulatory framework evaluated for effectiveness and tailored for the specificities of WTS needs to be developed.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Lama El Kadi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sanaa Mugharbil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Sreeramareddy CT, Pradhan PM, Sin S. Prevalence, distribution, and social determinants of tobacco use in 30 sub-Saharan African countries. BMC Med 2014; 12:243. [PMID: 25518855 PMCID: PMC4296681 DOI: 10.1186/s12916-014-0243-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 11/21/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the Framework Convention on Tobacco Control prioritizes monitoring of tobacco use by population-based surveys, information about the prevalence and patterns of tobacco use in sub-Saharan Africa is limited. We provide country-level prevalence estimates for smoking and smokeless tobacco (SLT) use and assess their social determinants. METHODS We analyzed population-based data of the most recent Demographic Health Surveys performed between 2006 and 2013 involving men and women in 30 sub-Saharan African countries. Weighted country-level prevalence rates were estimated for 'current smoking' (cigarettes, pipe, cigars, etc.) and 'current SLT use' (chewing, snuff, etc.). From the pooled datasets for men and women, social determinants of smoking and SLT use were assessed through multivariate analyses using a dummy country variable as a control and by including a within-country sample weight for each country. RESULTS Among men, smoking prevalence rates were high in Sierra Leone (37.7%), Lesotho (34.1%), and Madagascar (28.5%); low (<10%) in Ethiopia, Benin, Ghana, Nigeria, and Sao Tome & Principe; the prevalence of SLT use was <10% in all countries except for Madagascar (24.7%) and Mozambique (10.9%). Among women, smoking and SLT prevalence rates were <5% in most countries except for Burundi (9.9%), Sierra Leone (6%), and Namibia (5.9%) (smoking), and Madagascar (19.6%) and Lesotho (9.1%) (SLT use). The proportion of females who smoked was lower than SLT users in most countries. Older age was strongly associated with both smoking and SLT use among men and women. Smoking among both men and women was weakly associated, but SLT use was strongly associated, with education. Similarly, smoking among men and women was weakly associated, but SLT use was strongly associated, with the wealth index. Smoking and SLT use were also associated with marital status among both men and women, as well as with occupation (agriculturists and unskilled workers). CONCLUSIONS Prevalence of smoking among women was much lower than in men, although the social patterns of tobacco use were similar to those in men. Tobacco control strategies should target the poor, not/least educated, and agricultural and unskilled workers, who are the most vulnerable social groups in sub-Saharan Africa.
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Affiliation(s)
- Chandrashekhar T Sreeramareddy
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Selangor, 43000, Malaysia.
| | - Pranil Mansingh Pradhan
- Department of Community Health Sciences, Patan Academy of Health Sciences (PAHS), P. O. Box 26500, Lagankhel-5, Lalitpur, Kathmandu, 44700, Nepal.
| | - Shwe Sin
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Selangor, 43000, Malaysia.
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Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014; 109:1801-10. [PMID: 25078252 PMCID: PMC4487785 DOI: 10.1111/add.12659] [Citation(s) in RCA: 386] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 05/13/2014] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
AIMS We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence that can guide future policy. METHODS Studies were identified by systematic database searches and screening references to February 2014. RESULTS EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking. CONCLUSIONS Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.
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Affiliation(s)
- Peter Hajek
- UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Nagelhout GE, Wiebing MA, van den Putte B, de Vries H, Crone M, Bot SM, Willemsen MC. 'I bet I can do it!' - Reach and effectiveness of a television show about smoking cessation among low, moderate, and high educated smokers. TSG : TIJDSCHRIFT VOOR GEZONDHEIDSWETENSCHAPPEN 2014; 92:84-92. [PMID: 26692815 PMCID: PMC4676708 DOI: 10.1007/s12508-014-0032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Smoking is in the Netherlands more prevalent among lower and moderate educated than among higher educated people. The entertainment-education television show 'I bet I can do it!' was specifically designed to stimulate smoking cessation among low and moderate educated smokers. METHODS The effect of the television show was evaluated with longitudinal data of the International Tobacco Control Policy Evaluation Project. Dutch smokers (n = 1,743) aged 15 years and older filled in a survey before and after the seven episodes of 'I bet I can do it!' in 2008. RESULTS Low educated (OR = 1,55, p = 0,048) and moderate educated respondents (OR = 1,99, p < 0,001) had seen the television show significantly more often than high educated respondents. The show was not significantly associated with self efficacy, quit intention, and quit success, but it was significantly associated with more quit attempts among moderate educated respondents (OR = 2,36, p < 0,001). CONCLUSION The reach of 'I bet I can do it!' and the effect on quit attempts was larger among moderate educated smokers. The entertainment-education strategy for smoking cessation television programs should be further refined. This can possible lead to a program that has positive effects on the quit intention, self efficacy, quit attempts and the quit success of low and moderate educated smokers.
