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Introduction: Few studies have examined the transitions of smokers in the general population through multiple periods of daily, occasional smoking, or abstinence over time. Transitions from daily to occasional smoking are particularly of interest as these may be steps toward cessation., Methods: The Ontario Tobacco Survey panel study followed 4,355 baseline smokers, semiannually for up to 3 years. Probabilities of all possible changes in smoking status more than 6 months were estimated using 13,000 repeated measures observations generated from sets of 3 consecutive interviews (n = 9,932 daily smokers, 1,245 occasion smokers, and 1,823 abstinent for at least 30 days, at Time 1)., Results: For initial daily smokers, an estimated 83% remained daily smokers more than 2 follow-ups. The majority of those who had been abstinent for 30 days at 1 interview, were also former smokers at the following interview. In contrast, occasional smoking status was unstable and future smoking status was dependent upon smoking history and subjective dependence. Among daily smokers who became occasional smokers 6 months later, an estimated 20% became a former smoker, at the next interview, but 50% returned to daily smoking. Daily, turned occasional smokers who rebounded back to daily smoking were more likely to describe themselves as addicted at Time 1. Continuing occasional smokers were somewhat less likely to intend to quit, or have tried, despite considering themselves less addicted., Conclusions: Reducing to occasional smoking can be a stepping stone toward cessation but entails a greater risk of return to daily smoking, compared with complete abstinence.

We examined young adult smoking cessation behaviors, coding cessation behavior as no attempt, quit attempt (< 30 days), or abstinence (≥ 30 days) during follow-up from July 2005 through December 2008, observed in 592 young adult smokers from the Ontario Tobacco Survey. One in 4 young adults made an attempt; 14% obtained 30-day abstinence. Cessation resources, prior attempts, and intention predicted quit attempts, whereas high self-efficacy, using resources, having support, and low addiction predicted abstinence, indicating that young adult smokers require effective and appropriate cessation resources.

We examined income source and match between recommended and received care among users of community mental health services. We conducted a secondary analysis of needs-based planning data on adults in Ontario community mental health programs from 2000 to 2002. The outcome was whether clients were severely underserved (yes/no) based on the match between level of care recommended and received. A logistic regression model investigated if income source predicted this outcome. 13% of clients were severely underserved. Over 40% were on public assistance and they had a higher risk of being severely undeserved than the others. Men were at greater risk. One aim of mental health reform is to increase access to care for vulnerable individuals. The finding that among users of community mental health services, individuals with public assistance income support are most vulnerable to being severely underserved should be considered by service planners and providers.

Aims: This study explores differences in psychosocial, behavioral and clinical characteristics among smoking and non-smoking individuals with diabetes attending diabetes education centers (DEC)., Methods: A questionnaire was administered to 275 individuals with type 2 diabetes attending two DECs between October 2003 and 2005. The participants' characteristics were analyzed and multivariable linear and ordinal regressions were performed to adjust for variables correlated with smoking., Results: Findings revealed that smokers, compared to non-smokers, had lower outcome expectations of the benefits of self-management, lower diastolic blood pressure, and followed their recommended diet and tested blood glucose levels less often than non-smokers. Smokers also had lower intentions to use resources outside and within the DEC., Conclusions: Results demonstrate poorer self-care behaviors among smokers compared to non-smokers and further suggest cognitive and behavioral differences between smokers and non-smokers regarding participation and attitudes toward self-management practices. These findings identify issues that need to be addressed in diabetes self-management programs to allow for more effective interventions tailored to the healthcare needs of this specific population., (Copyright © 2011 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Objectives: Blue-collar workers are a recognised priority for tobacco control. Construction workers have very high smoking rates and are difficult to study and reach with interventions promoting smoke-free workplaces and cessation. The objectives of this study were to explore the smoking-related social climate in the North American residential construction sector and to identify potential barriers and facilitators to creating smoke-free worksites., Methods: The data source used was a popular internet forum on home building. Participants included a broad and unselected population of employers, employees and freelance tradespersons working in residential construction. The forum archive contained 10 years of discourse on the subjects of smoking, workplace secondhand smoke and smoking restrictions on construction sites. Qualitative data analysis methods were used to describe major and minor discussion themes relevant to workplace smoking culture and policies in this sector., Results: Participants described considerable tension between smoking and non-smoking tradespersons, but there was also much interpersonal support for cessation and support for non-smokers' rights. Employers and employees described efforts to make construction sites smoke free, and a movement towards preferential hiring of non-smoking tradespersons was discussed. Board participants wanted detailed scientific evidence on secondhand smoke exposure levels and risk thresholds, particularly in open-air workplaces., Conclusions: Experience with success of smoking bans in other challenging workplaces can be applied to the construction sector. Potential movement of smokers out of the workforce represents a challenge for public health systems to ensure equitable access to cessation supports and services.

