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Context: Tobacco use is a leading cause of preventable death in the U.S. and around the world. Increasing tobacco price through higher taxes is an effective intervention both to reduce tobacco use in the population and generate government revenues. The goal of this paper is to review evidence on the economic impact of tobacco price increases through taxation with a focus on the likely healthcare cost savings and improvements in employee productivity., Evidence Acquisition: The search covered studies published in English from January 2000 to July 2012 and included evaluations of national, state, and local policies to increase the price of any type of tobacco product by raising taxes in high-income countries. Economic review methods developed for The Guide to Community Preventive Services were used to screen and abstract included studies. Economic impact estimates were standardized to summarize the available evidence. Analyses were conducted in 2012., Evidence Synthesis: The review included eight modeling studies, with seven providing estimates of the impact on healthcare costs and three providing estimates of the value of productivity gains. Only one study provided an estimate of intervention costs. The economic merit of tobacco product price increases through taxation was determined from the overall body of evidence on per capita annual cost savings from a conservative 20% price increase., Conclusions: The evidence indicates that interventions that raise the unit price of tobacco products through taxes generate substantial healthcare cost savings and can generate additional gains from improved productivity in the workplace., (Published by Elsevier Inc.)

Introduction: Previous studies examining tobacco retailers' compliance with youth tobacco access policies have mostly evaluated retailers' likelihood of selling cigarettes to minors, and none have evaluated the likelihood of selling snus (a new smokeless tobacco product) to minors. We assessed the availability of snus and the likelihood of selling snus to adolescents in tobacco retailers in a large city in Minnesota., Methods: We randomly selected 71 eligible retailers located in a large city in Minnesota, and assessed the availability of snus through Camel snus retailer listings and phone inquiry. Purchase attempts by an underage buyer were used to assess the likelihood of selling snus to minors. χ2 tests were used to examine the store and neighbourhood characteristics associated with availability of snus., Results: We found that 31 retailers (43.7%) carried snus in the store, and 4 (12.9%) sold snus to the underage buyer. Retailers who sold gasoline were more likely to carry snus in the store (p<0.01). Neighbourhood demographic characteristics were not associated with availability of snus (p>0.10)., Conclusions: Prevalence of snus sales to minors appeared to be higher than that of cigarette sales to minors according to the 2011 Synar report. Futures studies are needed to determine whether tobacco retailers are more likely to sell snus than cigarettes to minors. Interventions such as public and retailer policies are needed to reduce the likelihood of tobacco retailers selling snus to minors., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Previous cross-sectional studies found that positive beliefs about electronic nicotine delivery systems (commonly known as electronic cigarettes or e-cigarettes) were associated with use of these products. However, the prospective association between these beliefs and subsequent use of e-cigarettes is unclear. Purpose: To identify the beliefs predicting subsequent use of e-cigarettes. Methods: A total of 1379 young adults (mean age=24.1 years) from the Minnesota Adolescent Community Cohort who reported never using e-cigarettes at baseline (collected Oct 2010–Mar 2011) and completed follow-up data collection (during Oct 2011–Mar 2012) were included in this analysis. Participants’ beliefs about e-cigarettes (potential as quit aids, harmfulness and addictiveness relative to cigarettes) were asked at baseline (yes/no). At follow-up, participants were asked if they had ever used e-cigarettes. Logistic regression models were used to assess the associations between beliefs about e-cigarettes and subsequent experimentation. Analysis was conducted in 2012. Results: At follow-up, 7.4% of the sample reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Participants who believed e-cigarettes can help people quit smoking and perceived e-cigarettes to be less harmful than cigarettes at baseline were more likely to report experimenting with e-cigarettes at follow-up (p<0.05). These associations did not differ by smoking status. Conclusions: Given that young adults are still developing their tobacco use behaviors, informing them about the lack of evidence to support e-cigarettes as quit aids and the unknown health risk of e-cigarettes may deter young adults from trying these products. [Copyright &y& Elsevier]

