Search

Research has demonstrated that a lapse in cigarette abstinence often leads smokers to fully relapse (i.e., return to daily smoking). However, patterns of smoking resumption beyond the point at which relapse occurs have not been examined in systematic follow-up studies. Daily cigarette intake data for 108 female adult smokers who participated in a smoking cessation trial were recorded at several points during the 365 days following the participants' quit date. SAS Proc Traj, a group-based mixture modeling procedure, was used to determine cigarette-use trajectories over time (i.e., patterns of smoking resumption). Over the 365 days, 27% of the sample maintained abstinence. Among the 73% who relapsed, four distinct trajectories emerged: low-level users (8% of the overall sample), moderate users (17%), slow-returners (15%), and quick-returners (33%). A few individual characteristics differentiated these groups. Overall, the findings illustrate that, after relapsing, smokers do not follow a unitary course of smoking resumption; rather, they exhibit more variable resumption patterns than previously assumed.

This study investigated longitudinally the extent to which childhood friends who smoke influence adolescents' smoking transitions, and compared that influence with that of parents who smoke. In a sample of 4744 children, results showed that the probability, per close friend, that a smoking close friend influenced the adolescent to make the first transition to trying smoking was 38% (95% CI: 28%, 46%); to make the second transition from trying to monthly smoking, 10% (95% CI: 5%, 15%); and to make the third transition from monthly to daily smoking, 11% (95% CI: 5%, 17%). Compared to parents' smoking, close friends' smoking was 12% (p=0.03) more influential for the first transition, no different for the second transition (p=0.53), and 16% (p=0.01) less influential for the third transition. Results provide new evidence suggesting that childhood close friends who smoke influence not only initiation but also escalation of adolescents' smoking. Results also confirmed the important role of parents' smoking. Targeting both childhood close friends' and parents' smoking would be valuable in prevention research.

The aim of the study was to analyse predictors of the body mass index (BMI) after smoking cessation. The sample included 4075 residents aged 18-64 years in a northern German area (participation rate 70.2%), drawn randomly from the resident registration files, among them 1545 current and 903 former daily smokers. The current smokers were followed up 36 months after baseline. Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) including questions about body weight and height at baseline and postal questionnaires at follow-up were employed. The data reveal that the number of cigarettes smoked at time of peak consumption in life contributed substantially, and years of abstinence from daily smoking contributed marginally to the BMI in a general linear model. It is concluded that the contribution of smoking cessation to the BMI increase was practically negligible. Efforts to prevent weight gain after smoking cessation should focus especially on heavy smoking.

Background. Research has shown that social images or prototypes of smoking peers play a role in adolescents' decisions to start smoking. To devise effective prevention measures, specific information is needed about how adolescents evaluate characteristics associated with smoker prototypes. Such evaluation is assumed to occur through self-comparison processes, that is, ‘self-consistency’ and ‘self-enhancement’ motivations. This is one of the first studies to examine longitudinal relations between both these motivational processes and smoking behavior. Methods. Self-reported data on motivational processes and smoking were gathered at two waves (with a 1-year interval) among Dutch adolescents (12–16 years). Relations between self-comparison processes and willingness to smoke or future smoking behavior were tested among a sample of 1938 respondents. Results. Smoker prototypes predicted adolescents' smoking onset, particularly those images that referred to daily smoking peers as being “cool” or “rebellious.” Furthermore, self-consistency and self-enhancement motivations predicted smoking onset for certain characteristics associated with smoker prototypes. Conclusion. Evidence for the role of self-consistency and self-enhancement motivations in adolescents' smoking onset suggests that smoking prevention projects should target both similar and aspiring features associated with the image of smoking peers.

ResumenObjetivoEstudiar la asociación de los factores cognitivos del modelo de cambio conductual Attitude Self-Efficacy (ASE) a las diferentes fases de inicio del consumo de tabaco en adolescentes.MétodoSe realizó un estudio transversal (durante el año 2000) en el que se encuestó al alumnado de 2.° de Educación Secundaria Obligatoria (13-14 años de edad) de los institutos de educación secundaria públicos de Cornellà de Llobregat (Barcelona) sobre las actitudes y el consumo de tabaco. Se realizó un análisis de regresión logística para identificar las variables asociadas con cada estado del consumo de tabaco (odds ratio [OR] de experimentadores frente a no fumadores y de fumadores frente a experimentadores).ResultadosLa prevalencia del consumo diario de tabaco fue del 22,9% (intervalo de confianza [IC] del 95%, 16,5-29,3) en los chicos y del 36,2% (IC del 95%, 29,7-42,6) en las chicas. Los determinantes de la experimentación (frente a no fumar) fueron las actitudes hacia el tabaco –desacuerdo con los espacios sin humo (OR=3,46; IC del 95%, 1,65-7,24) y acuerdo con la promoción del tabaco (OR=3,42; IC del 95%, 1,42-8,28)– y la norma subjetiva (amigos percibidos como fumadores: OR=2,50; IC del 95%, 1,17-5,35). Los factores asociados con el consumo regular de tabaco (frente a experimentar) fueron de autoeficacia y actitudinales.ConclusionesParece indicado trabajar los determinantes de norma subjetiva y las actitudes hacia el tabaco en programas dirigidos a edades más tempranas, ya que están más asociados con el paso de no fumador a experimentador, e insistir más tarde en las habilidades para el rechazo de tabaco ofrecido por amigos que cobró importancia en la fase de experimentador a fumador.AbstractObjectiveTo study the association between cognitive factors of the behavioral change model «Attitude Self Efficacy» (ASE) at different phases of smoking initiation among adolescents.MethodsWe carried out a cross-sectional survey among students in the second grade of Compulsory Secondary Education (13-14 years old) from Cornellà de Llobregat (Barcelona, Spain) in 2000 to obtain information on cognitive factors and smoking. Logistic regression analysis was used to investigate the variables associated with smoking (odds ratio [OR] of experimenters vs. non-smokers and of smokers vs. experimenters).ResultsThe prevalence of daily smoking was 22.9% (95% CI, 16.5%-29.3%) among boys and 36.2% (95% CI, 29.7%-42.6%) among girls. Factors associated with experimenting (vs. non-smoking) were: attitudes to smoking (disagreement with smoke-free areas [OR=3.46; 95% CI, 1.65-7.24], agreement with smoking promotion [OR=3.42; 95% CI, 1.42-8.28]), and subjective norms (perceiving friends as smokers [OR=2.50; 95% CI, 1.17-5.35]). The variables associated with regular smoking (vs experimenting) belong to: self-efficacy and attitudes to smoking.ConclusionsFocussing on subjective norms and smoking attitudes with programs targetted younger ages seems appropriate, since these factors are more closely associated with the experimenting phase. Encouraging skills to refuse cigarettes offered by friends is appropriate at a more advanced age, since this determinant is associated with the change from experimenting to regular smoking.

