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Studies on parental smoking behavior have mostly been conducted for developed countries and show that current parental smoking is negatively associated with children's current health. Using four waves of a Chilean longitudinal survey (Encuesta de Proteccion Social), we estimate probit and ordinary least squares models relating parents' self-report of their children's current health status to several covariates, including current parental smoking status and change (transitions) in parental smoking status across the waves of the survey. The data were collected in the years 2004, 2006, 2009, and 2015. The working sample includes 25,052 observations. The study revealed that parents' self-report of their children's current health status is strongly associated with current and past parental smoking status. Parents who smoke have an increased 11.17% probability of reporting that their children are in fair, poor, or very poor health status, when compared to non-smoking parents. The effect is stronger if the smoker is the mother, and it is exacerbated if she is less educated or unemployed/inactive. In addition, quitting smoking has a significant positive effect on children's reported health status, which is greater if the mother quits smoking. Cessation among mothers who are unemployed or inactive is also associated with a more positive assessment of their children's health status. The findings suggest that cessation programs may have health benefits not only for smoking parents, but also for their children. Improving coverage or establishing a national cessation program may have important present and future effects on population health and well-being.

In June 2016, California implemented a Tobacco 21 (T21) policy that increased the minimum sale age of tobacco products from 18 to 21. This study examined the association between California's T21 policy and smoking behavior (ever, current, daily, and nondaily) in 18–20 year-olds using data from the 2012–2019 Behavioral Risk Factor Surveillance System (n = 15,863). The annual change in odds of smoking among 18–20 year-olds post-policy (July 2016–December 2019) was compared with the pre-policy period (January 2012 – June 2016) 1) within California and 2) compared with states without a T21 policy. As a sensitivity analysis, 21–23 year-olds in California were used as the referent. Difference-in-difference estimates (D-I-D) were calculated using adjusted logistic regression and compared the post to pre-policy change in trends in California to the referent groups. Before California's T21 policy, there was an 11% annual decrease in the odds of ever smoking among 18–20 year-olds in California and a 6% decrease in the referent states. After the policy, these trends did not change significantly. Results for current smoking were similar. For daily smoking, there was an 8% annual decrease before the policy and a 26% annual decrease after the policy among 18–20 year-olds in California; D-I-D estimates were 0.80 (95% CI: 0.57, 1.14) using referent states as the comparison and 0.62 (95% CI: 0.41, 0.95) using 21–23 year-olds in California as the comparison. There was an association between California's T21 policy and a decrease in daily smoking among 18–20 year-olds, compared with 21–23 year-olds, more than three years post-implementation.

Thank you for the opportunity to respond to the commentary by Kim-Mozeleski and colleagues on “Food insecurity transitions and smoking behavior among older adults who smoke”. This study examined the influence of food insecurity transitions on smoking cessation and daily cigarette consumption in 2014 within a sample of older U.S. adults from the Health and Retirement Study (HRS) who indicated that they smoked in 2012. In particular, Kim-Mozeleski and colleagues highlight that findings of Bergmans (2019) contrast with results of a previous publication by Kim-Mozeleski and colleagues. In sum, it is not readily apparent why findings contradict those of Kim-Mozeleski et al. (2018). Moderation or confounding due to macroeconomic factors that influence health and behavior is a possibility. Bergmans (2019) examined associations over a recent 2-year period of U.S. economic growth. In contrast, data from Kim-Mozeleski et al. (2018) spanned 12 years and overlapped the Great Recession. A detailed response to the commentary is provided.

Smokefree environment created by smokefree policies is associated with smoking reduction; however, there is paucity of literature on the relationship between smokefree home rules and smoking intensity in low-and-middle income countries (LMICs), and how smokefree policy affects smoking behavior of smokers at different stages of smoking cessation. This study examined the relationship between smokefree home rules and average number of cigarettes smoked per day (CPD) among daily smokers at different stages of the transtheoretical model (TTM) of change. Data from 18,718 current daily cigarette smokers from the Global Adult Tobacco Survey (GATS) conducted from 2011 to 2017 in 20 LMICs were analyzed. Weighted multivariable linear regression analyses were conducted using the log of CPD as the outcome variable with smokefree home rules as the exposure variable, controlling for selected covariates. Approximately 15% of the participants were in precontemplation, 5% were in preparation, 15% lived in partial smokefree homes, and 30% lived in complete smokefree homes. The average number of CPD was 12.3, 12.0, and 10.6 among participants living in homes where smoking was allowed, partial smokefree homes, and complete smokefree homes, respectively. Compared to living in homes where smoking was allowed, living in complete smokefree homes were associated with 22.5% (95%CI = 18.4%–26.5%), 17.9% (95%CI = 8.4%–27.3%), and 29.3% (95% CI = 17.1%–41.5%) fewer CPD among participants in precontemplation, contemplation, and preparation stages, respectively. These findings suggest that complete smokefree home policy will benefit smokers in LMICs irrespective of their intention to quit smoking in addition to protecting non-smokers from secondhand smoke exposure.

We examined the change over time in tobacco advertising, promotion and sponsorship exposure and the concurrent changes in cigarette smoking behavior among students age 13 to 15years in two African countries with different anti-tobacco advertising, promotion and sponsorship policies. In South Africa, anti-tobacco advertising, promotion and sponsorship policies became more comprehensive over time and were more strictly enforced, whereas the partial anti-tobacco advertising, promotion and sponsorship policies adopted in Botswana were weakly enforced.We analyzed two rounds of Global Youth Tobacco Survey data from South Africa (1999, n=2342; 2011, n=3713) and in Botswana (2001, n=1073; 2008, n=1605). We assessed several indicators of tobacco advertising, promotion and sponsorship exposure along with prevalence of current cigarette smoking and smoking susceptibility for each data round. Logistic regression was used to examine changes over time in tobacco advertising, promotion and sponsorship exposure and smoking behavior in both countries.Between 1999 and 2011, South African students' exposure to tobacco advertising and sponsorship decreased significantly by 16% (p value,0.0001) and 14% (p value,0.0001), respectively. Exposure to tobacco promotion was lower and did not decrease significantly. Botswanan students' tobacco advertising, promotion and sponsorship exposure did not change significantly between 2001 and 2008. South African students' prevalence of cigarette smoking decreased over time (OR, 0.68) as did susceptibility to smoking (OR, 0.75), but declines did not remain significant after adjusting for parents' and friends' smoking. In Botswana, students' prevalence of cigarette smoking increased significantly over time (OR, 1.84), as did susceptibility to smoking (OR, 2.71).Enforcement of strong anti-tobacco advertising, promotion and sponsorship policies is a vital component of effective tobacco control programs in Africa. Such regulations, if effectively implemented, can reduce tobacco advertising, promotion and sponsorship exposure among adolescents and may influence cigarette smoking behavior.