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Affiliation(s)
- Gera E Nagelhout
- Universiteit Maastricht (CAPHRI) ; STIVORO voor een rookvrije toekomst
| | | | | | | | | | | | - Marc C Willemsen
- Universiteit Maastricht (CAPHRI) ; STIVORO voor een rookvrije toekomst
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Dozier AM, Diaz S, Guido J, Quiñones de Monegro Z, McIntosh S, Fisher SG, Ossip DJ. Cohort study of smoke-free homes in economically disadvantaged communities in the Dominican Republic. Rev Panam Salud Publica 2014; 35:30-37. [PMID: 24626445 PMCID: PMC4458847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To analyze household smoking-ban prevalence over time and predictors among communities in the Dominican Republic, historically a significant tobacco-growing country with few tobacco control regulations. METHODS Baseline (2004) and follow-up surveillance surveys (2006, 2007) (each n > 1 000 randomly selected households) conducted in six economically disadvantaged communities (three tobacco-growing and two each urban, peri-urban, and rural) assessed household members' demographics, health status, and household characteristics, including smoking restrictions. RESULTS Between 2004 and 2007, household smoking-ban prevalence increased in all communities, with overall rates increasing from 23.9% (2004) to 45.3% (2007). Households with smokers adopted smoking bans at lower rates (6%-17%) versus those without smokers (which had an adoption rate of 35%-58%). Logistic regression models demonstrated that the associations between allowing smoking in households with no members who smoked and being located in a tobacco-growing community, being a Catholic household, and having a member with a cardiovascular problem were statistically significant. The association between having a child under age 5 or a member with a respiratory condition and prohibiting smoking in the home was not statistically significant. CONCLUSIONS Prevalence of households banning smoking increased in all communities but remained well below rates in industrialized countries. For low- and middle-income countries or those in early stages of tobacco control, basic awareness-raising measures (including surveillance activities) may lead to statistically significant increases in household smoking-ban adoption, particularly among households with no smokers. An increase in household smoking-ban prevalence may result in changes in community norms that can lead to a further increase in the adoption of smoking bans. Having household members who smoke and being in a tobacco-growing community may mitigate the establishment of household bans. Increasing individuals' knowledge about the far-reaching health effects of secondhand smoke exposure on children and nonsmoking adults (healthy or unhealthy) may help overcome these obstacles.
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Affiliation(s)
- Ann M Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America,
| | - Sergio Diaz
- Centro de Atención Primaria Juan XXIII, Santiago, Dominican Republic
| | - Joseph Guido
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, United States of America
| | | | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America,
| | - Susan G Fisher
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America,
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McRobbie H, Raw M, Chan S. Research priorities for Article 14--demand reduction measures concerning tobacco dependence and cessation. Nicotine Tob Res 2013; 15:805-16. [PMID: 23139406 PMCID: PMC3601913 DOI: 10.1093/ntr/nts244] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 10/04/2012] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco dependence treatment (TDT) interventions are often seen as expensive with little impact on the prevalence of tobacco use. However, activities that promote the cessation of tobacco use and support abstinence have an important role in any comprehensive tobacco control program and as such are recognized within Article 14 (A14) of the Framework Convention on Tobacco Control. OBJECTIVES To review current evidence for TDT and recommend research priorities that will contribute to more people being helped to stop tobacco use. METHODS We used the recommendations within the A14 guidelines to guide a review of current evidence and best practice for promotion of tobacco cessation and TDT, identify gaps, and propose research priorities. RESULTS We identified nine areas for future research (a) understanding current tobacco use and the effect of policy on behavior, (b) promoting cessation of tobacco use, (c) implementation of TDT guidelines, (d) increasing training capacity, (e) enhancing population-based TDT interventions, (f) treatment for different types of tobacco use, (g) supply of low-cost pharmaceutical devices/ products, (h) investigation use of nonpharmaceutical devices/ products, and (i) refinement of current TDTs. Specific research topics are suggested within each of these areas and recognize the differences needed between high- and low-/middle-income countries. CONCLUSIONS Research should be prioritized toward examining interventions that (a) promote cessation of tobacco use, (b) assist health care workers provide better help to smokers (e.g., through implementation of guidelines and training), (c) enhance population-based TDT interventions, and (d) assist people to cease the use of other tobacco products.