Aims To compare low-rate daily smokers (one to five cigarettes/day) with other daily smokers, using the Transtheoretical Model of Change as a framework. Design Mail survey with a follow-up after 7 months. Setting A randomly selected population sample in French-speaking Switzerland, in 1998. Participants A total of 2338 daily smokers aged 25 + years, including 95 smokers of one to five cigarettes/day, 324 smokers of six to 10 cigarettes/day, 399 smokers of 11–15 cigarettes/day and 1520 smokers of 16 + cigarettes/day, and 1765 people (75% of 2338) at 7-month follow-up. Findings Compared with smokers of 16 + cigarettes/day, low-rate smokers of one to five cigarettes/day included more women (67% versus 46%, P

Objective Even though many young addicted smokers profess a desire to quit, majority of them are unsuccessful in their attempts. A major goal was to determine whether successful quitters are better equipped cognitively and behaviorally to deal with the adverse effects associated with the cessation process than unsuccessful quitters, because they possess a larger repertoire of learned resourcefulness skills. Method Undergraduate university students, consisting of 69 never-smokers, 59 successful quitters and 61 unsuccessful quitters, completed Rosenbaum's (1980) Self-Control Schedule assessing one's general repertoire of learned resourcefulness skills. Daily smoking rate, age started smoking, years smoking, quit attempts, difficulty quitting, quitting importance, motivation, self-efficacy and use of smoking self-regulatory strategies also were compared for the smoking groups. Results Never-smokers and successful quitters were significantly more resourceful than unsuccessful quitters. Even though both smoking groups smoked the same daily rate and started smoking at the same age, unsuccessful quitters in comparison to successful quitters viewed quitting smoking as less important and as more difficult, were more extrinsically motivated to quit, less efficacious, and used fewer self-regulatory strategies during their quit attempts. Discussion The discussion highlights the prominent role that SCS scores, self-efficacy and especially perceived quitting difficulty play in the smoking cessation process. Conclusions and practical implications Low resourceful smokers having difficulty quitting may find workshops on general life skills beneficial. Concurrently providing them with specific smoking cessation strategies may further serve to enhance these smokers’ self-efficacy.

Background: The aim of the study was to investigate the changes in smoking habits among physicians in Finland between 1990 and 2001. Methods: Three independent cross-sectional surveys using a self-administered questionnaire regarding smoking behaviour as well as knowledge, skills and attitudes in smoking were carried out by mail among physicians in Finland in 1990, 1995 and 2001. Results: The prevalence of daily smoking decreased in both men and women between 1990 and 1995, but did not decrease any further between 1995 and 2001. In 2001, 7% of male and 4% of female physicians reported smoking daily. Daily smoking was highest (8–12%) among male physicians in the oldest age group. Occasional smoking was more prevalent at a younger age (22–24% in males and 7–10% in females). Conclusion: Smoking prevalence among physicians in Finland is relatively low and has not changed since 1995. A further reduction in daily and occasional smoking requires a different, specially adjusted and physician-targeted approach. Received 17 April 2002. Accepted 15 January 2003.

Background. No study to date in Syria has documented the smoking and quitting characteristics in a representative sample of university students, and this study aims to fill this void. Design. In 2003, a cross-sectional survey was carried out among students at Aleppo University using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 ± 2.1 years; response rate, 98.8%). Experiences and attitudes related to smoking and quitting were assessed for two popular forms of tobacco use in Syria-cigarettes and narghile (waterpipe). Results. Current cigarette smoking was reported by 30.9% of male and 7.4% of female students and daily smoking by 24.8% of male and 5.2% of female students. Narghile smoking was seen among 25.5% of men and 4.9% of women, mostly on an occasional basis. More than half of current smokers (56%) believed they could quit cigarettes, 75.2% were interested in quitting, and 78% of those had made a quit attempt in the past year. Important correlates of cigarette smoking among students were being older, male, and smoking narghile, while being older and from a poorer family were associated with increased interest in quitting. Interestingly, peers' smoking was associated with current smoking among students, but inversely with their willingness to quit. Conclusions. Cigarette smoking is mainly a problem of male students, whose narghile smoking is likely to be dramatically increasing as well, sometimes practiced as a substitute for cigarettes. The findings that most smokers in this sample are interested in quitting smoking and have tried unsuccessfully to do so indicate that cessation support for youths in this country is urgently needed.