Regulations requiring a reduction of the nicotine content in cigarettes to minimally addictive levels could significantly reduce the public health impact of cigarette smoking. Clinical trials evaluating this strategy are ongoing and methods have been developed to use nicotine biomarkers to estimate compliance with use of very low nicotine content cigarettes (VLNCs). To date, these methods have not considered the potential contribution of nicotine absorption from environmental tobacco smoke (ETS) among research participants. This study used data from 100 randomly selected study completers in ongoing clinical trials of VLNCs (50 randomized to Usual Nicotine Content Cigarettes (UNCs) and 50 to VLNCs) to assess the use of plasma cotinine to estimate compliance. Plasma cotinine and smoking behavior were recorded at baseline after 2 weeks smoking UNC cigarettes, and then after 18 weeks of either continuing smoking UNCs or reducing the nicotine content such that the last 6 weeks comprised smoking VLNCs. Plasma cotinine remained stable (267 ng/ml) in the UNC group but reduced to 93 ng/ml in the VLNC group (p 0.01). Compliance with smoking VLNCs was first estimated by comparing the cotinine per cigarette on VLNCs with UNCs after allowing for potential compensatory smoking. We found that 29 (58%) of the VLNC group were compliant. Adjusting for potential ETS exposure estimated 32 (64%) to be compliant. This latter group (n = 32) had a mean plasma cotinine on VLNCs of 7 ng/ml (range = 3-16.4 ng/ml). Adjusting for potential ETS exposure may improve identification of participants who plausibly complied with exclusive VLNC use.

Thirty-day smoking, although a widely used measure of adolescent smoking (age 12–16), has been questioned as an accurate measure of young adult (age 26–30) smoking behavior, particularly when critiquing studies linking use of e-cigarettes with subsequent cigarette smoking. We used logistic regression to test two measures of 30-day adolescent smoking as predictors of young adult smoking in the National Longitudinal Survey of Youth 1997. Adjusting for psychosocial covariates, compared to those who smoked zero days in the past 30 days in adolescence, odds of any past-30-day smoking in young adulthood ranged from 2.85 (95% CI: 1.85–4.37) for those who smoked 1 day to 4.81 (3.50–6.59) for those who smoked daily as adolescents, and adjusted odds of daily smoking in young adulthood ranged from 1.99 (1.24–3.18) to 4.69 (3.42–6.43). Compared with adolescent never smokers, adjusted odds of any past-30-day smoking in young adulthood among adolescent former smokers was 2.11 (1.77–2.53), and among adolescent current smokers, ranged from 3.03 (2.22–4.14) for those who smoked 1–5 cigarettes per month to 8.19 (5.80–11.55) for those who smoked daily. Adjusted odds of daily smoking in young adulthood were 2.49 (2.12–2.91) for adolescent former smokers and, among adolescent current smokers, ranged from 2.54 (1.92–3.37) for those who smoked 1–5 cigarettes per month to 8.65 (6.06–12.35) for those who smoked daily. There is a strong dose-response relationship between 30-day smoking in adolescence—even a single day in the month—and 30-day and daily smoking in young adulthood.

This Letter to the Editor raises questions regarding a recently published article, "Food insecurity transitions and smoking behavior among older adults who smoke."

Cross-sectional data reveal that smoking cigarettes is highly prevalent among those who are food insecure. However, there is limited and conflicting evidence concerning whether causal factors may influence associations of food insecurity with smoking behavior. Additionally, temporality is a core feature of food insecurity that should be considered when examining linkages between food insecurity and health behaviors like smoking cessation. In 2019, data were extracted from waves 2012 and 2014 of the Health and Retirement Study—a representative sample of U.S. adults over age 50. Analyses were limited to those who smoked cigarettes in 2012 (n=2,197). Food insecurity was assessed in 2012 and 2014 to indicate food insecurity transitions: (1) initially food insecure (food insecure in 2012 only); (2) became food insecure (food insecure in 2014 only); (3) remained food insecure (food insecure in 2012 and 2014), and; (4) not food insecure (reference group). Multivariable logistic regression examined odds of smoking cessation in 2014 due to food insecurity transition. Becoming food insecure was associated with a 2.0 (95% confidence interval=1.2-3.4) higher odds of smoking cessation. Employment loss or retirement (p=0.020) and diagnosis of a new chronic condition (p=0.026) were also associated with higher odds of smoking cessation. In older U.S. adults, smoking cessation was associated with decreased spending power and new health problems. Future studies should examine whether findings of this study may be similar among younger adults and; whether those who quit smoking due to food insecurity are more susceptible to relapse than those who quit due to other factors.

Objective Deprived neighborhoods play an important role in adult smoking behavior, but little research exists about youth on this topic. This study explored the relationship between deprivation and youth smoking to examine whether this association differs by gender and ethno-racial origin. Methods Individual-level data from the Canadian Community Health Survey (2000–2005) were combined with neighborhood-level data from the 2001 Canada Census to assess smoking among youth aged 12–18 (n = 15,615). Results Youth who were female (OR = 1.27, 95%CI:1.16–1.38), White (OR = 1.95, 95%CI:1.71–2.21) and living in deprived neighborhoods (OR = 1.22, 95%CI:1.16–1.28) were more likely to smoke. In multilevel models, White females were more likely to smoke relative to non-White females and males (OR = 1.42, 95%CI:1.06–1.89). Youth with a strong sense of community belonging and living in deprived neighborhoods were at increased risk of smoking (OR = 1.18, 95%CI:1.06–1.32). The individual-level risk factor, household smoker, contributed substantially to youth smoking reducing the bivariate association between material deprivation and smoking by 33%. Conclusion White females, youth cohabiting with other smokers and youth living in poor neighborhoods with a strong sense of community belonging, are at an increased risk of smoking. Future anti-smoking efforts might have greater impact if they target at-risk youth as well as household members who cohabit with youth.

Purpose To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001. Methods Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis. Results Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking. Conclusion This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required.