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Affiliation(s)
- Hayden McRobbie
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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14
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Costello MJ, Logel C, Fong GT, Zanna MP, McDonald PW. Perceived risk and quitting behaviors: results from the ITC 4-country survey. Am J Health Behav 2012; 36:681-92. [PMID: 22584095 PMCID: PMC4009356 DOI: 10.5993/ajhb.36.5.10] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To rigorously test the relation between perceived risk (i.e., belief about the likelihood of harm) and quitting smoking. METHODS Data from a longitudinal study with a nonrestrictive sample of smokers (N = 4307) from the United States, Canada, the United Kingdom, and Australia were examined to predict quitting behaviors at 8-12 months. RESULTS Perceived risk predicted plans to quit, quit attempts, and, to some extent, sustained quitting. The relation was stronger for relatively simple (e.g., plans to quit) than for complex behaviors (e.g., sustained quitting). CONCLUSION Perceived risk plays a significant role in predicting quitting smoking, more so for relatively simple behaviors.
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Affiliation(s)
- Mary Jean Costello
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Nagelhout GE, de Vries H, Boudreau C, Allwright S, McNeill A, van den Putte B, Fong GT, Willemsen MC. Comparative impact of smoke-free legislation on smoking cessation in three European countries. Eur J Public Health 2012; 22 Suppl 1:4-9. [PMID: 22294778 DOI: 10.1093/eurpub/ckr203] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success. METHODS Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England). RESULTS In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England. CONCLUSION The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation.
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Sansone GC, Raute LJ, Fong GT, Pednekar MS, Quah ACK, Bansal-Travers M, Gupta PC, Sinha DN. Knowledge of health effects and intentions to quit among smokers in India: findings from the Tobacco Control Policy (TCP) India pilot survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:564-78. [PMID: 22470310 PMCID: PMC3315264 DOI: 10.3390/ijerph9020564] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 11/16/2022]
Abstract
Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.
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Affiliation(s)
- Genevieve C. Sansone
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L3G1, Canada; (G.T.F.); (A.C.K.Q.)
- Author to whom correspondence should be addressed; ; Tel.: +1-519-888-4567 (ext. 38991)
| | - Lalit J. Raute
- Healis Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, 400 614, Navi Mumbai, India; (L.J.R.); (M.S.P.); (P.C.G.)
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L3G1, Canada; (G.T.F.); (A.C.K.Q.)
- Ontario Institute for Cancer Research, MaRS Centre, South Tower, 101 College Street, Suite 800, Toronto, Ontario M5G 0A3, Canada
| | - Mangesh S. Pednekar
- Healis Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, 400 614, Navi Mumbai, India; (L.J.R.); (M.S.P.); (P.C.G.)
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L3G1, Canada; (G.T.F.); (A.C.K.Q.)
| | | | - Prakash C. Gupta
- Healis Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, 400 614, Navi Mumbai, India; (L.J.R.); (M.S.P.); (P.C.G.)
| | - Dhirendra N. Sinha
- School of Preventive Oncology, A/27, Anandpuri, West Boring Canal Road, 800001, Patna, Bihar, India;
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Household smoking behavior: effects on indoor air quality and health of urban children with asthma. Matern Child Health J 2011; 15:460-8. [PMID: 20401688 DOI: 10.1007/s10995-010-0606-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of the study was to examine the association between biomarkers and environmental measures of second hand smoke (SHS) with caregiver, i.e. parent or legal guardian, report of household smoking behavior and morbidity measures among children with asthma. Baseline data were drawn from a longitudinal intervention for 126 inner city children with asthma, residing with a smoker. Most children met criteria for moderate to severe persistent asthma (63%) versus mild intermittent (20%) or mild persistent (17%). Household smoking behavior and asthma morbidity were compared with child urine cotinine and indoor measures of air quality including fine particulate matter (PM(2.5)) and air nicotine (AN). Kruskal-Wallis, Wilcoxon rank-sum and Spearman rho correlation tests were used to determine the level of association between biomarkers of SHS exposure and household smoking behavior and asthma morbidity. Most children had uncontrolled asthma (62%). The primary household smoker was the child's caregiver (86/126, 68%) of which 66 (77%) were the child's mother. Significantly higher mean PM(2.5), AN and cotinine concentrations were detected in households where the caregiver was the smoker (caregiver smoker: PM(2.5) μg/m(3): 44.16, AN: 1.79 μg/m(3), cotinine: 27.39 ng/ml; caregiver non-smoker: PM(2.5): 28.88 μg/m(3), AN: 0.71 μg/m(3), cotinine:10.78 ng/ml, all P ≤ 0.01). Urine cotinine concentrations trended higher in children who reported 5 or more symptom days within the past 2 weeks (>5 days/past 2 weeks, cotinine: 28.1 ng/ml vs. <5 days/past 2 weeks, cotinine: 16.2 ng/ml; P = 0.08). However, environmental measures of SHS exposures were not associated with asthma symptoms. Urban children with persistent asthma, residing with a smoker are exposed to high levels of SHS predominantly from their primary caregiver. Because cotinine was more strongly associated with asthma symptoms than environmental measures of SHS exposure and is independent of the site of exposure, it remains the gold standard for SHS exposure assessment in children with asthma.
