Search

Objectives. We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). Methods. Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. Results. Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. Conclusions. When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health. (Am J Public Health. 2010;100:2487-2492. doi: 10.2105/AJPH.2009.175091)

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners. Methods. Women prisoners (n=360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement. Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers. Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations. (Am J Public Health. 2010;100:1442-1448. doi: 10.2105/AJPH.2009.172783)

Objectives. We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit. Methods. We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group. Results. We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence ([F.sub.1,12]=6.84; P Conclusions. The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans. (Am J Public Health. 2010;100:1307-1312. doi: 10.2105/AJPH.2009.181214)

Objectives. We aimed to investigate population-level changes in smoking initiation during California's Tobacco Control (CTC) Program from 1990 to 2005, a period during which tobacco industry marketing practices also changed. Methods. We used a discrete time survival analysis of data from the California Tobacco Survey to model changes in age of first smoking experimentation across birth cohorts. Results. Smoking initiation patterns were stable across cohorts aged 9 years or older at the start of the CTC program. For children entering preadolescence since 1990, initiation declined with each more recent cohort. By 2005, the observed decline in experimentation was 80% for male participants and 92% for female participants at age 12 to 14 years; by age 15 to 17 years, 10% of Californian adolescents had experimented in 2005 compared with 45% in preprogram cohorts. However, rates of new experimentation after age 17 years did not change, except for a recent increase in late experimentation (after age 20 years) among young adult men. Conclusion. Our models suggest that the CTC program greatly reduced adolescent smoking initiation among younger adolescents. Late experimentation may have recently increased among young adult men in California, coincident with an increase in tobacco industry marketing aimed at young adults. (Am J Public Health. 2010;100:1298-1306. doi: 10.2105/AJPH.2009.160416)

Objectives. We evaluated the effect of strict tobacco control policies, implemented beginning in 1995 in the Republic of Korea, on smoking prevalence and deaths. Methods. SimSmoke is a simulation model of the effect of tobacco control policies over time on smoking initiation and cessation. It uses standard attribution methods to estimate lives saved as a result of new policies. After validating the model against smoking prevalence, we used it to determine the Korean policies' effect on smoking prevalence. Results. The model predicted smoking prevalence accurately between 1995 and 2006. We estimated that 70% of the 24% relative reduction in smoking rates over that period was attributable to tobacco control policies, mainly tax increases and a strong media campaign, and that the policies will prolong 104812 male lives by the year 2027. Conclusions. Our results document Korea's success in reducing smoking prevalence and prolonging lives, which may serve as an example for other Asian nations. Further improvements may be possible with higher taxes and more comprehensive smoke-free laws, cessation policies, advertising restrictions, and health warnings. (Am J Public Health. 2010;100:1267-1273. doi: 10.2105/AJPH.2009.166900)

Objectives. We analyzed demographic and social network variables associated with the timing of ratification of the Framework Convention on Tobacco Control (FCTC). Methods. We compiled a 2-mode data set that recorded country participation in FCTC negotiations, as well as the number of individuals per country per year who joined an online tobacco control network. We used logistic regression analysis of these 2 data sets along with geographic location to determine whether exposure to prior FCTC adoptions was associated with a country's likelihood of adoption. Results. In the logistic regression analysis, higher income and more nongovernmental organizations (NGOs) involved in the Framework Convention Alliance (a network dedicated to the FCTC) were associated with being among the earliest adopters (for income, adjusted odds ratio [AOR] = 2.41; 95% confidence interval [CI] = 1.55; for NGOs, AOR = 1.66; 95% CI = 1.26, 2.17) or among early adopters (for income, AOR = 1.42; 95% CI = 1.09, 1.84; for NGOs, AOR = 1.23; 95% CI = 1.03, 1.45). Network exposure and event history analysis showed that in addition to income, the likelihood of adoption increased with increasing affiliation exposure to FCTC adopters through GLOBALink (an online network facilitating communication between tobacco control advocates). Conclusions. Public health programs should include a plan for creating opportunities for network interaction; otherwise, adoption and diffusion will be delayed and the investments in public health policy greatly diminished. (Am J Public Health, 2010; 100:1260-1266. doi: 10.2105/AJPH.2009.167833)