Persons with alcohol use disorders (AUDs) and substance use disorders (SUDs) appear to be heavily affected by cigarette smoking. In order to address the consequences of smoking in this population, an understanding of the current state of knowledge is needed. Epidemiologic research provides the opportunity to obtain detailed information on smoking behaviors in large community samples. The aim of this paper was to synthesize the epidemiologic evidence on smoking among persons with AUDs/SUDs and suggest directions for future research. Literature searches of Medline and PubMed were used to identify articles and additional articles were elicited from publication reference lists. To be included in the review, papers had to be published in English, analyze epidemiologic data, and examine an aspect of smoking behavior in persons with AUDs/SUDs. Twenty-nine studies met inclusion criteria and were included in the review. In summary, epidemiologic evidence to date suggests greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms for persons with AUDs/SUDs compared to other people. Most studies examined nationally representative data and were conducted on persons in the United States and Australia. Few publications examined outcomes by demographics (e.g., gender, age) but these studies suggested that specific patterns differ by demographic subgroups. More research is needed on persons with AUDs/SUDs in order to develop the most effective public health and clinical interventions to reduce smoking behaviors, improve cessation outcomes, and reduce the harmful consequences of smoking for those with AUDs/SUDs.

To determine the national prevalence of smoking among Iranian youths and its environmental influencing factors.This study was performed in 2003-2004 among 11,966 school students, ages 11-18 years, selected by multi-stage random cluster sampling from 20 provinces in Iran. The participants filled out self-administered anonymous questionnaires.The prevalence of self-reported cigarette smoking was 14.3%, with a higher prevalence in boys than in girls (18.5% vs. 10.1%, respectively, P0.001), and in high school than in middle school students (17.4% vs. 10.6%, respectively, P0.001). Overall, 42.2% of smokers were daily smoker, and the rest were occasional smoker. The mean age of the first attempt to smoke was 13.2 +/- 2.5 years with no significant gender difference but was significantly lower in daily than in occasional smokers. The place of the first attempt to smoke was mostly in friend parties (41.6%) and traditional teahouses (23.2%) for boys and the family parties (37.1%) and the traditional teahouses (27.4%) for girls. The higher school level and having a tobacco user at home significantly increased the likelihood of smoking in adolescents, with the highest odds ratio (OR) found for having a smoker sister in girls (OR = 4.5, 95%CI, 2.5, 8.2), and having a smoker brother in boys (OR = 2.4, 95%CI, 2.03, 3.05).Smoking is becoming as a major public health threat among Iranian youths. Control measures should be considered not only for cigarette smoking, but also for the socially accepted habit of water pipe use that is revived in traditional teahouses.

Model of unplanned smoking initiation of children and adolescents: an integrated stage model of smoking behavior.Kremers SP, Mudde AN, De Vries H.Department of Health Education and Health Promotion, Universiteit Maastricht, Maastricht, The Netherlands. s.kremers@gvo.unimaas.nlBACKGROUND: Two lines of psychological research have attempted to spell out the stages of adolescent smoking initiation. The first has focused on behavioral stages of smoking initiation, while the second line emphasized motivational stages. METHODS: A large international sample of European adolescents (N = 10,170, mean age = 13.3 years) was followed longitudinally. Self-reported motivational and behavioral stages of smoking initiation were integrated, leading to the development of the Model of Unplanned Smoking Initiation of Children and Adolescents (MUSICA). The MUSICA postulates that youngsters experiment with smoking while they are in an unmotivated state as regards their plans for smoking regularly in the future. RESULTS: More than 95% of the total population resided in one of the seven stages distinguished by MUSICA. The probability of starting to smoke regularly during the 12 months follow-up period increased with advanced stage assignment at baseline. Unique social cognitive predictors of stage progression from the various stages were identified, but effect sizes of predictors of transitions were small. CONCLUSIONS: The integration of motivational and behavioral dimensions improves our understanding of the process of smoking initiation. In contrast to current theories of smoking initiation, adolescent uptake of smoking behavior was found to be an unplanned action

Background Identifying factors that affect cotinine levels in smokers may be useful for smoking cessation programs. Our aims were to characterize the distribution of salivary cotinine levels in Chinese smokers and to investigate factors that influence cotinine concentrations. Methods In a cross-sectional study, 600 Chinese adult smokers answered a questionnaire on smoking habits and provided a saliva sample for cotinine analysis. Modification of the relation between number of cigarettes smoked and cotinine concentration by individual characteristics, smoking behavior, and type of tobacco was evaluated. Results Quadratic model provided the best fit for the relation between number of cigarettes smoked in the previous 24 hours and salivary cotinine concentration. Among those smoking up to 20 cigarettes, the median cotinine concentration was higher among younger subjects, those smoking cigarettes without filter and regular rather than light cigarettes, and those inhaling frequently and deeply. Such trends were not observed among heavier smokers. The increase in cotinine per cigarette tended to be larger in those with lower median cotinine level. Conclusions Our findings show that smoking behavior-related factors modify the relation between number of cigarettes smoked and salivary cotinine concentration. This suggests that smokers may regulate their smoking behavior to achieve a certain optimum nicotine level.

Background. Knowledge of the impact of smoking cessation on health-related quality of life may be important in encouraging smokers to quit. We determined whether the difference in quality of life between ex- and current smokers is influenced by amount of smoking or time since quitting. Methods. Data were collected within a cross-sectional study among a random sample of the general population in The Netherlands. Health-related quality of life was measured with the RAND-36 questionnaire (adapted from SF-36). Smoking behavior was assessed with a self-administered questionnaire. Adjusted differences in quality of life scores between ex- and current smokers were tested with multivariate analysis of variance, among 9,660 men and women aged 20–59 years, without history of tobacco-related chronic diseases. Results. Ex-smokers reported significantly higher quality of life scores than current smokers. This was more pronounced for mental health, especially for role functioning limitations due to emotional problems (difference 6.5 points; P < 0.0001), than for physical health dimensions. Differences were generally larger between ex- and current heavy smokers than between ex- and current light or moderate smokers (P trend

Background. Adolescent smoking has been an issue of major concern in the United States. This has led to a need for the development, evaluation, and dissemination of effective youth cessation programs. The purpose of this paper is to report the results of a 2-year demonstration study (1999–2000) of the American Lung Association's teen smoking cessation program, the Not On Tobacco (NOT) program. Methods. The study used a “matched” design wherein each NOT school was matched to a brief intervention (BI) school. The study consisted of 20 NOT and 20 BI Florida high schools encompassing 627 students. The primary outcome measures were carbon monoxide-validated quit and reduction rates for NOT and BI schools at 5.2 months postprogram. Results. NOT smoking cessation and reduction outcomes were significantly better than those of the brief intervention. Further, data indicate that NOT was more effective than the brief intervention for females compared with males; males showed successful quit attempts in both intervention groups. Overall, more NOT youth either quit or reduced smoking than did BI youth. Conclusions. These positive smoking behavior changes suggest that NOT is an effective teen smoking cessation option.

