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Sleepiness while driving causes a significant number of motor vehicle crashes. A review of statistics from several online databases revealed that 1% to 3% of all crashes were caused by drivers falling asleep at the wheel. Approximately 96% of crashes involve passenger vehicles while the remainder involve trucks. Young age, shift work, alcohol and other drug use and a history of sleep disorders were risk factors for crashes caused by sleepiness.

It is unlikely that the world will be smoke-free by the year 2000 but many advances have been made. The FDA has proposed regulating nicotine as a drug and cigarettes as a drug delivery device, a regulation announced by Pres Clinton. Internal tobacco industry documents that were leaked to the press are now available on the Internet. The documents reveal possible criminal activity by the industry that is being investigated by the Justice Dept. Several class-action lawsuits have been filed against the industry and several states are suing to recover the costs of treating the health effects of smoking. The Agency for Health Care Policy and Research has issued a Smoking Cessation Clinical Practice Guideline and OSHA is proposing nationwide smoking bans in workplaces. On the other hand, many legislators receive substantial amounts of money from the industry, and in 1995, ABC publicly apologized for an episode of Day One that criticized the industry. The industry also publishes information that distorts the economic impact of tobacco regulation.

The American Medical Association (AMA) accepts that merely expressing contrition for its failure to address the racial divide in the profession will not be enough to negate years of segregation. Contrition must be followed by a period of reconciliation and trust-building and, finally, collaboration, in order to achieve racial harmony in health care.

Since 1965, the number of smokers in the United States has declined by 40 percent. Although smoking is decreasing, and many individuals are quitting, the high rate of relapse is a major obstacle to lowering these statistics further. Also, the number of individuals who typically remain abstinent for one year after quitting is estimated to be between 20 and 40 percent. No formal studies have been conducted to assess the efficacy of smoking cessation programs in this country. This study investigated methods used to quit, noted differences between individuals who used a program (rather than quitting on their own), and looked for characteristics that distinguished successful quitters from relapsers. Data compiled by the 1986 Adult Use of Tobacco Survey were used in the investigation. Succeeders were defined as smokers who had quit within the last 10 years and who had once smoked for at least one year. Relapsers were defined as current smokers who tried to quit within the last 10 years, but were smoking at the time of the survey. Cessation methods included assisted and unassisted approaches. Few differences in characteristics of the succeeders and relapsers were noted, although relapsers tended to be younger and succeeders tended to be more educated. Those who were most likely to use a formal cessation program included women, the middle-aged, heavier smokers, individuals who had tried to quit before, and those with more education. Out of the individuals who had attempted to quit in the last 10 years, 47.5 percent were successful on their own, and 23.6 percent of those who used a program were able to stop. Of the successful quitters, 90 percent had stopped on their own, and 80 percent of the relapsers tried to stop on their own. It was concluded that smoking cessation programs, in general, have little impact, but may be helpful to a specific and small population of smokers. This is significant because among this population is the heavier smoker, who is at highest risk for smoking-related illness and death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Young people have little difficulty in buying cigarettes, in spite of laws in 46 states that limit access. The tobacco industry has issued stirring statements in support of compliance with these laws: nonetheless, only 32 vendor violations were reported in 1989, while 1 billion packs of cigarettes were sold to minors. Results are discussed from several studies of cigarette-buying behavior on the part of young people under 18 years. Since October 1989, several cities in Minnesota enacted vending machine restrictions, some of which were total bans. Cities in other states have followed suit. However, most sales to teenage smokers are over-the-counter, and a study in the December 11, 1991 issue of The Journal of the American Medical Association shows that merchant education alone is not enough to stop illegal sales. A bill has been proposed by Secretary of Health and Human Services Louis Sullivan that would create a retail licensing system for tobacco. Some cities have adopted such schemes. Another study in the same Journal issue indicates that such an approach can be effective. In that study, penalties against merchants in one community who sold cigarettes to minors almost completely eliminated such sales. This was combined with a merchant education program concerning the tobacco access law. Another study revealed the lenient approach taken by judges toward the store clerks who sold cigarettes to minors; their approach to store owners or managers may have been different, however. It is more practical to entrust enforcement of these laws to health departments than to police officers. Litigation by customers against stores who sold them cigarettes as minors may also help control illegal sales. The effects of reducing children's access to tobacco are not known; some argue that tobacco access laws may actually encourage children to try to buy cigarettes. Research concerning many aspects of tobacco use by teenagers is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Passive cigarette smoking, the inhalation of cigarette smoke by persons other than the smoker, has been cited as a cause of lung cancer, leading to as many as 3,800 deaths per year in the United States. The Tobacco Institute suggests that smokers exercise courtesy in considering the wishes of others regarding smoking, and that nonsmokers request smokers to abstain in a 'pleasant and friendly' manner. To determine whether such courteous demeanor actually occurs, data from the 1987 National Health Interview Survey of Cancer Epidemiology and Control (NHIS-CEC) were analyzed and compared with an earlier study of smoking (the Roper Organization study), which was reported in 1978. Results were based on answers to five questions that were asked during a nationwide, household survey, regarding beliefs about smoking and the extent to which smoke irritated the respondents. If they were smokers, the respondents were asked what they would do in a public place that has no rules about smoking and, if nonsmokers, what they would do when someone lights a cigarette in such a place. Results showed that 81 percent of all adults, and 67 percent of smokers, 'strongly agree' or 'agree' that passive smoking is harmful. However, 21 percent of smokers said they light up if they wish, 14 percent ask if others would mind, and 33 percent do not smoke in such a situation. In the earlier Roper study, more smokers (36 percent) said they would light up without asking, and fewer people said that they would refrain from smoking. Nonsmokers tend to move away from a smoker (about 50 percent), do nothing (39 percent), or ask the smoker to put out the cigarette (4 percent). Approximately the same proportion of nonsmokers said they would ask to have the cigarette extinguished in the earlier study. Overall, although four-fifths of adults believe passive smoking is harmful, it appears that the common courtesy approach advocated by the Tobacco Institute is a poor way of eliminating the dangers of passive smoking. Legislation to ban or restrict smoking will probably be the only effective approach for dealing with this problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Education, rather than gender, is the primary sociodemographic factor determining the prevalence of smoking, according to an analysis of smoking patterns from 1974 to 1985. While the numbers of people smoking decreased across groups from all educational levels, the less educated stopped smoking five times more slowly than those at higher education levels. Twice as many people with four or more years of college quit smoking during the period than those without a high school diploma. In addition, fewer college-educated people started smoking than less educated people. The only demographic group in which the number of people starting to smoke cigarettes increased was less-educated women. However, this trend changed abruptly in 1987, when fewer less-educated women began to smoke. Nevertheless, the gap in the prevalence of smoking between groups of different levels of education suggests that health promotion efforts need to be evaluated.

