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Background: We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults. Methods: We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013–2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults. Results: In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean = − 0.50, 95% CI = − 0.89, − 0.12; hospitality law change in mean = − 0.72, 95% CI = − 1.14,–0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited. Conclusions: We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-related deaths in Europe. Europe's Beating Cancer Plan calls for a comprehensive approach to the disease in general but not specifically to lung cancer. Such a comprehensive approach, integrating efforts to strengthen anti-tobacco policies, early detection and underlying models of care, is sorely needed for lung cancer – particularly considering disruptions to care during the COVID-19 pandemic. In a recently published think piece, a multidisciplinary group of experts proposed four key policy priority areas. First, to reduce stigma and improve awareness of potential symptoms, there is a need to foster a better understanding of lung cancer – among the public and healthcare professionals. Second, opportunities for early detection should be enhanced, and the implementation of targeted screening through low-dose computed tomography should be encouraged as a complement to smoking cessation services. This complementarity should be recognised and built into joint policy proposals, with development and better integration of screening and smoking cessation programmes on the ground. Third, the socioeconomic inequalities underpinning disparities in outcomes in people with lung cancer must be addressed, with targeted approaches to overcome barriers to access Finally, the overall quality of lung cancer care must be improved, making multidisciplinary care available to all and ensuring survivorship is given due attention. [Display omitted] • Stigma remains a key issue for people with lung cancer, and needs urgent attention. • Targeted screening through low-dose computed tomography must be implemented. • Socioeconomic inequalities underpinning disparities in outcomes need to be tackled. • Multidisciplinary care should be available to all. [ABSTRACT FROM AUTHOR]

Background: Tobacco epidemic is one of the biggest public health threats, killing nearly seven million people annually. With implementation of smoke-free public places legislation, cabs in India are smoke free. However, large majority of cab drivers are addicted to tobacco. Aims: The objectives were to measure cab drivers' knowledge, attitude, and practices about tobacco pre and post intervention, educate them regarding hazards of tobacco and need for smoke-free cabs, perform oral cancer screening, and provide assistance to quit tobacco. Subjects and Methods: This interventional study among cab drivers was conducted in Mumbai during 2015–2018. Different cab unions in Mumbai were contacted and 400 cab drivers were enrolled and interviewed. They were offered health education, oral cancer screening, and tobacco cessation assistance at regular intervals for 1 year. Results: About 63.8% of cab drivers used tobacco, mainly in smokeless forms. Almost 94.1% intended to quit, 66.3% had made previous quit attempts, and 69.8% expressed the need of assistance for quitting. One hundred and twelve cab drivers were diagnosed with oral precancers and one with oral carcinoma. About 49.4% of cab drivers quit tobacco and 46.7% reduced tobacco consumption at the end of 1 year. According to multivariate logistic regression analysis, Muslim cab drivers were less likely to quit tobacco as compared to Hindus. Conclusion: Adherence to smoke-free laws plays a significant role in reducing exposure of cab drivers to secondhand smoke. This program demonstrates the successful implementation of tobacco cessation program that could be replicated among other workforces. [ABSTRACT FROM AUTHOR]

In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation. [ABSTRACT FROM AUTHOR]

This study examined factors associated with smoking behaviors among late adolescents in Taiwan. A cross-sectional survey was conducted with 377 adolescents from four high schools who answered self-report questionnaires. The results indicated that 10.8%(n=41) of the participants were current smokers. Univariate analysis indicated that current smoking status was significantly associated with smoking social confidence, smoking social connection, friend smoking, and smoking policy in schools. Logistic regression showed smoking social confidence (adjusted odds ratio = 1.41, 95% CI [1.16, 1.72], p = .01) and friend smoking (adjusted odds ratio = 2.80, 95% CI [1.67, 4.70], p < .01) were significantly associated with being a current smoker. Health professionals should consider implementing school-based programs to reduce influence of friend smoking, through strategies for resisting peer pressure, to reduce smoking. Educating late adolescents on improving skills related to social confidence, such as increasing communication abilities, should also be a part of these programs. [ABSTRACT FROM AUTHOR]