Background. Most adult smokers report trying their first cigarette before age 18 years. Understanding the impact of smoking initiation at young ages may help public health policy makers and practitioners improve strategies to prevent or delay adolescent cigarette smoking. Methods. This paper examined age of initiation of cigarette smoking and subsequent patterns of smoking among U.S. high school students 16 years of age and older (N = 13,858). We used data from the 1991–1997 national Youth Risk Behavior Surveys, conducted by the Centers for Disease Control and Prevention. Results. The majority of students 16 years of age and older (60.4%) reported ever having smoked a whole cigarette, and 11.1% initiated smoking at age 10 years or younger. Age of smoking initiation was significantly related to current frequent smoking, daily smoking, and whether students had ever smoked daily. A younger age of smoking initiation was associated with smoking more cigarettes per day than was initiating at an older age. Conclusions. Delaying the onset of smoking may affect the likelihood of becoming addicted to nicotine and smoking heavily. For students who are already addicted to nicotine, smoking cessation programs are needed.

Objectives.The aim of this work was to examine changes in the smoking behavior of elderly Mexican Americans in the southwestern United States from the early 1980s to the early 1990s. Methods.Data from the 1993–1994 Hispanic EPESE study (n= 2,809) on persons ages 65 to 74 and 75 to 84 residing in the five southwestern states were compared with data from the 1982–1984 Hispanic HANES study (n= 753, persons ages 55 to 74), which included a Mexican American sample from the same five southwestern states. Results.Rates of current smoking in 1993–1994 for persons ages 65 to 74 were approximately half the rates for persons of the same age a decade earlier. Smoking rates for persons ages 75 to 84 in 1993–1994 were significantly lower than rates for persons ages 65 to 74 a decade earlier. Finally, rates for persons ages 65 to 74 in 1993–1994 were significantly lower than those for persons ages 55 to 64 in 1982–1984. Conclusions.Although some of the declines in smoking in recent years represent aging effects (including declines due to greater mortality among smokers), the much lower rates for same-age people (65 to 74) over the 10-year period are more significant in that they represent cohort differences. It appears that the broader public health message that is causing the general population to quit smoking is reaching the elderly Mexican American population of the Southwest.

Department of Medical Sociology, Maastricht University, The Netherlands. R.Engels@MedSoc.Unimaas.NLBACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.Publication Types: Multicenter Study

Background. Smoking regulations at the workplace have been found to be acceptable and effective in many studies conducted in the United States. There is limited knowledge, however, on acceptance and effects of smoking regulations in European countries, particularly among blue collar employees. Methods. We conducted a survey on smoking behaviour and attitude toward smoking regulations and passive smoking in a South German metal company. A self-administered questionnaire was mailed to 1,500 predominantly blue collar employees of whom 974 participated in the study (response rate 64.9%). Results. About 30% of the employees were not allowed to smoke at their immediate work area. Among them, about 95% of both smokers and nonsmokers agreed with this smoking policy. More than 60% of nonsmoking blue collar workers were bothered by passive smoking at work whether or not smoking was allowed at their immediate work area. In contrast, the proportion of nonsmoking white collar employees who were bothered by passive smoking varied from 52% if smoking was allowed at their immediate work area to 18% if smoking was not allowed. Prevalence of active smoking and average amount of smoking among active smokers were considerably lower among employees who were not allowed to smoke at work than among other employees. These differences were partly due to confounding by occupation, however, which was strongly related to both smoking habits and smoking policy. Conclusions. Our results, which confirm and extend previous findings, give further support to the acceptability and potential effectiveness of smoking regulations at the workplace. Particular efforts should be devoted to limit both active and passive smoking among blue collar employees.

Background.This study examines the influence of the social environment in worksites on employees’ intention to quit smoking by applying the attitude–social influence–efficacy model.Methods.Regression analyses were conducted with 509 smoking employees from eight Dutch worksites. Variables of interest were attitudes toward smoking, perceived social pressure to quit, perceived smoking behavior of others, self-efficacy, demographics, smoking history variables, company type, and smoking tolerance.Results.Attitude, social pressure from people outside the worksetting (partner, children), and self-efficacy explained 23% of the variance for intention. Past behavior increased the adjustedR2from 0.23 to 0.29. Social influences in the worksite were unrelated to employees’ intention to quit smoking.Conclusions.It was concluded that, in Dutch worksites, social influences stemming from people at work have less influence on employees’ intention to quit smoking than other important people outside the work situation. Implications for smoking control strategies in worksites are briefly discussed.

In a cross-sectional study of 2,112 Norwegian army conscripts ages 18 to 25, the prevalence of daily smoking was 50.9%. Among the smokers, 55.7% had increased smoking during military service, and 7.8% of the nonsmokers had started to smoke. These changes in smoking behavior were correlated with having a best friend who smoked, with dissatisfaction with the military service, with physical inactivity, and with frequent alcohol consumption. Ninety percent lived in dormitories where cigarette smoking occurred regularly. Attitudes toward smoking restrictions were determined mainly by the subjects′; smoking behavior and subjective discomfort caused by cigarette smoke. Smokers as well as nonsmokers having a best friend who smoked were significantly less bothered by cigarette smoke than others. The findings support the conclusion that military service has a negative influence on the smoking behavior of young Norwegian men. Intervention strategies are recommended.

The relationship between smoking regulations at the workplace and smoking habits was assessed among public-sector employees in southern Germany.A cross-sectional study was conducted among 931 employees who were working under three different, long-existing types of smoking regulations: (a) no restrictions at all, (b) a requirement that employees make their own agreement, and (c) a general prohibition of smoking.Smoking prevalence was lower among employees at workplaces with smoking restrictions (24.8 and 29.2% for workplaces with the agreement policy and the general smoking ban, respectively) than among other employees (31.4%), but these differences were not statistically significant. Large and highly statistically significant (P0.001) differences were found, however, in the average numbers of cigarettes smoked per day by active smokers. The mean number ranged from 20.5 in smokers without worksite restrictions to 14.1 and 13.2 in smokers working under the agreement policy and the general smoking ban, respectively. These differences persisted after multivariable control for potential confounders.Despite inherent limitations of the cross-sectional study design, our results suggest that regulation of smoking at the workplace may help active smokers substantially reduce their daily cigarette consumption. Such regulations might therefore be very effective public health measures.