Introduction: American Indians have the highest smoking rates in the United States, yet few randomized controlled trials of culturally specific interventions exist. This study assessed American Indians’ opinions about evidence-based treatment and attitudes toward participating in clinical trials. Methods: Six focus groups were conducted based on smoking status (current/former smoker), sex, and elder status (55 years and older or younger). Meetings were held at local American Indian community organizations. This project was accomplished in partnership with the American Indian Community Tobacco Projects, a community–academic research partnership at the University of Minnesota. Thematic qualitative data analyses were conducted. Results: Participants desired the following: (a) programs led by trained American Indian community members, (b) the opportunity to connect with other American Indian smokers interested in quitting, and (c) programs promoting healthy lifestyles. Strategies desired for treatment included (a) free pharmacotherapy, including nicotine replacement therapy (NRT); (b) nominal incentives, e.g., gift cards for groceries; and (c) culturally specific program components such as American Indian images, education on traditional tobacco use, and quit-smoking messages that target the value of family and include narratives or story telling in recruitment and program materials. Biochemical verification of smoking abstinence, such as salivary cotinine or carbon monoxide breathalyzers, is likely acceptable. Standard treatment or delayed treatment control groups were viewed as potentially acceptable for randomized study designs. Conclusions: Rigorously conducted randomized controlled trials of culturally specific smoking cessation interventions are sorely needed but will only be accomplished with the commitment of funders, researchers, and collaborative trusting relationships with the community. [ABSTRACT FROM PUBLISHER]

Background: Despite declines over recent years, youth tobacco and other substance use rates remain high. Latino youth are at equal or increased risk for lifetime tobacco, alcohol, marijuana, and other illicit drug use compared with their white peers. Family plays an important and influential role in the lives of youth, and longitudinal research suggests that improving parenting skills may reduce youth substance use. However, few interventions are oriented towards immigrant Latino families, and none have been developed and evaluated using a community-based participatory research (CBPR) process that may increase the effectiveness and sustainability of such projects. Therefore, using CBPR principles, we developed a randomized clinical trial to assess the efficacy of a family-skills training intervention to prevent tobacco and other substance use intentions in Latino youth. Methods/Design: In collaboration with seven Latino community-serving agencies, we will recruit and randomize 336 immigrant families, into intervention or delayed treatment conditions. The primary outcome is youth intention to smoke 6 months post intervention. The intervention consists of eight parent and four youth sessions targeting parenting skills and parent-youth relational factors associated with lower smoking and other substance use in youth. Discussion: We present the study protocol for a family intervention using a CBPR randomized clinical trial to prevent smoking among Latino youth. The results of this trial will contribute to the limited information on effective and sustainable primary prevention programs for tobacco and other substance use directed at the growing US Latino communities. Trial registration: ClinicalTrials.gov: NCT01442753 [ABSTRACT FROM AUTHOR]

Introduction:: No previous studies document the effects of both comprehensive tobacco control and its defunding on youth smoking. This study tests the effect of the youth-focused Minnesota Youth Tobacco Prevention Initiative (MYTPI) and its shutdown on youth smoking and determines whether these effects differed by age. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to identify patterns of tobacco initiation, current use, and smoking cessation and their correlates in the adult American Indian population in the Twin Cities, using community-based participatory research methods. A total of 300 American Indians aged 18 years or older participated in in-person interviews. Participants were recruited to fill age-gender quotas that reflect the demographic distribution of American Indians in Minnesota. Almost everyone in this sample had smoked cigarettes recreationally: Only 12% had smoked fewer than 100 cigarettes, and nearly two-thirds (62%) reported that they were current smokers. Only 29% of ever-smokers had quit smoking. More than two-thirds (68%) of current smokers would like to quit, and most of them (53% of all smokers) had tried unsuccessfully to quit in the previous 12 months. Our results show a level of current smoking and low cessation rates among American Indians in the Twin Cities area that reflect a crisis for public health and for the Indian community. [ABSTRACT FROM AUTHOR]