Prior research on smoking in the criminal justice system has focused on men. This study examines smoking behavior among female arrestees in New York City (NYC). The sample includes 836 women interviewed as part of the Drug Use Forecasting (DUF) Program. Questionnaire items analyzed here include the use of licit and illicit substances, current pregnancy, childbearing history, demographics, age at smoking initiation, daily smoking, dependency on tobacco, and quit attempts. Bivariate techniques and logistic regression analyses were used. Fully 71% of all women and 64% of pregnant women were daily smokers. Recent cocaine or heroin users were the most likely to be daily smokers (84% and 92%). Among daily smokers, nearly a third had ever tried to cut down or quit. In the regressions, Latinas were more likely to have tried to quit; recent heroin users and women who had ever felt dependent on tobacco were the least likely to have tried. The authors strongly recommend that female inmates are prime candidates for smoking cessation counseling.

Objective: To evaluate the effects of the 1977 and 1995 tobacco sales bans on tobacco acquisition of minors. Design: Biennial nationwide postal surveys (adolescent health and lifestyle survey, AHLS) in 1977–2003; annual classroom surveys (school health promotion survey, SHPS) in 1996–2003. Setting and participants: Entire Finland—12, 14, 16, and 18 year olds (AHLS, n = 80 282); eighth and ninth graders (14–16 year olds) (SHPS, n = 226 681). Main outcome measures: Purchase of tobacco from commercial sources during the past month, purchase from different commercial (shop, kiosk, other outlet) and social sources, ease of buying tobacco, overall acquisition of tobacco products, daily smoking, tobacco experimenting. Results: Decrease in tobacco purchase from commercial sources was small and short term after 1977 but large and permanent after 1995: purchase rate among 14 year old smokers diminished from 90% to 67% in 2003, 16 year olds from 94% to 62%. Purchases in shops decreased most (14 year olds: from 39% to 14%; 16 year olds: from 76% to 27%); purchases in kiosks less. An increase was observed in obtaining tobacco from other outlets and friends (social sources). Only 2–3% of 14–16 year old smokers used commercial sources exclusively when obtaining tobacco. Daily smoking began to decrease after 2001, following an earlier decrease in those experimenting. No changes were observed among age groups not targeted by the ban. Conclusions: Legislation appears to have permanently changed tobacco sales practices and decreased purchases from commercial sources. Social sources need to be taken into account when controlling access to tobacco. Sales bans should be accompanied by other health promotion measures.

Objective: To investigate the associations between psychosocial conditions at work, social capital/social participation, and daily smoking. Design/setting/participants/measurements: The 2000 public health survey in Scania is a cross sectional postal questionnaire study with a 59% participation rate. A total of 5180 persons aged 18–64 years that belonged to the work force and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work/unemployment, social participation, and daily smoking. Psychosocial conditions at work were defined according to the Karasek-Theorell demand–control/decision latitudes into relaxed, active, passive, and jobstrain categories. The multivariate analyses included age, country of origin, education and economic stress. Results: 17.2% proportion of all men and 21.9% of all women were daily smokers. The jobstrain (high demands/low control) and unemployed categories had significantly higher odds ratios of daily smoking among both men and women compared to the relaxed (low demands/high control) reference category. The passive (low demands/low control), jobstrain, and unemployed categories were also significantly associated with low social participation. Low social participation was significantly and positively associated with daily smoking within each of the psychosocial work conditions and unemployed categories. Conclusions: The positive association between low social capital/low social participation and daily smoking is well known. However, both social participation and daily smoking are associated with psychosocial work conditions and unemployment. Psychosocial work conditions and unemployment may affect daily smoking both directly and through a pathway including social participation.

Purpose To explore the hypothesis that older siblings' smoking, after controlling for parents' smoking, influences children's smoking. Methods Study participants were 2981 students in the control cohort of a school-based smoking prevention randomized trial for whom parents' smoking and older siblings' smoking data were collected at 3rd grade and daily smoking data was assessed 9 years later through a self-report questionnaire at the 12th grade. Data were analyzed using conditional logistic regression and likelihood ratio tests. Results For families in which no parent smoked, the 12th grade prevalence of daily smoking was 31% when at least one older sibling smoked compared to 18% when no older sibling smoked. For families in which at least one parent smoked, the 12th grade prevalence of daily smoking was 41% when at least one older sibling smoked compared to 29% when no older sibling smoked. There was a substantial increase in the odds (OR = 1.60, p = .004) of children's daily smoking at 12th grade when their older siblings smoked, even after adjusting for parents' smoking. Conclusions Older siblings' smoking is associated with increased risk of children's smoking after adjusting for parents smoking. Furthermore, there was no evidence to suggest that the influence of older siblings' smoking was different in families where no parent smoked compared to those where at least one parent smoked. Also, there was no evidence that the influence of older siblings' smoking was different in boys vs. girls.

In 1977 a survey of Victorian dentists measured their smoking prevalence, and their attitudes to dealing with patients who smoked. In 1993 these questions were repeated as part of a telephone survey of Victorian dentists. From 1977 to 1993 their prevalence of daily smoking had dropped from 30 per cent to 6 per cent, and this was not attributable simply to an influx of younger dentists who had never smoked. Many of those who had graduated in 1977 or more recently had never smoked, but many of the earlier graduates had quit, and there was no difference in the current smoking prevalence of the two groups. There had also been a change in dentists' attitudes towards smoking patients, with more of the 1993 sample (55 per cent) than the 1977 sample (43 per cent) agreeing with the statement 'I encourage all my patients to give up smoking wherever possible'. Again, the more experienced dentists were adopting the new behaviours, not just the more recent graduates. Even so, in 1993 nearly half the dentists waited until the patient either was affected by smoking, or asked for advice before raising the issue.