Objective To evaluate the impact of a smoke-free campus policy on college students' smoking behaviors and attitudes. Methods The current study utilized repeated cross-sectional surveys with a nested 4-wave longitudinal cohort design. Data were collected from undergraduate students at two large matched public universities in Indiana before and after one of the campuses went smoke-free in January 2008. Baseline data were collected in fall 2007 (n = 3266) and follow-up data were collected in fall 2009 (n = 3207). In addition, volunteers provided longitudinal follow-up data at four different time points. Results In the cross-sectional analyses, students exposed to the smoke-free campus policy demonstrated significant favorable changes in smoking behavior (16.5% to 12.8%, p

Background. The results of the MRFIT smoking intervention program are presented for the 4,103 special intervention and 4,091 usual care men who reported smoking cigarettes at the first screening visit. Results. Among the special intervention men, the reported cessation rate increased from 43.1% at 12 months to 48.9% at 72 months. The reported cessation rate among the usual care men increased from 13.5% at 12 months to 28.8% at 72 months. Among smokers who reported cessation at 72 months, 51.3% of special intervention men and 22.7% of usual care men had quit smoking within the first year and remained abstinent thereafter. Average thiocyanate and expired-air carbon monoxide served as objective measures of smoking and were significantly lower among the special intervention men that among the usual care men over the entire follow-up period. The reported cessation rates at 72 months varied according to initial levels of smoking. Smokers reporting 1–19 cigarettes per day at entry were more likely to quit than heavier smokers. For each category of smoking at entry (1–19, 20–39, and 40 or more cigarettes per day) significantly more special intervention than usual care smokers reported cessation. Conclusion. These results indicate that the MRFIT smoking intervention program was successful in promoting early cigarette smoking cessation and maintaining cessation over the entire trial for a large percentage of cigarette smokers.

Objective. Socioeconomic status (SES) has been associated with smoking among adolescents, but it is not known which attributes of SES are responsible for the added risk, or whether these associations are consistent in ethnically diverse samples. Methods. This study investigated the associations between SES variables and smoking behavior among an ethnically diverse sample of 1847 8th grade adolescents in Southern California in 2002. Several aspects of SES were examined: an objective composite measure of family and neighborhood SES, the adolescent's spending money, and the adolescent's perception of SES (family's ability to afford basic necessities, wealth relative to others, and wealth relative to last year). Results. After controlling for demographic characteristics, smoking behavior of parents and friends, and parental monitoring, low scores on the objective SES index and large amounts of pocket money were associated with an increased risk of smoking. The subjective measures of perceived SES were not associated with smoking. Conclusions. Results indicate that increased smoking prevention efforts are needed in low-SES areas, and that limiting adolescents' pocket money may be an effective strategy for preventing smoking.

There has been no report to date on mass screening of passive smoking in children using biomarkers.To identify children exposed to actual environmental tobacco smoke (ETS), 261 children were divided into the following 3 groups: (A) both parents smoke; (B) one parent smokes; and (C) no parent smokes. Child urinary cotinine measurement and a parent questionnaire were obtained.Urinary cotinine was positive (10 ng/ml) in 92 (35.2%) of the 261 children. Of the 92 children, 29 were classified into group A, 47 into group B, and 16 into group C. The percentages of children who tested positive for urinary cotinine in groups A, B, and C were 56.9%, 31.1%, and 27.1%, respectively. However, in group B, the percentage of children who tested positive for urinary cotinine was significantly higher if only the mother smoked (47.1%) than if only the father smoked (29.1%) (P0.05). The mean+SD urinary cotinine level in group A was 12.9+/-6.5 ng/ml, and that in group B was 10.4+/-3.8 ng/ml if the mother smoked and 5.4+/-2.6 ng/ml if the father smoked.This smoking screening program may be useful in identifying children with actual ETS exposure and motivating their parents to either quit smoking or modify their smoking behavior around children.

Background. Passive smoking is a well-known health hazard for infants. This study was conducted to: (1) estimate the prevalence of passive smoking among Japanese infants and (2) clarify the prevalence of indoor smoking and associating factors among parents having infants. Methods. Subjects were all 53,575 infants born throughout Japan on January 10–17, 2001 or July 10–17, 2001. When the infants reached 6 months of age, the questionnaires were mailed to the homes. Family members answered questions that included information about the current smoking behavior of the parents. Results. A total of 44,562 questionnaires (83.2%) were analyzed. The prevalence of smoking among the mothers and the fathers were 17.1% and 63.5%. The percentages of mothers and fathers who smoked indoors were 12.1% and 36.2%. The percentage of households where mothers and/or fathers smoked indoors was 37.5%. Multivariate logistic analysis indicated that young age, having a spouse who was a smoker, infants having many siblings, the mother not breast-feeding, and lower annual incomes had significantly higher odds ratios for both the mother's and the father's indoor smoking. Conclusions. Passive smoking is common among Japanese infants. To protect Japanese infants from passive smoking, further public health measures must be taken.

Background. A survey on smoking behavior and relating factors among university students is necessary for establishing antismoking measures toward younger generation. To determine brand preferences of young smokers, we conducted a cross-sectional survey for students in a university. Methods. An anonymous questionnaire was completed by the students at their annual health examinations. A total of 5688 students out of 7136 responded this survey (79.7%). The questionnaire included questions about smoking status, number of cigarettes smoked, brand preference, etc. Results. Smoking prevalence was 55.2% for males and 12.0% for females. Estimated consumption of Japanese-brand cigarettes was 46.8% for males and 36.1% for females, whereas that of American-brand cigarettes was 36.3% for males and 45.1% for females. These values are much higher than the market share of imported cigarettes in Japan (17.1% in 1992). Five American brands ranked in the top 10 brands among these university students, whereas only one American brand was ranked in the top 10 brands in the Japanese market in 1992. Smokers who prefer cigarettes with higher nicotine ratings were more likely to have a higher consumption rate than otherwise. Conclusion. Cigarette brand preference is an important aspect to realize the smoking behavior among young smokers.