Background There is currently no comprehensive legislation protecting non-smokers and children from second-hand smoke (SHS) exposure in private cars at the European Union (EU) level. This study aims to assess smokers' support for smoke-free cars legislation in six EU countries. Methods Data come from the EUREST-PLUS ITC Europe Surveys: Wave 1 (2016, n  = 6011) and Wave 2 (2018, n  = 6027) conducted in Germany, Greece, Hungary, Poland, Romania and Spain. Support for smoke-free cars carrying pre-school children and non-smokers and voluntary implementation of smoke-free cars were assessed among adult smokers. Generalized estimating equations models were used to assess changes in support between waves. Results In 2018, 96.3% [95% confidence interval (CI) 95.4–97.0%] of the overall sample supported smoke-free legislation for cars carrying pre-school children, representing an increase of 2.4 percentage points in comparison to 2016. Smoke-free legislation for cars transporting non-smokers was supported by 85.2% (95% CI 83.1–87.1%) of smokers' in 2016 and 90.2% (95% CI 88.6–91.7%) in 2018. Among smokers who owned cars, there was a significant 7.2 percentage points increase in voluntary implementation of smoke-free cars carrying children from 2016 (60.7%, 95% CI 57.2–64.0%) to 2018 (67.9%, 95% CI 65.1–70.5%). All sociodemographic groups of smokers reported support higher than 80% in 2018. Conclusion The vast majority of smokers in all six EU countries support smoke-free legislation for cars carrying pre-school children and non-smokers. This almost universal support across countries and sociodemographic groups is a clear indicator of a window of opportunity for the introduction of comprehensive legislation to protect non-smokers and children from SHS exposure in cars. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The number of smoking cessation outpatient clinics (SCCs) is increasing day by day in Turkey. The objective of this study is to evaluate the situation of smoking cessation clinics in our country. MATERIALS AND METHODS: The SCC list was obtained from the website of the Ministry of Health of the Republic of Turkey. A total of 305 centers from 80 cities were called by telephone, and a questionnaire including questions about polyclinics was directed to SCC employees whose verbal consent was obtained. RESULTS: Of the 305 SCCs, 183 could be reached, 33 of which did not provide outpatient services. A questionnaire was directed to 146 SCCs. A total of 347 doctors work in these centers. Of these 146 SCCs, 69 (47.3%) accepted patients with appointments and 77 (52.7%) accepted patients directly. The specializations of physicians in the SCCs were as follows: 84 (57.5%) were chest disease specialists, 30 (20.5%) were general practitioners, 10 (6.8%) were psychiatrists, 12 (8.2%) were other branch physicians, 6 (4.1%) were family physicians, and 3 (2.1%) were public health physicians. A total of 125 (85.6%) physicians working in SCCs received smoking cessation training. Only 35 (24%) SCCs have one or more provincial tobacco control members. Eighty (54.8%) SCCs had a separate SCC room, 74 (50.7%) had a waiting room for the patients, and 63 (43.2%) had a carbon monoxide (CO) measurement device in the SCC. CONCLUSION: All physicians in Turkey are able to provide smoking cessation services, but the chest physicians are mostly responsible for this task. In addition to increasing the number of SCCs, it is very important to increase the quality and comply with the standards. [ABSTRACT FROM AUTHOR]