Objective: The purpose of this study was to examine alcohol use, alcohol-related problems, other risk-taking behaviors, and parental monitoring in adolescents who tested positive for alcohol in an emergency department. Study design: A matched case-control design was implemented for adolescents presenting to a pediatric emergency department who were screened for alcohol use. An alcohol-positive sample (N = 150) was compared with a matched alcohol-negative sample (N = 150) for alcohol use, alcohol problems, depression, smoking, risk-taking behavior, and parental monitoring. Results: The alcohol-positive group reported significantly higher drinking frequency, drinking problems, prior alcohol-related injuries, and episodes of driving after drinking and riding with a drinking driver than the alcohol-negative adolescents. The same pattern was true for depressed mood, reckless behaviors, poor grades in school, and daily smoking. The parents of alcohol-positive teens reported their teens had come home intoxicated more often than parents of alcohol-negative teens. There were no differences between parent groups in monitoring of teens. Conclusion: Adolescents who test positive for alcohol in an emergency department are a high-risk group who meet the criteria for indicated prevention. Screening for alcohol abuse is recommended. (J Pediatr 2001;139:694–9)

Objective: Based on the survey of the knowledge-attitude-belief and practice to tobacco control between Chinese and foreign medical students in Soochow University, the authors intended to explore the current situation, differences and influencing factors of Chinese and foreign medical students, in order to provide a reference for tobacco control policies and measures set by the Medical College of Soochow University. Methods: By stratified sampling, we selected 200 Chinese medical students and 200 foreign medical students of Medical College in different grades and different majors, and adopted anonymous questionnaires to investigate. Results: The smoking rates of Chinese and foreign male medical students were 7.4%, 15.5% respectively , while female medical students' smoking rates were 0.0, 8.1% respectively. Foreign medical students’ daily smoking was mostly 4~10, which was significantly greater than the Chinese medical students （PConclusion: There is a need for schools to adopt health education measure to promote the school tobacco control based on the differences of the knowledge-attitude-belief and practice to tobacco control between Chinese and Foreign Medical students. Help medical students to translate knowledge of tobacco control they have already mastered into belief, and further affect their behavior.

Background: Effective smoking cessation campaigns require as baseline, precise estimations of smoking habits in different populations. Aim: To assess the prevalence of smoking in academic, non-academics workers and student of the University of Concepción. Material and methods: In a random and stratified sample of 272 workers (including academics) and 1146 students, a previously validated, self administered questionnaire about smoking was applied. Daily smoking was defined as smoking seven or more cigarettes per week and occasional smoking as smoking less than seven cigarettes per week. Results: The prevalence of smoking was 23% among academics, 34% among non-academic workers and 44% among students. Nineteen percent of men and 16% of women were occasional smokers; 23% of men and 25% of women were daily smokers. Students started smoking at 15 ± 2 years old and workers did so at 18 ± 3 years old. The grater influence about smoking came from parents. Workers from the administrative services and from the natural sciences faculty had the higher prevalence of the habit. The total annual cost of smoking was $33,000,000 (US$62,000). Conclusions: The prevalence of smoking at the University of Concepción is higher among students than workers. Quitting programs are urgently needed (Rev Méd Chile 2000; 128: 977-84).

Five thousand parents of children born in 1992 in Denmark, Finland, Iceland, Norway and Sweden were asked about their smoking behaviour while indoors with their children. The prevalence of daily smoking was 20% among fathers, 15% among married or cohabiting mothers and 47% among single mothers. Both parents reported smoking daily in 7% of the households, while one parent smoked in 22% of the households. The prevalence of smoking varied with social group. Rules to limit smoking indoors had been introduced in 75% of the households, and 82% of the current smokers had tried to change their smoking habits for the sake of their children. Of the parents who had smoked at the beginning of the pregnancy, 77% reported having changed their habits during the pregnancy, but the changes were far less pronounced among expecting fathers than among expecting mothers. In 25% of the households, children were exposed to environmental tobacco smoke at home during the week. In households where at least one parent smoked, 57% reported that children were present when someone smoked.

A ‘Quit and Win’ contest strategy was implemented as a method to assist smokers to stop smoking. This method was developed in the United States at the beginning of the 1980s in three programmes for prevention of cardiovascular disease in the population. It was first introduced in Europe in 1986 in the North Karelia Project in Finland (Tillgren, 1995). The basis for this population-directed model is that most tobacco users wish to quit, and the use of a contest involving attractive prizes has been shown to be an effective method for stimulating and supporting tobacco users to quit. Quit and Win contests have been held in Sweden both nationally and locally since 1988.

An experimental smoking cessation programme for youngsters was implemented when a number of students requested assistance to stop smoking in a smoking prevention programme by peer counsellors, prepared by the school staff in collaboration with the Israel Cancer Association. In Israel, 28% of the adult population smokes, representing 32% of the male population and 25% of the female population. The highest rate of smoking is among people aged 25–44. People with a higher level of education smoke less than those with a lower level of education. The rate of daily smoking among youngsters aged 16–17 is 11% for boys and 10% for girls. More than 25% of students aged 12–17 have tried smoking at least once.

A coalition called ‘Tobacco-free’ was established between The Norwegian Cancer Society, The Norwegian Medical Association, The Norwegian Confederation of Sport, The Norwegian Association against Tobacco, The Norwegian National Health Association, The Norwegian Asthma and Allergy Association and The Norwegian Coordinating Board of Health Education, which prepared an action plan for a tobacco- free Norway 1994–98 (Sanner et al., 1993). This was presented to the Norwegian Minister of Health on 15 November 1993.