The article presents information on community-wide research program on alcoholism and alcohol abuse among adolescents. The aim of the study is to prevent or delay onset of alcohol use among young adolescents. Project Northland is a community-wide research program funded by the National Institute on Alcoholism and Alcohol Abuse, for a 5-year period (1990-95). Alcohol use among adolescents continues to be a major social and public health issue in contemporary American society. Tobacco use results in chronic diseases that manifest later in life, the health consequences of alcohol use are evident during adolescence. In particular, motor vehicle crashes kill more teenagers than any other single cause of death and the majority of these crashes involve alcohol.

The article presents information on the results of a survey of tenth graders in two Minnesota cities to determine the major sources of cigarettes for underage teenagers. The prevalence of teenage smoking has remained high nationally and in Minnesota. The major effort to prevent teenage smoking in Minnesota, has been to reduce demand for cigarettes through school-based educational programs. The surveys were anonymous and voluntary, and self-administered during class. Students were considered non-smokers if they reported smoking no cigarettes in the past 7 days. The results of this survey suggest several areas with potential to reduce access by young people to tobacco.

Objectives. This study examined adolescent smokers' provision of tobacco to other adolescents. Methods. Data from a survey of 8th-, 9th-, and 10th-grade students in Minnesota were analyzed by using mixed-model logistic regression. Results. More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mother's smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. Conclusions. The social availability of tobacco to youth needs further examination. [ABSTRACT FROM AUTHOR]

Background: Reported prevalence of cigarette smoking among American Indian youth is higher than other racial/ethnic minorities, and limited data indicate that this disparity is especially pronounced in the Upper Midwest of the U.S. The purposes of this study are to measure traditional and recreational tobacco use among American Indian youth in an urban Upper Midwest area, and to identify social and environmental factors associated with recreational tobacco use (cigarette smoking). Methods: A cross-sectional convenience sample of 336 American Indian youth aged 11–18 years was given a self-administered survey. Data were analyzed using bivariate chi-square tests and multivariate logistical stepwise regression. Results: Almost 37% reported some recreational smoking in the previous 30 days, with about three times as many in the group aged 16–18 years reporting smoking as in the group aged 11–13 years (p<0.0001). Social exposure to cigarette smoking was very strong; more than three fourths reported living with an adult who smokes, and 44% have a brother/a sister who smokes. Yet more than 65% report a household rule against their smoking, and 43% report a household rule against anyone smoking inside. Youth who smoke report buying cigarettes often and smoking on school property. Household rules against smoking and hearing of someone getting caught smoking at school have an independent negative association with likelihood of being a smoker. Conclusions: These results indicate that American Indian youth in this area report high use of recreational tobacco, and the statewide focus on youth smoking prevention has not eliminated the disparity in smoking levels between American Indian youth and Minnesota youth overall. These findings suggest several pathways to reduce cigarette smoking among urban American Indian youth. [Copyright &y& Elsevier]

Purpose. This study examines the relationship between smoking-related parental, family, and home factors with adolescents' cigarette use. Design. Cross-sectional surveys of adolescents, via a self-administered questionnaire in classrooms, and their parents, via a telephone interview, were conducted.Setting. Fifteen suburban and rural communities within Minnesota. Subjects. The study sample included 8th, 9th, and 10th grade public school students and their parents. Measures. The dependent variable was monthly tobacco use among students. The independent measures were parental, family, and home smoking-related characteristics. There were 1343 parent-child dyads with completed surveys. Results. The final, multivariate logistic regression model found the following variables to be independently related to higher smoking rates among adolescents: child's grade (odds ratio [OR] = 3.03 for 10th vs. 8th), parents' permissiveness of adult smoking (OR = 1.80), parents' having higher normative estimates of how many people smoke (OR = 1.70), parents' decreased likelihood of punishing their teenager for smoking (OR = 1.65), smoking by an adult living in the home (OR = 1.99), and sibling smoking (OR = 8.95). Lack of communication about consequences for breaking family smoking rules was associated with lower smoking rates among adolescents (OR = .49). Conclusion. The results of this study highlight the importance of parental smoking norms and attitudes and smoking role models in the home. It is important that smoking prevention strategies target and include the entire family. Limitations of the study are its cross-sectional design and that the sample was primarily white. [ABSTRACT FROM AUTHOR]