Many studies have evaluated the impact of indoor smoking bans on secondhand smoke (SHS) exposure. No studies have assessed the impact of a smoking ban on SHS in enclosed areas outside separately ventilated, designated smoking rooms (DSRs). This study evaluated the overall impact of the Smoke-Free Ontario Act implemented May 31, 2006, on SHS in bars and coffee shops and the impact of banning DSRs on SHS outside DSRs. Air particulate matter (PM) and carcinogenic particulate polycyclic aromatic hydrocarbons (PPAH) were measured in May 2006 before the ban inside and outside DSRs in Toronto venues (13 coffee shops and 14 bars) that allowed smoking only in DSRs, and in Windsor venues (10 coffee shops and 10 bars) where smoking was allowed in shared spaces. Measurements were repeated 2 months post-ban. Air quality index values (AQIs) were calculated. Mixed model analysis was applied, taking into account measurement errors for repeated measures. Post ban, mean PM and PPAH levels were reduced by 87% (from 494 to 67 mm(2)/m(3)) and 94% (from 196 to 11 ng/m(3)), respectively, inside Toronto DSRs. Mean PM and PPAH levels were reduced by 10% (from 124 to 111 mm(2)/m(3)) and 46% (from 45 to 24 ng/m(3)), respectively, outside Toronto DSRs. In all Windsor venues, mean PM and PPAH levels were reduced by 83% (from 488 to 81 mm(2)/m(3)) and 90% (from 107 to 10 ng/m(3)), respectively. All reductions were statistically significant (p < 0.0001). In Toronto venues, the AQI was reduced from the "very unhealthy" range inside DSRs and the "moderate" range outside Toronto DSRs to the "good" range, and in Windsor venues from the "unhealthy for sensitive groups" range to the "good" range post-ban. Pre-ban PPAH levels including those outside Toronto DSRs may be associated with cardiovascular injury. DSRs did not provide adequate protection from SHS. The Smoke-Free Ontario Act produced a significant and firm reduction in SHS exposure in venues both with and without DSRs.

Objective: To test the effects of the volume of alcohol consumption and drinking patterns on alcohol-related aggression and victimization, both at the individual and class levels., Methods: Representative sample drawn from the European School Survey Project on Alcohol and Other Drugs (ESPAD) of 6496 Swiss adolescents (13 to 16 years). Hierarchical multi-level models were used to simultaneously estimate individual and environmental influences. In addition to indicators of consumption of alcohol and other substances, age, sex, socioeconomic indicators and satisfaction with the relationship to parents were used as covariates., Results: After controlling for confounding, both volume of alcohol consumption and the frequency of binge drinking occasions were associated independently with alcohol-related problems (aggression/victimization) on the individual level. On the aggregate level, there was colinearity between volume of drinking and frequency of heavy drinking occasions. When entered in the same model, however, only the effect of volume effect stayed in the same direction., Conclusions: Not only individual volume of drinking, but also the way alcohol is consumed influences individual problem levels. This includes individual patterns of drinking as well as environmental influences at school. These results open up important considerations for theory, research and prevention.