INTRODUCTION Implementing comprehensive smoke-free laws is an important part of tobacco control and has been promoted since China ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005. This study shows the predictors of adopting subnational smoke-free laws and their alignment with Article 8 of WHO FCTC. METHODS The legislations of 125 cities from China's top three city grades were assessed, covering the cities that have smoke-free laws. Logistic regression is applied to evaluate the characteristics of cities that adopted a smoke-free law. We also compare each smoke-free law with the WHO FCTC Article 8 requirements. RESULTS Provincial capital cities were more likely to adopt smoke-free laws compared with other cities. Smoke-free laws vary from comprehensive to partial bans with major exemptions. Among the 21 cities that have enacted smoke-free laws, 9 cities prohibited smoking in all indoor workplaces, indoor public places (restaurants, bars, health facilities, government buildings and schools) and public transportation. More than half of the smoke-free laws still allow designated indoor smoking rooms. Smoke-free laws that clearly ban e-cigarettes in smoke-free areas have been implemented in only two cities (Nanning and Hangzhou). CONCLUSIONS This study shows that a number of Chinese cities have taken legislative measures to protect people from exposure to tobacco smoke. It identifies signs of progress but also areas for improvement, such as the scope of smoke-free laws, imperfect implementation of such laws, and the potential omission of e-cigarettes from the legislation. [ABSTRACT FROM AUTHOR]

In the last 20 years, the United States has made stunning progress reducing the rate of adult smoking. However, the smallest reduction is among older adults. Compared to younger smokers, older smokers are more likely to be lower socioeconomic status (SES), have several tobacco related comorbidities, and are less likely to be treated for tobacco addiction yet, in tobacco policy, they are not considered a marginalized group. The tobacco industry's interest in older smokers contrasts with the lack of interest shown by tobacco control. A double whammy is a set of two bad events or situations that have an effect at the same time. The purposes of this article are to use the health disparity paradigm to (a) discuss the "double whammy" of marginalization by tobacco control and valuation by the tobacco industry on the health of older smokers and (b) provide strategies to promote health equity for older smokers. [ABSTRACT FROM AUTHOR]

Tobacco consumption is a worldwide health problem threatening all, making no differentiation between gender age, race, and cultural or educational background. Tobacco is responsible for 7 million deaths each year Over 6 million deaths are directly related to tobacco consumption, and over 890.000 deaths involve non-smokers exposed to tobacco smoke. Although the harmful effects of cigarettes on human health have been confirmed repeatedly, still over 1 billion people worldwide are tobacco consumers, and according the World Health Organization (WHO), unless a strict action plan is implemented, tobacco-related deaths will rise to more than 8 million per year by 2030. The WHO published the Framework Convention on Tobacco Control in 2003, which could form a common policy to guide countries in the struggle against tobacco. Tobacco control in the Convention is defined as "a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke." This agreement was adopted by Turkey in 2004 with the Law No. 5261. In 2008, the WHO published the MPOWER package, containing the following six basic strategies, which are parallel with the Tobacco Framework Convention measures and practices: 1. Monitor tobacco use. 2. Protect people from tobacco smoke. 3. Offer help to quit tobacco use. 4. Warn about the dangers of tobacco. 5. Enforce bans on tobacco advertising and promotion. 6. Raise taxes on tobacco products. In the 2013 Global Tobacco Control Report by the WHO, Turkey was announced as the first country achieving a high level of success in the six MPOWER strategies, and other countries were advised to adopt the Turkish policies. Here we review Turkey's MPOWER tobacco control strategies one by one. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Despite substantial reductions in smoking prevalence in many countries, rates remain high among people who are experiencing disadvantage. This study aimed to explore attitudinal and behavioural responses to population-wide tobacco control policies among Australian smokers experiencing disadvantage.Design and Methods: Semi-structured qualitative interviews were conducted with 84 smokers attending community service organisations in the mental health, homelessness, and alcohol and other drug sectors. Interviewees discussed various tobacco control policies (tobacco taxes, smoke-free areas, plain packaging and graphic health warnings). The interview transcriptions were coded and thematically analysed.Results: Responses to tobacco taxes were mixed. Some interviewees reported smoking less as a result of price increases, while others reallocated funds from other budget areas. Many perceived smoke-free area policies as effective, although some described strategies they use to circumvent this policy, thereby diminishing its effectiveness. Plain packaging and graphic warnings were perceived as being least effective.Discussion and Conclusions: While tobacco control policies can elicit intended attitudinal and behavioural responses, additional efforts are needed to enhance their effectiveness among smokers experiencing disadvantage. Future efforts to reduce smoking rates should address responses that diminish policy effectiveness among groups exhibiting high smoking prevalence. This could be achieved through strategies that address the specific needs of these groups, such as providing additional cessation support, enforcing existing smoke-free policies in ways that minimise inequitable effects, and addressing self-exempting beliefs. [ABSTRACT FROM AUTHOR]