Background Despite numerous studies on adolescents' recognition of the medical risks of primary smoke, there have been surprisingly few investigations of how adolescents perceive the risks associated with exposure to secondhand smoke. This study examined whether adolescents' risk estimates when exposed to secondhand smoke differed by: (1) actual smoking experience and (2) adolescents' intentions to smoke in the near future. We also explored whether adolescents perceive different risk depending on who is producing the secondhand smoke. Methods Three hundred and ninety-five 9th graders (mean age = 14.0) completed a survey concerning their perceptions of secondhand smoke, smoking experiences, and intentions. Results On average, adolescents were aware of the serious risks posed by exposure to secondhand smoke. However, adolescents who smoke or intend to smoke were more likely to perceive the risks from exposure to secondhand smoke as lower than did adolescents who had never smoked or had no intentions to smoke. Conclusions The findings from this study suggest that education regarding the risks of secondhand smoke might serve as an additional deterrent against smoking and smoking intentions. Further study using longitudinal data is still needed to fully understand the relationship between such perceptions and smoking behavior.

Background. This paper examines the effectiveness of the “Smoke-Free Class Competition” in delaying the onset of smoking in adolescence. Each participating class must decide if they want to be a “smoke-free class” for the 6-month period from fall to spring. Classes monitor their (non-)smoking behavior and report it to the teacher regularly. Classes in which pupils refrain from smoking for this period of time participate in a prize draw, in which they can win a number of attractive prizes. Methods. To evaluate the effectiveness of the competition, a sample of 131 participating and nonparticipating classes (number of pupils 2,142; mean age 12.9 years, SD 0.98) was compared with regard to their smoking behavior. Smoking status was determined by self-assessment on three occasions: (a) prior to the beginning of the competition, (b) 1 month after the competition, and (c) 1 year after the start of the competition. Results. From pretest to posttest smoking increased by 7.5% in the comparison group, while it decreased by 0.2% in the intervention group (OR 2.19; P < 0.001). In the follow-up measurement, a clear increase in smoking prevalence occurs in all groups; however, the pupils in the intervention condition still have a significant lower increase of smoking (OR 1.45; P < 0.01). Moreover, with regard to the nonsmokers at baseline, pupils in the comparison group showed significantly higher prevalences in smoking than the intervention group in the postmeasurement, 7.8 versus 13.9% (OR 1.98; P < 0.001), as well as in the in the follow-upmeasurement, 17 versus 21.3% (OR 1.36; P < 0.05). Conclusions. The results suggest that the participation in the competition could delay the onset of smoking in adolescence. © 2002 American Health Foundation and Elsevier

The effects of mothers' attitudes and concerns about tobacco use on whether their children take up smoking are largely unknown. This study examined the predictive effects of mothers' attitudes about tobacco and concerns about their children smoking.Self-reported data from a large number of 12th-grade students (2,736) and their mothers were used. Mothers' attitudes and concerns were assessed when their children were 3rd graders (age 8), at the start of the smoking acquisition period; their children were then followed prospectively (with attrition of only 5%) for 9 years to the end of the period (12th grade) for the assessment of smoking behavior.In households in which both parents are nonsmokers, strong maternal antismoking attitudes are associated with a statistically significant approximately 50% reduction (P0.05) in the prevalence of smoking by adolescent children. In contrast, in households in which one or both parents are current smokers, there was no reduction in adolescent smoking associated with mothers' antismoking attitudes.Maternal antismoking attitudes when their children are young predict adolescents' adoption of smoking at 12th grade, but only when parental behavior is consistent with these attitudes.

Background. Current research on the continuum of smoking initiation has largely focused on phases of progressing frequency of smoking. To gain more insight into reasons some adolescents do, and others do not, proceed to advanced levels of smoking behavior, a continuum in which two categories of ex-smoking are proposed is examined. Methods. Standardized scores on psychosocial predictors of smoking among adolescent nonsmoking deciders and quitters were compared cross-sectionally with those of the categories of never smokers, triers, experimenters, and regular smokers (n = 23,317). Results. Never smokers, triers, experimenters, and regular smokers had significantly different characteristics with regard to psychosocial predictors of smoking (P < 0.01), with scores of never smokers indicating that they were least at risk of smoking in the future and those of regular smokers indicating that they were most at risk. Scores of nonsmoking deciders showed that they were less at risk than triers and experimenters and more at risk than never smokers. Quitters seemed to have less risky psychosocial characteristics than experimenters and more risky characteristics than nonsmoking deciders. Conclusions. Studying transitions of smoking behavior based on six possible phases (i.e., never smoking, nonsmoking deciding, trying, experimenting, regular smoking, and quitting) might lead to more valid insights into predictors of adolescent smoking behavior.

Background. The prognosis of patients with estabLished coronary artery improves if smoking is stopped. Still, about half of patients who suffer a myocardial infarction continue smoking after that event. In order to predict to whom additional support should be offered, various baseline characteristics were compared with smoking status at short-term and long-term follow-up. Methods. Demographics, medical history, presence of coronary risk factors, psychological determinants, and the clinical course were recorded in a group of 530 unselected consecutive patients who had been admitted with a myocardial infarction and were smoking. Patients who were smoking at admission, and who were alive at 4-year follow-up, were studied to relate smoking status and baseline characteristics. Results. At 3 months, persistent smokers were younger than quitters, had shorter hospital stays, underwent revascularization procedures less often, smoked more cigarettes per day at baseline, and were more socially isolated. After 4 years, patients who stopped smoking had had a more serious myocardial infarction and had a lower displeasure score than those who continued smoking. Also, quitters received more support from their social environment. Conclusions. Although the majority of the patients try to stop smoking after a myocardial infarction, about half smokes after 4 years. In the future, special support should be offered to smokers who suffer myocardial infarction, especially to those whose psychosocial profiles are less favorable.

Background. In an effort to learn more about the smoking behavior of hospital employees, a study was conducted at the University of Kansas Medical Center (KUMC) regarding tobacco usage and secondhand smoke exposure. Methods. An anonymous voluntary survey was distributed to 4177 full-time employees in Kansas City and Wichita during June and July of 1998. Questions included tobacco usage and exposure to secondhand smoke. The survey results were assimilated in a data base, which was analyzed in a variety of ways to arrive at several conclusive findings. Results. Of the 1187 respondents (28.4%), 35.1% had smoked at least 100 cigarettes in their life (41% of those had at least a 10 pack-year history), and 11.8% currently smoked. The groups with the highest percentage of current smokers were females (12%), blacks (17%), Kansas City campus employees (12%), and nonfaculty (13%). Sixty-seven percent of respondents were exposed to secondhand smoke in the previous week, and 25% were exposed at KUMC. Conclusions. After arriving at the results of this study, recommendations include starting an educational campaign against smoking, promoting cessation programs, moving the current smoking area to a less populated area on campus, and investigating a total campus ban on smoking.