Tobacco smoking is steadily declining in Scandinavia, but just under four million people in the Nordic countries are still stuck in the habit of daily smoking, which causes sickness and suffering and takes years from their lives at great cost to the smokers themselves, to their employers and to society at large. Acceptance of exposure to second-hand smoke is increasingly on the wane and the number of smoke-free environments has increased since the successful introduction of mandatory smoke-free workplaces and restaurants in Scandinavia. The global tobacco industry realises that the end is near for the traditional cigarette, especially in the Western world. In order to keep their old customers and recruit new ones to nicotine addiction, a steadily growing number of cigarette manufacturers supplement their arsenals with various smoke-free products, including Scandinavian-type oral moist snuff (snus). The development of snus products for women and other specific target groups is a clear trend. There exists in Sweden and Norway a particular Swedish variety of oral moist snuff that is banned in the other European Union (EU) countries. Despite the increasingly more intensive product development and marketing and the mandatory smoke-free environments, daily use of snus has decreased among Swedish men from 22% in 2004 to 19% in 2007. Among women, there is a slight increase, from 3% to 4%. In Norway, snus consumption among men has been greatly on the rise over …

OBJECTIVES: This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS: Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS: Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS: If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.

Because smokers die, on average, a decade younger than nonsmokers, and smoking kills between one third and one half of those who start,1 it is important that all physicians become cognizant of the hazards related to the early onset of smoking. When one of us (Dr Richmond) assumed the post of Surgeon General in 1977, it was accepted that addiction to nicotine was caused by years of daily smoking. It was assumed that anyone who experienced nicotine withdrawal had to smoke at least 5 times per day to keep it in abeyance. Given this, it was assumed that addiction did not begin until a person smoked 5 cigarettes daily, and anyone smoking less than this did not experience withdrawal and was not addicted.2 Because novice smokers typically take 2 to 3 years to reach 5 daily cigarettes,3 it was assumed that prolonged regular daily smoking was a prerequisite for dependence. Through the end of the century, the onset of dependence was envisioned as a creeping, protracted, erosion-like process, the product of tens of thousands of doses of nicotine.4 It was intriguing, therefore, when 1 of our … Address correspondence to Joseph R. DiFranza, MD, University of Massachusetts Medical School, Department of Family Medicine and Community Health, 55 Lake Ave, Worcester, MA 01655. E-mail: difranzj{at}ummhc.org

Estimations of the prevalence of daily smoking of cigarettes by men and women on a college campus were obtained from 775 college students. Estimations greatly exceeded the percent of students who personally reported smoking cigarettes daily.

This study is a report on the data of psychological nicotine dependence among Norwegian daily smokers. Nicotine dependence was higher among smokers smoking hand-rolled cigarettes than smokers smoking manufactured cigarettes in spite of the fact that the average number of cigarettes smoked per day was the same for both groups. The dependence also increased as the starting age of daily smoking decreased. Nicotine dependence was higher among daily smokers of low education compared to smokers of higher eductaion. This was explained by a difference in the proprotion of smokers of hand-rolled cigarettes in the two groups. The data are discussed in light of Norwegian research showing that hand-rolled cigarettes can contain two to three times as much nicotine and tar as manufactured cigarettes. The differences in dependence levels among smokers of hand-rolled and manufactured cigarettes suggest that the smokers are also exposed to different amounts of other harmful substances present in tobacco. Moreover, smokers of hand-rolled cigarettes were less motivated to quit, which implies that these smokers are exposed to greater health damage compared to smokers of manufactured cigarettes. These findings are discussed with regard to Norwegian taxing policy, which appears to encourage the consumer to smoke the more harmful product. Furthermore, the research findings are discussed in light of the fact that Norway has neither set a maximum limit of poisonous substances in rolling tobacco nor required that packs of rolling tobacco be labeled with a declaration of contents.

SUMMARY Teaching about tobacco and related diseases is essential in the undergraduate medical course in order for students to gain knowledge about smoking and how to intervene with patients who smoke. The objective of the study was to assess students'smoking-related behaviour, knowledge and attitudes towards tobacco, and perceptions of their future role as doctors. Data were collected from two consecutive years of year 1 and year 5 medical students at the University of New South Wales, Sydney. A total of 594 (79%) of students across the 2 years completed the survey: 90% of year 1 students, and 69% of year 5 students. The daily smoking rate among the total medical students was 2.9%: 11.8% in year 1 (2.3% daily, 9.5% occasional) and 13.7% in year 5 (3.3% daily, 10.4% occasional). There were significantly more male than female smokers in year 5 (P < 0.05). The overall smoking rates for males in years 1 and 5 were 12.4% and 19.3%, and the smoking rates for females were 11.2% and 8%. Knowledge about the causal role of tobacco in the development of specific diseases improved significantly from year 1 to year 5 (P < 0.001). Nevertheless, in year 5 there remained a lack of knowledge about the relationship of smoking and some diseases. Fifty-seven per cent of students thought that their current knowledge was sufficient to counsel smokers, with year 5 students (89%) being far more positive than year 1 students (34%) (P < 0.001). Teaching medical students about smoking-related diseases and a patient-centred smoking cessation intervention results in an increase in knowledge, as well as positive perceptions about their future role in intervening with smokers.

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 revealed that smoking is the third largest risk factor for death globally and is responsible for over 6 million deaths in 2010. The complex epidemiology of tobacco, with major health effects only appearing several decades after the peak in smoking prevalence and consumption, emphasises the importance of understanding changes in exposure levels for public policy. Methods To develop a full-time series of daily smoking prevalence from 1980 to 2010, we compiled a database of all available surveys on population-level tobacco use prevalence. Frequency of use and type of tobacco consumed were then mapped to a consistent definition of daily tobacco smokers using linear regression. A two-stage approach of spatiotemporal modelling and Gaussian process regression were employed to generate estimates of daily tobacco smoking prevalence in each country over time. Estimates were generated by 5-year age groups for each sex. Findings Preliminary analysis revealed that, globally, daily tobacco smoking prevalence dropped among males from 38·1% (95% CI 37·3–40·9) in 1980, to 26·6% (25·2–28·2) in 2010, while females also experienced a notable decrease, from 11·8% (11·0–12·8) to 5·4% (5·0–5·8). For males in 2010, countries with high age-standardised prevalence rates were concentrated in eastern Europe, including Armenia (41·9%, 37·7–46·4), Latvia (38·7%, 33·1–44·4), and Russia (36·5%, 30·7–42·1). For females, high-burden countries included Austria (20·7%, 15·5–26·8) and Bulgaria (18·0%, 12·4–24·8). In 2010, the age group with the highest global smoking prevalence was 40–44 years (38·6%, 31·9–45·4) for males and 45–49 years (8·2%, 6·5–10·7) for females. Interpretation Increases in smoking prevalence have already had substantial health and economic impacts. These findings highlight the importance of allocating sufficient resources to address the rising smoking trends in high-risk populations and intensifying efforts to prevent children from starting to smoke. Funding None.