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Storr CL, Cheng H, Alonso J, Angermeyer M, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Karam EG, Kostyuchenko S, Lee S, Lepine JP, Medina Mora ME, Myer L, Neumark Y, Posada-Villa J, Watanabe M, Wells JE, Kessler RC, Anthony JC. Smoking estimates from around the world: data from the first 17 participating countries in the World Mental Health Survey Consortium. Tob Control 2009; 19:65-74. [PMID: 19965796 DOI: 10.1136/tc.2009.032474] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To contribute new multinational findings on basic descriptive features of smoking and cessation, based upon standardised community surveys of adults residing in seven low-income and middle-income countries and 10 higher-income countries from all regions of the world. METHODS Data were collected using standardised interviews and community probability sample survey methods conducted as part of the WHO World Mental Health Surveys Initiative. Demographic and socioeconomic correlates of smoking are studied using cross-tabulation and logistic regression approaches. Within-country sample weights were applied with variance estimation appropriate for complex sample survey designs. RESULTS Estimated prevalence of smoking experience (history of ever smoking) and current smoking varied across the countries under study. In all but four countries, one out of every four adults currently smoked. In higher-income countries, estimated proportions of former smokers (those who had quit) were roughly double the corresponding estimates for most low-income and middle-income countries. Characteristics of smokers varied within individual countries, and in relation to the World Bank's low-medium-high gradient of economic development. In stark contrast to a sturdy male-female difference in the uptake of smoking seen in each country, there is no consistent sex-associated pattern in the odds of remaining a smoker (versus quitting). CONCLUSION The World Mental Health Surveys estimates complement existing global tobacco monitoring efforts. The observed global diversity of associations with smoking and smoking cessation underscore reasons for implementation of the Framework Convention on Tobacco Control provisions and prompt local adaptation of prevention and control interventions.
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Affiliation(s)
- Carla L Storr
- Department of Family and Community Health, University of Maryland, Baltimore, School of Nursing, Baltimore, Maryland, USA.
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Kim S, Wipfli H, Navas-Acien A, Dominici F, Avila-Tang E, Onicescu G, Breysse P, Samet JM. Determinants of Hair Nicotine Concentrations in Nonsmoking Women and Children: A Multicountry Study of Secondhand Smoke Exposure in Homes. Cancer Epidemiol Biomarkers Prev 2009; 18:3407-14. [DOI: 10.1158/1055-9965.epi-09-0337] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bondy SJ, Victor JC, O'Connor S, McDonald PW, Diemert LM, Cohen JE. Predictive validity and measurement issues in documenting quit intentions in population surveillance studies. Nicotine Tob Res 2009; 12:43-52. [PMID: 19955339 DOI: 10.1093/ntr/ntp171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Discrete classification of smokers by intention to quit is desirable in many public health and clinical settings. METHODS Two methodological studies examine measurement properties of measures of discrete-time intention to quit smoking used in population-based tobacco surveillance surveys: an ecological comparison of rates of positive intention in relation to the form of measure used and a prospective analysis examining predictive validity of self-reported quit intentions using multiple possible points of dichotomization of an ordinal measure of intention to quit. The prospective analysis used a repeated measures design and follow-up to 1 year for 2,047 smokers in the Ontario Tobacco Survey cohort. RESULTS The estimated percent of smokers intending to quit was significantly higher using the Stages of Change intention measure, relative to another single question measure. Significant dose-response effects were found. The sooner one intended to quit the more likely one was to make an attempt or achieve at least 30 days abstinence in the next 6 months. Intending to quit in a month or later was not associated with cessation during follow-up among respondents without prior attempts. Examination of cutpoints revealed no value, which maximized both positive and negative prediction. Regardless of quit attempt history, greatest predictive validity was found where respondents stated that they had no intention at all. DISCUSSION Measures of intentions quit smoking in specific time periods and expressed as dichotomies have limited psychometric properties but utility in applied research. Our findings suggest a possible measurement effect warranting caution in comparisons across studies.