Background. Six specific hypotheses regarding putative mechanisms by which stressful life events might lead to initiation of smoking among adolescents were proposed and tested on a Grade 6 cohort of students in Scarborough, Ontario, Canada. In addition, the data were used to determine the set of risk factors for initiation of smoking most pertinent to the experience of the cohort. Methods. The same relationships were examined for the 1,543 students when they were in Grade 8 and compared to the earlier Grade 6 results. The hypotheses include the effects of personal resources (coping, self-esteem, social support, and mastery), social conformity, rebelliousness, attitudes, smoking environment factors, and gender differences. Results. The hypotheses were not unequivocally supported, except for the hypotheses about attitudes and smoking environment as well as gender effects. Males and females differ with regard to the variables and interrelationships in both years and in the final models developed. In Grade 6, there are more smoking environment items for males than for females. By Grade 8, male smoking is influenced by mastery, social conformity, and rebelliousness, while for females environmental smoking and rebelliousness are important. Conclusion. Male and female students differ in how stress, depression, and smoking are related in the presence of psychosocial factors.

Background.Smoking has become more prevalent among U.S. men and women and European men in lower socioeducational groups. The relation between socioeducational status and smoking among European women has been studied less. Methods.A survey assessing the smoking behavior and educational level of 943 women and 961 men ages 35 to 74 years from Geneva, Switzerland, was conducted. Results.The prevalence of never smokers has declined among younger women but has remained stable among men. More men than women have ever smoked, but the difference has decreased among younger generations. Ever smoking was more prevalent among women with secondary (47.6%, age-adjusted OR 2.03, 95% CI 1.29 to 3.18) or tertiary (46.6%, age-adjusted OR 1.83, 95% CI 1.13 to 2.97) education relative to women with primary education (30.7%). Among males, ever smoking was slightly more prevalent among lower levels of education. There were moderate differences in quit ratio (ex-smokers/ever smokers) across educational levels among women (trendP= 0.08). In contrast, men with tertiary education stopped smoking more often (63.6%) than those with secondary (54.2%) or primary (47.6%) education (trendP= 0.008). For most women, primary education was associated with a later age at start of smoking while the inverse was true for men. Conclusion.Smoking behavior is evolving across generations of women in Geneva. It is more prevalent among educated women of the older generations, but this is less so among the younger generations. Women from Geneva may be currently experiencing the transition of smoking from upper to lower social classes.

Background. The Commit to Quit trial was designed to address the methodological problems of prior studies that have examined the contribution of exercise to smoking cessation. Methods. This paper provides an overview of the study design and describes the sample of women who participated in this trial ( N = 281). Interrelationships among eating, exercise, and smoking behavior are examined. Results. Subjects randomized into the study compared with the sample of women who completed the initial assessment but were not randomized were more likely to be white, to have at least a high school education, and to smoke fewer cigarettes per day. Overall, the most frequent ineligibility criteria were health-related issues and scheduling conflicts. On average, participants in this study smoked more cigarettes per day than national samples of women smokers. Significant interrelationships include the positive association of motivational readiness for quitting smoking and enhanced levels of dietary restraint and the positive association of motivational readiness for exercise adoption and high levels of weight concern. Conclusions. This study represents the first adequately powered randomized controlled clinical trial comparing the relative efficacy of a cognitive-behavioral smoking cessation treatment plus vigorous exercise with the same treatment plus contact control.

Background. National pipe-smoking prevalence data have rarely been reported, and mortality associated with pipe smoking has not been estimated. Methods. We analyzed National Health Interview Survey data from 1965, 1966, 1970, 1987, and 1991 to estimate adult pipe-smoking prevalence in the United States. For each of these years, we estimated pipe smoking-attributable mortality from chronic obstructive pulmonary disease and cancers of the oral cavity, larynx, esophagus, and lung. Results. From 1965 to 1991, the prevalence of current pipe smoking for men declined 12.1 percentage points (from 14.1% to 2.0%) while pipe smoking remained very uncommon among women. By 1991, pipe smoking was a behavior found primarily among men age 45 years or older. Most men who smoked pipes also used other tobacco products, especially cigarettes. About 830 deaths (range 720–2,495) in 1965 and 1,095 deaths (range 655–2,820) in 1991 were attributable to pipe smoking. Conclusions. If current trends continue, pipe smoking will become extremely rare in the United States by the year 2000. Reasons for the decline in pipe smoking may include the lack of appeal of pipe smoking to women and adolescents or the increasingly unfavorable image of smoking behavior in general. Prevention and cessation efforts need to be directed against all forms of tobacco, including smokeless tobacco use, cigar smoking, and pipe smoking.

Background. Some smokers maintain a low daily smoking rate and do not appear to be addicted to nicotine (tobacco "chippers"). In a context of increasing social and environmental constraints on cigarette smoking, it is of interest to determine the population prevalence and the characteristics of low-rate smoking behavior. Methods. A representative population survey was used to determine the prevalence and the correlates of low-rate smoking (five or less cigarettes a day). A range of sociodemographic, contextual, cognitive, and smoking-behavior variables was examined. Results. Of 697 smokers age 20 years and over who had smoked for more than 2 years, 8.2% smoked five or less cigarettes a day; their average age was 39 years, and half were under 35 years of age; 88% had been smoking for 6 or more years; 86% were in the contemplation or preparation stages of readiness to quit. The significant independent predictors of being a low-rate smoker, compared to smoking at a higher daily rate, were perceiving quitting as not very difficult, smoking the first cigarette of the day more than 30 min after waking, buying packets of 30 or less cigarettes, and having not been advised by a doctor to quit. Conclusions. There were few differences between low-rate and other smokers on the range of variables that we were able to assess in a population survey. Since there is no safe level of cigarette smoking, medical advice to quit and public-education campaigns could target low-rate smokers specifically. Such initiatives could make significant contributions to reducing overall smoking prevalence.