Objective To test the specificity of the association between tobacco advertising and youth smoking initiation. Design Longitudinal survey with a 30 month interval. Setting 21 public schools in three German states. Participants A total of 1320 sixth-to-eighth grade students who were never-smokers at baseline (age range at baseline, 10–15 years; mean, 12.3 years). Exposures Exposure to tobacco and non-tobacco advertisements was measured at baseline with images of six tobacco and eight non-tobacco advertisements; students indicated the number of times they had seen each ad and the sum score over all advertisements was used to represent inter-individual differences in the amount of advertising exposure. Primary and secondary outcome measures Established smoking, defined as smoked >100 cigarettes during the observational period, and daily smoking at follow-up. Secondary outcome measures were any smoking and smoking in the last 30 days. Results During the observation period, 5% of the never-smokers at baseline smoked more than 100 cigarettes and 4.4% were classified as daily smokers. After controlling for age, gender, socioeconomic status, school performance, television screen time, personality characteristics and smoking status of peers and parents, each additional 10 tobacco advertising contacts increased the adjusted relative risk for established smoking by 38% (95% CI 16% to 63%; p

OBJECTIVES: This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS: At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS: Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS: The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.

Pre- and post-natal growth was studied from week 17 of pregnancy until 5 years of age in children of women who reported daily smoking at the time of conception, and compared to the growth in children of non-smokers. Fetal abdominal diameter, femur length and biparietal diameter were measured in weeks 17 and 37 of pregnancy, and weight, height and head circumference were measured at birth, and at 6, 13 and 60 months of age in 185 children of smokers and 345 children of non-smokers. Cross sectional data at birth showed that infants of smokers had lower weight and length, but similar ponderal index as infants of non-smokers, and this may suggest a symmetrical growth retardation. Longitudinal growth curves indicated that the growth retardation took place in the second half of pregnancy. During the first 5 years of life, children of smokers had complete catch-up growth in weight, a partial catch-up in height, and no catch-up growth in head circumference. At 5 years, children of smokers had a higher ponderal index and skinfold thickness, suggesting that these children, on average, were more obese than children of non-smokers.

To test our hypothesis that there is an increased lability in parents' smoking behaviour after a childbirth, and to search for demographic factors associated with lability in parents' smoking behaviour.A one month, prospective questionnaire study.Maternal and child health centres in Oslo, Norway.222 families in which at least one adult was smoking were enrolled in the study. 37 families dropped out (16.7%) and 185 families completed both questionnaires.Changes in daily smoking, smoking quantity, and practical measures to prevent passive smoking by the children, as assessed by parental reports.Families with a child aged less than one year (infant) were more likely to make one or another positive change (quit, reduce, stop smoking indoors, stop smoking in living rooms) than families with only older children. There was a trend for families with an infant to make negative changes more often (start smoking, increase) as well. Older parents made positive changes more often than younger ones. Single parents were less likely to make positive changes.The study indicates that there is an increased lability in parents' smoking behaviour after a childbirth.

An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested. A total of 443 consecutive families with one or two smoking parents, attending mother and child health centres in Oslo, Norway, were randomly allocated to an intervention group (n = 221) and a control group (n = 222). Eighty families (18%) dropped out during the study period. For the intervention group, the communication between the health visitor and the family was prolonged at one well-child visit with a brief session on smoking, and the parents were given three brochures. The families in the control group received no information on smoking. Changes in practical measures to prevent passive smoking by the children (e.g. no smoking indoors) as well as changes in daily smoking and smoking quantity were assessed by parental reports. We found no significant differences between the groups with respect to change in smoking behaviour.

Correspondence to : Merete Osler, Institute of Social Medicine, University of Copenhagen, Blegdamsvej 3, 2200 N, Denmark Abstract Objective -To describe changes during the period 1982 to 1992 in the prevalence of daily smoking in relation to occu pation, and to examine the effect of becoming unemployed on smoking pre valence among Danish men and women. Design Questionnaire data collected in two independent cross-sectional studies. In 1982 the participation rate was 79% among 4807 randomly selected men and women aged 30, 40, 50, and 60 years. In 1992 it was 73% among 2226 randomly selected men and women of similar ages. Five years later the participants from the study in 1982 were re-examined. Of the 2432 men and women who were employed at the initial examination, 190 had been unemployed for more than one month. Setting Eleven municipalities in the county of Copenhagen. Main outcome measures Prevalence of daily and heavy smoking. Results From 1982 to 1992, the preva lence of daily smoking decreased from 59 % to 48 % in men and from 50 % to 46 % in women, but the falling prevalence was found only among skilled workers and in the group of salaried employees and civil servants. An existing occupational differ ence in smoking prevalence was en hanced. In the 1982 study 63 % of women who subsequently experienced un employment smoked daily; this was a significantly higher percentage than the 47 % of daily smokers among women who remained continuously employed. In men there was no such difference. The ex perience of unemployment during the five-year follow up was not associated with increased prevalence of daily smok ing in men or women. Conclusion Smoking prevalence de clined in Denmark in the 1980s, during which time the disparity in smoking by occupational status increased. Becoming unemployed was not associated with in creased prevalence of smoking in men or women.