Tobacco control policies rely heavily on law and are steeped in litigation. Examining the creation of tobacco control laws in the European Union, this article lays out the potential costs and benefits of legalism for public health practitioners and advocates. Legalism is a form of governance that relies heavily on the authority of law to settle political disputes, with consequences for the ways in which governments make, and advocates push for, public health policies. To the extent that legalism creates procedural problems and distortions in the content of public health policy, then the content of law and its making is a public health problem. On the other hand, litigation can also be a public health tool, and an enforceable, justiciable right to health is a powerful political and legal weapon in its own right. [ABSTRACT FROM AUTHOR]

Smoke-free air laws and the denormalization of smoking are important contributors to reductions in smoking during the 21st century. Yet, tobacco policy and denormalization may intersect in numerous ways to affect smoking. We merge data from the National Longitudinal Survey of Youth 1997, Tobacco Use Supplement of the Current Population Survey, American Nonsmokers’ Right Foundation, and Census to produce a unique examination of the intersection of smoking bans and denormalization and their influence on any smoking and heavy smoking among young adults. Operationalizing denormalization as complete unacceptability of smoking within nightlife venues, we examine 1) whether smoking bans and denormalization have independent effects on smoking, 2) whether denormalization mediates the influence of smoking bans on smoking, and 3) whether denormalization moderates the impact of smoking bans on smoking. For any smoking, denormalization has a significant independent effect beyond the influence of smoking bans. For heavy smoking, denormalization mediates the relationship between smoking bans and habitual smoking. Denormalization does not moderate the relationship of smoking bans with either pattern of smoking. This research identifies that the intersection of denormalization and smoking bans plays an important role in lowering smoking, yet they remain distinct in their influences. Notably, smoking bans are efficacious even in locales with lower levels of denormalization, particularly for social smoking. [ABSTRACT FROM AUTHOR]

Background: To examine the impact of comprehensive smoke-free legislation (SFL) (Law 42/2010) on the incidence and prevalence of adult asthma and coronary disease in primary health care (PHC) patients from three Spanish regions, overall and stratified by sex. Methods: Longitudinal observational study conducted between 2007 and 2013 in the population over 15 years of age assigned to 66 PHC teams in Catalonia, Navarre and the Balearic Islands. Crude rates and age-standardized (truncated: asthma -16 years and coronary disease -35 years) incidence and prevalence rates using the direct method based on the European Standard Population were estimated based on data from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardized incidence and prevalence rates. Trends were expressed as annual percentage change and average annual percent change (AAPC). Results: The standardized asthma incidence rate showed a non-significant downward trend and the standardized prevalence rates rose significantly in the three regions. Standardized coronary disease incidence and prevalence rates were considerably higher for men than for women in all regions. The standardized coronary disease incidence rates in Catalonia (AAPC: -8.00%, 95% CI: -10.46; -5.47) and Navarre (AAPC: -3.66%, 95% CI: -4.95;-2.35) showed a significant downward trend from 2007 to 2013, overall and by sex. The standardized coronary disease prevalence trend rate increased significantly in the whole period in Catalonia and the Balearic Islands, although a non-significant downward trend was observed from 2010 in Catalonia. Conclusion: No changes in the trends of adult asthma and coronary disease in PHC Spanish patients were detected after the introduction of comprehensive SFL. [ABSTRACT FROM AUTHOR]