Objectives. We used a simulation model to analyze whether the Healthy People 2010 goal of reducing smoking prevalence from the current 19.8% rate to 12% by 2010 could be accomplished by increasing quit attempts, increasing the use of treatments, or increasing the effectiveness of treatment. Methods. We expanded on previous versions of the tobacco control simulation model SimSmoke to assess the effects of an increase in quit attempts, treatment use, and treatment effectiveness to reduce smoking prevalence. In the model, we considered increases in each of these parameters individually and in combination. Results. Individually, 100% increases in quit attempts, treatment use, and treatment effectiveness reduced the projected 2020 prevalence to 13.9%, 16.7%, and 15.9%, respectively. With a combined 100% increase in all components, the goal of a 12% adult smoking prevalence could be reached by 2012. Conclusions. If we are to come close to reaching Healthy People 2010 goals in the foreseeable future, we must not only induce quit attempts but also increase treatment use and effectiveness. Simulation models provide a useful tool for evaluating the potential to reach public health targets. (Am J Public Health. 2010; 100:1253-1259. doi: 10.2105/AJPH.2009.166785)

Smoking prevalence among the 1.1 million Americans living with HIV/AIDS is 2 to 3 times higher than the 19.8% rate among the general population. Since 1990, scientists have worked toward the discovery of health risks related to smoking in people living with HIV/AIDS; however, few studies have evaluated the delivery of smoking cessation interventions for this population. Increasing linkages between discovery science and delivery science may facilitate a faster transition to delivery of smoking cessation interventions for people living with HIV/ AIDS. (Am J Public Health. 2010;100:1245-1249. doi: 10.2105/AJPH.2009.172460)

Objectives. We evaluated the influence of financial strain on smoking cessation among Latino, African American, and Caucasian smokers of predominantly low socioeconomic status. Methods. Smokers enrolled in a smoking cessation study (N=424) were followed from 1 week prequit through 26 weeks postquit. We conducted a logistic regression analysis to evaluate the association between baseline financial strain and smoking abstinence at 26 weeks postquit after control for age, gender, race/ ethnicity, educational level, annual household income, marital status, number of cigarettes smoked per day, and time to first cigarette of the day. Results. Greater financial strain at baseline was significantly associated with reduced odds of abstinence at 26 weeks postquit among those who completed the study (odds ratio [OR]=0.77; 95% confidence interval [CI] =0.62, 0.94; P=.01). There was a significant association as well in analyses that included those who completed the study in addition to those lost to follow-up who were categorized as smokers (OR=0.78; 95% CI=0.64, 0.96; P=.02). Conclusions. Greater financial strain predicted lower cessation rates among racially/ethnically diverse smokers. Our findings highlight the impact of economic concerns on smoking cessation and the need to address financial strain in smoking cessation interventions. (Am J Public Health. 2010;100:702-706. doi: 10.2105/AJPH.2009.172676)

Objectives. We assessed the potential health and economic benefits of reducing common risk factors in older Americans. Methods. A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking. Results. The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198018 (diabetes), $137964 (hypertension), $118946 (smoking), and $51750 (obesity). Conclusions. Effective prevention could substantially improve the health of older Americans, and--despite increases in longevity--such benefits could be achieved with little or no additional lifetime medical spending. (Am J Public Health. 2009;99:2096-2101. doi: 10.2105/AJPH.2009.172627)

Objectives. We tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States. Methods. The study design was a randomized controlled trial with a 6-month waitlist control group. The intervention was a 10-week group intervention combined with nicotine replacement therapy. Two hundred and fifty participants received the intervention, and 289 were in the control group. Assessments occurred at baseline; end of treatment; 3, 6, and 12 months after treatment; and at weekly sessions for participants in the intervention group. Results. The intervention was efficacious compared with the waitlist control group. Point prevalence quit rates for the intervention group were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, quit rates that are consistent with outcomes from community smoking-cessation interventions. Conclusions. Female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community samples. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need.

In the public health literature, it is generally assumed that the perception of 'targeting' as positive or negative by the targeted audience depends on the product or message being promoted. Smoking prevalence rates are high among lesbian, gay, bisexual, and transgender (LGBT) individuals, but little is known about how they perceive tobacco industry targeting. We conducted focus groups with LGBT individuals in 4 US cities to explore their perceptions. Our findings indicated that focus group participants often responded positively to tobacco company targeting. Targeting connoted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate-community interaction. A better understanding of targeting may aid public health efforts to counter corporate disease promotion.