The theme of this paper is whether smoking is in the process of becoming socially unacceptable in Norway.

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.

Socio-economic differentials in mortality in Great Britain are well documented. Although their causes are diverse and not fully understood (1), it is recognised that behavioural factors, including smoking, are important contributors to mortality risk and its variation between social groups. Since 1972, the General Household Survey has provided data on the prevalence of regular smoking by social group for adults in Great Britain aged 16 and over. These data show that over the period 1972–1992 there was a decrease in smoking prevalence which among men occurred equally in those in manual and non-manual groups, while among women the decrease was more marked in the non-manual groups (2). In 1992, the prevalence of regular smoking in Great Britain was approximately 12% higher in manual (35%) than non-manual (23%) social groups. In Wales, it has been recognised that many of the most important factors influencing the health of its 3 million population relate to the lifestyles of individuals (3). As such, policies and programmes designed to promote healthy lifestyles and reduce the prevalence of health damaging behaviours form a key component in the health improvement strategy for Wales (4). Since 17.1% of deaths in Wales are estimated to be attributable to smoking (5), the reduction of smoking prevalence is a key target in that strategy, and has been a focus of activity since the launch of Heartbeat Wales in 1985 (6). Progress against many health improvement targets is being monitored through regular lifestyle surveys known as the Health In Wales Surveys, the most recent of which took place in 1993. These surveys build upon the 1985 Heartbeat Wales Survey, which provided baseline measures. This paper presents findings from the 1985 and 1993 surveys, and concentrates on the pattern of and changes in prevalence of daily smoking by social group.

U sing m ulti-stage cluster sam pling, 141eligible schools from six geog raphical regions w ere random lyselected and 82 ag reed to participate (response rate 58.2% ). S choolclasses w ere random ly selected, producing 3,434 students (m eanage 15.0 years), 51.7% m ale and 15.4% self-identified M aori.P robability w eights w ere assigned at the individual student lev el.In T able 1 w e present odds ratios for daily sm oking accordingto hom e S H S exposure. S tudents w hose response to the questionOH ow often do you sm oke now ?O w as Oat least once a dayO w ereclassified as Odaily sm okersO (12.7% ). S H S exposure w as m eas-ured by responses to the question ODuring the past sev en day s, onh ow m any days have people sm oked around you in your ow nhom eO. O verall, 43.8% reported S H S exposure at hom e, 17.7%on all seven da ys.U nivariable logistic reg ression m odels dem onstrated a cleardose-response effect (see T able 1). N o interaction effects w erefound betw een S H S and sex, ethnicity (M aori vs. non-M aori),and school ye ar. T here wa s no evidence that exposure to SHSdiffered by age, sex or ethnicity.S tudy lim itations include the cross-sectional design and inabilityto identify precisely w ho, in the household, smoke d. N ev erthe-o

BACKGROUND: Population surveys aimed to estimate prevalence of smoking are limited in reaching those members of the intended sample who rarely are present at home. Surveys of those proxy household members who are easier available could overcome this problem.The study aimed to evaluate the possibility to estimate population smoking prevalence through proxy reports with the use of the Global Adult Tobacco Survey (GATS) data collected in Ukraine in 2010.METHODS: Within the GATS methodology, data on all the adult household members of a selected gender was collected first from a household member present. Second, an individual interview was conducted with a selected individual. Two approaches were used. First approach compared the whole population of all the reported household members with the population of all individual respondents. Estimates of prevalence were compared by age groups and by gender. Second approach compared individual interview data with the data about same individuals provided by proxies. RESULTS. Compared by gender groups, estimates of smoking prevalence based on proxy data are closer to the rates of current smoking in men and daily smoking in women. With regard to younger groups, proxies better relay daily smoking while occasional smokers may be not reported; in older groups, proxy estimates are higher than individual data as family members may be unaware of recent quitting.In matched analysis most precise proxy reports were related to never smokers, experimenters, former smokers, and daily smokers. Discrepancies were related to occasional smokers, both those who never smoked daily and those who reduced smoking from daily to non-daily. CONCLUSIONS. It is recommended to survey the adult who is ready to answer the questions about whole family. The study sample may be increased significantly at low marginal cost, and proxy survey allows estimating population smoking prevalence with the use of statistical corrections.

Objective - To assess smoking-related be haviour, beliefs, and attitudes of students at different medical schools in Turkey, in comparison to those of students in non medical schools. Design - First- and final-year medical and nonmedical (science) students from seven universities located in different geographical areas in Turkey replied anonymously to an adapted World Health Organisation questionnaire in Turkish. Subjects - First-, fourth- and sixth (final) year medical students (total 3073) and first- and fourth- (final) year non medical students (total 2401) from dif ferent universities. Results - The prevalence of daily smok ing among first-year medical students (both sexes combined) was 11.8% (range 8.7-14.9% for the universities), signifi cantly lower than that of nonmedical first-year students (21.0%, range 12.1 28.4%) (p 0.05). Daily smoking prevalence for medical students was three times higher among males (30.5 %) than females (10.1 %), but was twice as high in nonmedical students (32.4% for males and 16.4% for females). A serious attempt to quit had been made by 45.0% of smokers in medical and 47.9% in nonmedical schools (p > 0.05); 30.6% of smokers in medical and 27.2% in non medical schools thought that they would no longer smoke in five years' time (p > 0.05). 87.9% of medical and 85.7% of nonmedical students believed smoking to be harmful to health. In medical schools, there were important defects in know ledge of smoking as a major cause of pulmonary emphysema, coronary artery disease, peripheral vascular disease, neo natal mortality, and bladder cancer. There were also important defects both in knowledge and motivation regarding counselling patients to stop smoking and the role of doctors in antismoking cam paigns. Legislative measures against smoking were equally likely to be sup ported by medical and nonmedical students. Conclusions - Smoking was much more prevalent among Turkish than among US, Australian, European, Asian (includ ing Japan but not Russia) and African medical students. This study indicates that the current system of medical edu cation in Turkey has little or no effect on the attitudes and behaviour of students regarding smoking.