Background . Two strategies to resolve the problem of under- or overreporting of tobaccouse among adolescents have been utilized: (a) objective measures for validating self-reports and (b) procedures for improving validity of self-reports, such as the pipeline procedure. The objectives of this article are to investigate the hypothesis that reporting biases may be related to intervention status and to examine what effect such biases would have on interpretation of treatment effects. Method . A two-by-two factorial design was used, with the first factor a pipeline manipulation consisting of pipeline versus control condition, and the second factor treatment status, consisting of treatment versus reference schools. Within each of the schools, half of the 9th-grade classrooms were randomly assigned to a pipeline condition and half served as controls. Analysis was conducted with school as the unit of analysis. Results . The main effect for pipeline condition and the significant interaction between treatment and pipeline conditions were not significant. However, the pipeline manipulation did have an effect on the difference detected between treatment and reference schools; 4.3% difference between treatment and reference schools in the control condition versus 9.9% difference in the pipeline condition, both in the direction of a treatment effect. Using saliva thiocyanate as an objective measure of smoking status suggested differential false negative reporting where students in the reference community falsely claimed to be nonsmokers more frequently than in the treatment community (10.04% versus 5.96%). Conclusions . The reporting bias assessed by the pipeline procedure alone appears to have masked treatment outcome effects. Adjusting the smoking-dependent variable for false negatives seems to have increased the treatment outcome effects even further. This result is contrary to the expectation that the treatment community would experience greater demand pressures to underreport their smoking behavior. Further investigation to address response biases in intervention studies is warranted.

Background. The Oslo Youth Study was designed to demonstrate that health education in schools can result in lowered rates of smoking and alcohol consumption, improved eating patterns, and increased physical activity. The study was conducted from 1979 to 1981 in six schools in Oslo, Norway. This article presents the 10-year follow-up outcomes of the Oslo Youth Study Smoking Prevention Program. Methods. In the fall of 1989, former Oslo Youth Study participants were contacted through the mail and asked to complete a short questionnaire containing questions regarding smoking behavior. A total of 796 subjects participated (participation rate of 74.0%). Results. Overall, there were no significant effects of the Oslo Youth Study Smoking Prevention Program on the onset of experimental smoking (ever having smoked) or regular smoking (weekly smoking). Significant intervention effects were observed, however, among baseline nonsmoking males; intervention students reported 30% less weekly smoking (35% vs 50%) and 25% greater nonsmoking status (58% vs 44%) in 1989 than did males having attended the reference schools. No treatment effects were observed for females. Conclusions. The results suggest that the smoking prevention program might have contributed to reduced long-term onset of smoking among participating male subjects.

Predictors of smoking behavior change were examined in a randomized controlled trial of individualized smoking cessation counseling delivered by a smoking cessation counselor during periodic health examination. Self-reports of not smoking at 6 and 18 months and attempts to quit were greater, but not significantly so, in the intervention group compared with the usual care group. There was no difference between the intervention group and the usual care group in reported continuous abstinence. Multivariate analysis showed that longer periods of abstinence in the past and having smoking identified as the main problem were important predictors of subsequent quitting. Having fewer other smokers in the household, stronger intentions to stop smoking in the next month, and being in the intervention group were also significant predictors of abstinence at 6 months, but not at 18 months. Those who had tried to quit by 6 months and 18 months were more likely to be in the intervention group, to have greater motivation to stop smoking, and to have more problems of daily living. Supplementing physician's advice with individualized smoking cessation counseling during health maintenance examinations was associated with a greater short-term quit rate and more quit attempts over 18 months than physician advice alone, but did not influence continuous abstinence from cigarettes over this time.

The Belgian Heart Disease Prevention Project is a controlled multifactorial prevention trial involving 19,390 men aged 40–59 years, employed by 30 Belgian industries. These industries were paired and randomized into a control or intervention unit. In each intervention factory, the subjects from the two highest deciles of a coronary risk score distribution curve were given semiannual individual advice. Furthermore, a health education campaign was organized in each intervention factory. In the control group, 10% of randomly chosen subjects had the same baseline examination as the whole of the intervention group. After 2 years, high-risk subjects as well as random samples of the control and intervention group were compared regarding smoking behavior. Among the high-risk subjects of the intervention group, 18.7% stopped smoking against 12.2% in the control group (P ⩽ 0.05). The random samples of both the intervention and control groups showed an almost identical quitting rate (12.5 and 12.6%). The drop in the number of cigarettes smoked daily by smokers at 2 years was significantly different when comparing the high-risk subjects of the intervention and control groups: 18.8 and 9.1% (P ⩽ 0.01). In a stepwise discriminant function analysis three baseline factors discriminated significantly between high-risk ex-smokers and smokers of the intervention group at 2 years: number of cigarettes smoked daily at entry, earlier attempts to stop smoking, and geographic location in Belgium. For the control group, two baseline factors discriminated between ex-smokers and smokers at 2 years: study level and earlier attempts to stop smoking.

Smoking-cessation programs at the worksite hold the potential to reduce the national prevalence of smoking. This article presents the 2-year results of a broad-spectrum smoking-cessation initiative that was part of the comprehensive Johnson & Johnson Live for Life wellness program. In a quasi-experimental design, four companies offered the complete Live for Life program to their employees, and three comparison companies offered only annual health screen assessments. Smoking status was assessed by self-report and serum thiocyanate at baseline and at a 2-year follow-up. At the Live for Life companies, 22.6% of all smokers quit versus 17.4% of smokers at the health screen only companies. The Live for Life program was particularly effective with smokers at high risk for coronary heart disease: 32% of all high-risk smokers quit at the Live for Life companies versus 12.9% at the health screen only companies. These results demonstrate that a company-wide smoking-cessation initiative can produce significant changes in smoking behavior.

Hospitals can and should restrict cigarette smoking to promote a healthy environment and to exemplify health promoting behavior. Questionnaires to determine policies and programs relating to smoking were sent to the administrative heads of 360 randomly selected hospitals across the nation. Returns were received from 330 hospitals for a response rate of 91.7%. Only 1.2% of the hospitals surveyed totally banned smoking. Visitors, patients who smoked, and physicians were seen as most resistant to smoking restrictions. The majority of hospitals (56.0%) continued to sell cigarettes on the premises. States whose economies are involved with tobacco are more permissive than the others to a significant degree. Since the hospital administration is the primary force in implementing smoking policy, the smoking behavior of the administrator may affect institutional smoking policies. It does affect their attitude about hospital employee smoking and the health professional's responsibility about smoking to a significant degree. Thus, hospitals are not demonstrating leadership in creating safe nonsmoking environments for the patients, nor in offering smoking education programs to the community.