More effort is needed to ban smoking in indoor areas. Passive smoking has been linked to lung cancer, heart disease, and other illnesses. Anyone who lives or works with smokers is at risk of passive smoking. People who work in airplanes, casinos, restaurants, bars, bingo halls, and bowling alleys are most at risk. Studies have shown that educating people is not enough. OSHA has proposed a total ban on smoking in worksites except in separately ventilated areas. Until this regulation is finalized, individual lawsuits may be the best way to stop smoking in workplaces.

Presents letters to the editor. Effectiveness of over-the-counter nicotine replacement therapy; Risk of hemolytic uremic syndrome from antibiotic treatment of Escherichia coli O157:H7 colitis.

Describes the inadequate information base for good care of the dying patient to support policy decisions and reports that the current patient care system is deficient in regard to the care of the terminally ill.

Assesses the readability of the Surgeon General's warnings on outdoor cigarette advertising in the U.S. Inclusion of outdoor billboards and taxicab ads; Effect of the use of small size of letters, excessive length of warnings, the distance between the viewer and the ads and the movement between the viewer and the ads.

Assesses the appropriateness of a linear model or trend for projections of smoking prevalence in the U.S. to the year 2000 for each major demographic category. Quantification of the changes in smoking prevalence on the major components that could be affected by public health efforts, namely the increasing number of former smokers and the decreasing number of new smokers.

Analyzes trends in smoking prevalence in the U.S. as a function of gender and race. Examination of trends in the measurement of smoking initiation and smoking cessation to better understand the observed changes in smoking prevalence; Data from the National Health Interview Survey that can be used to describe smoking behavior in the U.S.

Presents a letter to the editor commenting on the implementation of California's Proposition 65, a law that requires businesses to provide a clear and reasonable warning to people before exposing them to chemicals known to the state to cause cancer or reproductive toxic effects.

Objective: To assess the role of secondhand smoke (SHS) in the etiology of chronic rhinosinusitis (CRS)., Design: Matched case-control study. Associations between SHS and CRS were evaluated by conditional logistic regression odds ratios., Setting: Henry Ford Health System, Detroit, Michigan., Participants: A total of 306 nonsmoking patients diagnosed as having an incident case of CRS and 306 age-matched, sex-matched, and race/ethnicity-matched nonsmoking control patients., Main Outcome Measures: Exposure to SHS for the 5 years before diagnosis of CRS (case patients) and before study entry (controls) for 4 primary sources: home, work, public places, and private social functions outside the home, such as parties, dinners, and weddings., Results: Of controls and case patients, respectively, 28 (9.1%) and 41 (13.4%) had SHS exposure at home, 21 (6.9%) and 57 (18.6%) at work, 258 (84.3%) and 276 (90.2%) in public places, and 85 (27.8%) and 157 (51.3%) at private social functions. Adjusted for potential confounders (socioeconomic status and exposures to air pollution and chemicals or respiratory irritants from hobbies, work, or elsewhere), the odds ratios for CRS were 1.69 (95% confidence interval, 0.92-3.10) for SHS exposure at home, 2.81 (1.42-5.57) for exposure at work, 1.48 (0.88-2.49) for exposure in public places, and 2.60 (1.74-3.89) for exposure at private functions. A strong, independent dose-response relationship existed between CRS and the number of venues where SHS exposure occurred (odds ratio per 1 of 4 levels, 2.03; 95% confidence interval, 1.55-2.66). Approximately 40.0% of CRS appeared to be attributable to SHS., Conclusions: Exposure to SHS is common and significantly independently associated with CRS. These findings have important clinical and public health implications.