The effect of methadone dose on the cigarette smoking of five methadone maintenance subjects was studied in a clinical setting. Following a two-week baseline period, daily doses of methadone were either increased (50-80 mg) or decreased (80-50 mg) every two weeks according to an A-B-A-B study design. Continuous self-monitoring was used to collect data on natural smoking behavior, and expired air carbon monoxide (CO) levels were measured at each clinic visit. The predicted methadone dose-related changes in smoking were found in three of the five subjects. Fine-grained analysis of self-monitoring records showed that the proportion of total daily smoking was highest within 4 h after taking methadone for three subjects. CO levels were not significantly associated with smoking rate. The results further support and extend previous reports that methadone may produce dose-related increases in smoking. No reactive effects of self-monitoring were observed, and compliance with this procedure was extremely high, supporting the usefulness of this method for assessing natural smoking behavior in this population.

Introduction: This study tests hypotheses concerning ethnic disparities in daily cigarette smoking rate, nicotine dependence, cessation motivation, and knowledge and past use of cessation methods (e.g., counseling) and products (e.g., nicotine patch) in a multi-ethnic sample of smokers in Hawaii. Previous research has revealed significant differences in smoking prevalence among Native Hawaiians, Filipinos, Japanese, and Caucasians in Hawaii. However, no study has examined differences in dependence and cessation-related knowledge and practices among smokers representing these ethnic groups. Methods: Participants were recruited through newspaper advertisement as part of a larger smoking cessation intervention study. Participants (N=919; M age=45.6, SD=12.7; 48% female) eligible to participate provided self-report data through mail and telephone. Subjects included 271 self-identified Native Hawaiians, 63 Filipinos, 316 Caucasians, 145 “Asians” (e.g., Japanese, Chinese), and 124 “Other” (e.g., Hispanic, African-American). Results: Pair-wise comparisons of means, controlling for age, gender, income, education, and marital status, indicated that Native Hawaiian smokers reported statistically significantly higher daily smoking rates and higher levels of nicotine dependence compared to Asians. Native Hawaiian smokers reported significantly lower motivation to quit smoking as compared to Caucasians. Further, Filipino, and Native Hawaiian smokers reported lesser knowledge of cessation methods and products, and less frequent use of these methods and products compared to Caucasians. Conclusions: The results suggest that Native Hawaiian and Filipino smokers could be under-served with regard to receiving cessation-related advice, and may lack adequate access to smoking cessation products and services. In addition, cessation interventions tailored for Native Hawaiian smokers could benefit from a motivational enhancement component. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B37.

Purpose Trends in school-based differences of smoking prevalence among high school students in Japan was analysed to assess social inequalities in health among adolescents. Methods Cross-sectional nationwide surveys were conducted periodically. High schools were randomly sampled from throughout Japan in 1996, 2000, 2004, and 2008. All enrolled students in sampled schools were asked smoking and drinking behaviour. The number of schools participated in the survey was 80 junior high schools and 73 senior high schools in 1996 survey. The values were 99 and 77 in 2000, 92 and 87 in 2004, and 92 and 80 in 2008 survey, respectively. For assessing the differences in prevalence, the coefficient of variation (CV) was used. Results Smoking prevalence among students has decreased for both sexes. According to the lowering smoking prevalence, the variance of between-school differences in smoking prevalence has shrunk, however CV of the experiment rate, current smoking (smoked at least 1 day of the 30 days preceding the survey), and daily smoking has increased for both sexes and both junior and senior high school. For example, CV of current smoking in junior high school boys was 0.51 in 1996, 0.52 in 2000, 0.66 in 2004, and 0.92 in 2008. The CV in junior high school girls was 0.62 in 1996, 0.63 in 2000, 0.93 in 2004, and 0.95 in 2008. Conclusions Although the average (mean or median) of smoking prevalence by school decreased, the between-school differences have increased. This suggests that expansion of social inequalities in adolescent health may be occurring

Background: Varenicline is recently known as smoking cessation medicine has no results of researches conducted in the actual practice settings except for incipient clinical trials. This research attempted to analyze the factors for smoking cessation by using Varenicline prescribed in the family clinic, and the efficacy of Varenicline. Methods: Brief smoking cessation education was conducted on 140 people who visited the Department of Family Medicine at Dankook University and Varenicline was prescribed for them. This research checked whether smoking was stopped or not after six months and analyzed the factors for succeeding in smoking cessation. Results: Varenicline was prescribed for the 140 people. After six months, 46 smokers were successful in smoking cessation, representing the rate of success of 35.4%, and after 12 months, 31 people of 83 people were successful in smoking cessation, representing the rate of success of 37.3%. The group less smoke than 24.3 cigarettes/day (the average daily smoking amount) has higher quit rate than the group more smoke than 24.3 by 4.9 times. The group takes Varenicline longer than 26.7 days (the average Varenicline dosage period) has higher quit rate than the group takes Varenicline shorter than 26.7 by 4 times. Smoking-cessation rate was 4.5 times when trying to stop smoking by the doctor’s recommendation. It was higher than when trying to stop smoking by self-determination. In the multivariate analysis, there were significant relationships in daily smoking amount, dosage and period of Varenicline, and motivation of visits. Conclusion: Varenicline is one of the useful medication for quitting smoking in family practice setting. Better compliance of medicine shows better quitting rate.