Background: Circles of Tobacco Wisdom (CTW) was an elder-led, community-based project that aimed to enhance tobacco control in the American Indian community. Its goal was to provide elders with the knowledge, opportunities, and support to enable them to assume leadership of a tobacco control movement that was grounded in the ceremonial traditions of tobacco use. Purpose: The purpose of this study was to test the effects of the pilot intervention on participants. Design: The design of this pilot study intervention was a single group, pre–post comparison, with a pre–post survey, monthly check-ins, and a post-1-year focus group. Participants: Twelve elders were included in the pre- and post-analyses. All twelve elders were women who self-identified as American Indian (mean age = 64). Intervention: The CTW elders participated in monthly talking circles, quarterly learning sessions, and a post-1-year focus group, and took part in other learning, support, and community action opportunities. Data were collected from December 2008 through November 2009 and analyzed throughout the process. Main outcome measures: American Indian Elders'' tobacco-related knowledge, perceptions, beliefs, and behaviors were measured while participating in the CTW project. Results: Knowledge, perceptions, beliefs, and behavior changes were seen with cigarette smoking, secondhand smoke, and ceremonial tobacco use and risk perception. After 6 months, the number of people the elders had talked with about tobacco increased, elders were more likely to have a discussion on tobacco at a community event, and their comfort level talking about commercial and traditional tobacco also increased. A number of themes also were identified in the focus group: feeling more comfortable talking about tobacco issues, learning a lot about traditional and commercial tobacco, and realizing the dangers of smoking. Conclusions: Elders increased their knowledge about commercial and traditional tobacco and changed related attitudes as a result of CTW. Further, American Indian Elders perceived that CTW was effective. [Copyright &y& Elsevier]

Background: Taft–Hartley Health and Welfare Funds (“funds”) administer health insurance plans that cover approximately nine million U.S. adults. Unionized workers covered by funds work primarily in blue- and pink-collar occupations and smoke at a rate almost twice that of workers in other occupations. Most funds do not provide comprehensive coverage for tobacco cessation treatment for fund participants (workers, family members, and retirees). Purpose: This study tested a pilot intervention to increase the provision and promotion of cessation benefits among Minnesota-based funds by educating the funds'' advisors. Methods: Tailored educational outreach was conducted to advisors (administrators, consultants, attorneys) of 10 Minnesota-based funds (2009–2011). Pre- and post-intervention advisor interviews measured perceptions/knowledge/attitudes about tobacco use, cessation, coverage, and promotion of benefits. Pre- and post-intervention data on benefit provision were collected from Summary Plan Descriptions (SPDs) and Summary Material Modifications (SMMs) of 10 Minnesota-based funds and 19 comparison funds in Massachusetts and Washington, and compared in 2011. SPDs/SMMs were scored on benefit adequacy, comparing services covered and the extent to which they met DHHS recommendations. Results: Minnesota-based funds provided significantly higher coverage (except for copays and pre-conditions) pre-intervention. However, there were no significant differences between Minnesota and comparison funds in rate of improvement in benefits over time. At follow-up, advisors reported a significant increase in confidence in their knowledge to address smoking issues in funds. Advisors also reported sharing intervention information with fund trustees. Conclusions: Educational strategies to influence advisors who provide guidance to fund trustees may help to increase advisors'' confidence to address cessation benefit improvement. [Copyright &y& Elsevier]