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Affiliation(s)
- S J Bondy
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada M5T 3M7.
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Stefanek ME, Andrykowski MA, Lerman C, Manne S, Glanz K. Behavioral Oncology and the War on Cancer: Partnering with Biomedicine. Cancer Res 2009; 69:7151-6. [DOI: 10.1158/0008-5472.can-08-4005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim SY, England LJ, Kendrick JS, Dietz PM, Callaghan WM. The contribution of clinic-based interventions to reduce prenatal smoking prevalence among US women. Am J Public Health 2009; 99:893-8. [PMID: 19299672 DOI: 10.2105/ajph.2008.144485] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to estimate the effect of universal implementation of a clinic-based, psychosocial smoking cessation intervention for pregnant women. METHODS We used data from US birth certificates (2005) and the Pregnancy Risk Assessment Monitoring System (2004) to estimate the number of women smoking at conception. To calculate the number of women eligible to receive the cessation intervention, we used estimates from the literature of the percentage of women who quit spontaneously (23%), entered prenatal care before the third trimester (96.5%), and disclosed smoking to their provider (75%). We used the pooled relative risk (RR) for continued smoking from the 2004 Cochrane Review as our measure of the intervention's effectiveness (RR = 0.94). RESULTS We estimated that 944,240 women smoked at conception. Of these, 23.0% quit spontaneously, 6.3% quit with usual care, and an additional 3.3% quit because of the intervention, leaving 67.4% smoking throughout pregnancy. The calculated smoking prevalence in late pregnancy decreased from 16.4% to 15.6% because of the intervention. CONCLUSIONS Universal implementation of a best-practice, clinic-based intervention would increase the total number of quitters but would not substantially reduce smoking prevalence among pregnant women.
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Affiliation(s)
- Shin Y Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Smoking cessation counselling for pregnant and postpartum women among midwives, gynaecologists and paediatricians in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:96-107. [PMID: 19440272 PMCID: PMC2672345 DOI: 10.3390/ijerph6010096] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/23/2008] [Indexed: 11/17/2022]
Abstract
The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers. The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers.
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Matt GE, Romero R, Ma DS, Quintana PJ, Hovell MF, Donohue M, Messer K, Salem S, Aguilar M, Boland J, Cullimore J, Crane M, Junker J, Tassinario P, Timmermann V, Wong K, Chatfield D. Tobacco use and asking prices of used cars: prevalence, costs, and new opportunities for changing smoking behavior. Tob Induc Dis 2008; 4:2. [PMID: 18822157 PMCID: PMC2547891 DOI: 10.1186/1617-9625-4-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 07/31/2008] [Indexed: 11/26/2022] Open
Abstract
Secondhand smoke (SHS) causes premature death and disease in children and adults, and the scientific evidence indicates that there is no risk-free level of exposure to SHS. Smoking tobacco in a car can pollute the microenvironment of the car with residual SHS, leaving telltale signs to potential buyers (e.g., odor, used ash tray). This study examined (a) the proportion of used cars sold in the private party market that may be polluted with tobacco smoke and (b) whether asking prices of smoker and nonsmoker cars differed for cars of otherwise equivalent value. A random sample of 1,642 private party sellers were interviewed by telephone, and content analyses of print advertisements were conducted. Findings indicate that 22% of used cars were advertised by smokers or had been smoked in during the previous year. Among nonsmokers, 94% did not allow smoking in their car during the past year. Only 33% of smokers had the same restrictions. The smoking status of the seller and tobacco use in the car were significantly (p < .01) associated with the asking price independent of a car's Kelley Blue Book value (KBB). Used nonsmoker cars were offered at a considerable premium above their KBB value (>11%) and above comparable smoker cars (7–9%). These findings suggest that community preferences are affecting the value of smoke-free cars. New directions for research, tobacco control policies, and health education are discussed to further reduce smoking behavior, to help consumers make informed purchasing decisions, and to protect nonsmokers from SHS exposure.
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Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, USA.
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Greaves L, Tungohan E. Engendering tobacco control: using an international public health treaty to reduce smoking and empower women. Tob Control 2007; 16:148-50. [PMID: 17565123 PMCID: PMC2598510 DOI: 10.1136/tc.2006.016337] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, Box 48, E311-4500 Oak St, E3 Vancouver, Canada VGH 3NI.
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