Objectives. We sought to outline an optimistic yet achievable goal for future US smoking prevalence rates based on empirical evidence reflecting the success of smoking control efforts in California. Methods. Using a dynamic model and the smoking initiation and cessation rates achieved in California as a guide, we projected US adult smoking prevalence rates through the year 2020. Results. If smoking initiation and cessation rates for the nation do not change, population dynamics will result in smoking prevalence rates falling to 19.1% in 2010 and 16.8% in 2020. If the country attains California's initiation and cessation rates by 2010, adult smoking prevalence rates will be 18.5% in 2010 and 14.7% as of 2020. Conclusions. If California's smoking initiation and cessation rates are attained nationwide, the US smoking prevalence rate could be 5.9 percentage points lower than the 2005 rate by the year 2020, and there would be 10.2 million fewer smokers than in 2006. A target of 14% smoking prevalence by 2020 is aggressive yet feasible, given that it takes into account the constraints imposed by population demographics. (doi:10.2105/AJPH.2006.107441)

Objectives. In non-American Indian/Alaska Native groups, current smoking prevalence is similar for those with or without diabetes (26%) We analyzed current smoking prevalence in American Indian/Alaska Natives by diabetes status. Methods. Data were extracted from Indian Health Service clinic visit information from 1998 to 2003. After consolidation into unique patient records, the sample comprised 71 221 patients aged 14 years or older with both diabetes and current smoking information. Results. Cross-sectional results indicated that diabetic American Indian/Alaska Natives were significantly more likely than those without diabetes to be current smokers (29.8% vs 18.8%; P Conclusions. American Indian/Alaska Natives with diabetes at all sites and age categories were found to smoke at significantly higher rates than those without diabetes. Smoking cessation programs should target diabetic patients to more effectively prevent complications and promote successful management of diabetes in American Indians/Alaska Natives. (doi: 10.2106/AJPH.2006.104042)

Objectives. Because US smoking rates have not declined during the past decade, there is a renewed need to identify factors associated with smoking cessation. Using a nested case-control design, we explored the association between ability to sustain cessation over an extended period and demographic, smoking, medical, and behavioral variables. Methods. We selected a sample of 1379 sustained quitters (abstinent from smoking for at least 40 months) and 1388 relapsers (abstinent for more than 8 months before relapse) from participants in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study, a nutritional intervention study involving Finnish men aged 50 to 69 years at baseline. Contingency table and multiple regression analyses were used to evaluate potential differences between the 2 groups on baseline variables. Results. Compared with sustained quitters, relapsers were more likely to report symptoms of emotional distress and higher levels of nicotine dependence, to drink more alcohol, and to report more medical conditions. Conclusions. Factors associated with both tobacco use and comorbid conditions impact an individual's ability to maintain long-term smoking cessation. Understanding the underlying mechanisms of action and potential common pathways among these factors may help to improve smoking cessation therapies. (doi: 10.2105/AJPH.2005.084137)

Objectives. Reduction of cigarette smoking is an important public health goal. However, lower smoking prevalence may be associated with increased obesity prevalence. I sought to estimate the effect of decreases in smoking prevalence on obesity prevalence in the United States population. Methods. I combined current weight data by smoking status from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) with smoking prevalence data from past NHANES surveys to estimate weight status had smoking prevalence not changed. Results. Even relatively large changes in the prevalence of smoking were estimated to have little effect on obesity prevalence. For example, if smoking prevalence in 1999-2002 were at the higher 1971-1975 smoking level, the estimated 1999-2002 obesity prevalence would be 22.5% rather than the actual value of 23.9%, a difference of only 1.4 percentage points. Estimates for other weight categories were similarly small. Conclusions. Decreases in the prevalence of cigarette smoking probably had only a small effect, often less than 1 percentage point, on increasing the prevalence of obesity and decreasing the prevalence of healthy weight in :he population. (Am J Public Health. 2007;97:1510-1514. doi:10.2105/AJ PH.2005.084343)

Over 40% of all US smokers have comorbid alcohol, drug, or mental disorders. Using data from the 2000-2001 Healthcare for Communities survey, we conducted multivariate logistic regressions to examine these individuals' sensitivity to cigarette prices. We found that a 10% increase in cigarette prices was associated with 18.2% less smoking participation among individuals with alcohol, drug, or mental disorders, except those with alcohol dependence. Increasing cigarette taxes could be effective in reducing smoking among individuals with alcohol, drug, or mental disorders. (Am J Public Health. 2010;100:1243-1245. doi: 10.2105/AJPH.2009.159962)

We analyzed data from a randomized trial of 322 actively depressed smokers and examined the effect of smoking cessation on their mental health functioning. Only 1 of 10 measures at 4 follow-up time points was significant: participants who successfully stopped smoking reported less alcohol use than did participants who continued smoking. Depressive symptoms declined significantly over time for participants who stopped smoking and those who continued smoking; there were no group differences. Individuals in treatment for clinical depression can be helped to stop smoking without adversely affecting their mental health functioning. (doi:10.2105/AJPH.2006.101147)