Introduction: Simulation models can be used to evaluate existing and potential tobacco control interventions, including policies. The purpose of this systematic review was to synthesize evidence from computational models used to project population-level effects of tobacco control interventions. We provide recommendations to strengthen simulation models that evaluate tobacco control interventions.Methods: Studies were eligible for review if they employed a computational model to predict the expected effects of a non-clinical US-based tobacco control intervention. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively.Results: Six primary non-clinical intervention types were examined across the 40 studies: taxation, youth prevention, smoke-free policies, mass media campaigns, marketing/advertising restrictions, and product regulation. Simulation models demonstrated the independent and combined effects of these interventions on decreasing projected future smoking prevalence. Taxation effects were the most robust, as studies examining other interventions exhibited substantial heterogeneity with regard to the outcomes and specific policies examined across models.Conclusions: Models should project the impact of interventions on overall tobacco use, including nicotine delivery product use, to estimate preventable health and cost-saving outcomes. Model validation, transparency, more sophisticated models, and modeling policy interactions are also needed to inform policymakers to make decisions that will minimize harm and maximize health.Implications: In this systematic review, evidence from multiple studies demonstrated the independent effect of taxation on decreasing future smoking prevalence, and models for other tobacco control interventions showed that these strategies are expected to decrease smoking, benefit population health, and are reasonable to implement from a cost perspective. Our recommendations aim to help policymakers and researchers minimize harm and maximize overall population-level health benefits by considering the real-world context in which tobacco control interventions are implemented. [ABSTRACT FROM AUTHOR]

Introduction: In its fiscal year 2015 final rule, the Centers for Medicare & Medicaid Services (CMS) required reporting of tobacco treatment quality measures as part of the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). This pre-intervention, post-intervention policy analysis evaluates the impact of that policy at a large academic medical center that opted to improve performance as it implemented reporting measures.Methods: Electronic medical record data were collected retrospectively for all adult (≥18 years) inpatient psychiatric admissions from January 1, 2014 to December 31, 2015. Data from admissions were analyzed to determine changes in the provision of tobacco treatment including the proportions of patients screened for tobacco use, receiving tobacco cessation counseling, and receiving tobacco cessation medication(s) using a chi-square test. Covariate analysis of treatment differences based on psychiatric diagnosis was analyzed using Cochran-Mantel-Haenszel and Breslow-Day test.Results: Post-policy screening for admissions increased significantly (85% vs. 97%; p < .001). Referral to cessation counseling increased 18-fold (4% vs. 74%; p < .001). Receipt of Counselling (8% vs. 67%; p < .001) and referral for cessation medication (32% vs. 68%; p < .001) also increased dramatically. Though statistically non-significant, the number of tobacco users who actually received medications increased markedly between 2014 and 2015, 24% versus 35%. Gains in screening, referral, and treatment did not differ by psychiatric diagnosis.Conclusions: The Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program resulted in a 10-fold increase in the number of smokers who received inpatient tobacco treatment. Should CMS link prospective payment to performance, it could have a major impact on quality of care for tobacco dependence.Implications: This is the first study to examine the implementation and impact of new 2015 IPFQR program tobacco measures. This study may illustrate the potential effect that performance based penalties can have should facilities be required to do more than simply report on these tobacco measures. This study exemplifies the impact these new reporting measures can have when psychiatric facilities move beyond letter of the policy, to continually assess organizational performance and implement changes to improve treatment delivery. [ABSTRACT FROM AUTHOR]

Background: The Dutch Healthcare Inspectorate supervises care providers in order to improve quality of care. Recently the inspectorate assessed and promoted the use of a guideline on smoking-cessation counselling in midwifery practices. The supervision programme consisted of an announcement of the enforcement deadline for the guideline and site visits. The purpose of our qualitative study was to identify factors related to guideline adherence after the supervision programme, and investigate whether the programme had helped improve adherence.Methods: We conducted semi-structured interviews with inspected and non-inspected midwives. Additionally, we studied documents and observed the inspection process. The sampled midwives all work in primary care midwifery practices providing care to pregnant smokers. The questions included the current provision of smoking-cessation counselling, support to the midwife in counselling, recent changes in provision of counselling, reasons for recent changes, knowledge about the supervision programme, and experiences with supervision by the inspectorate.Results: Our results show that guideline adherence depends on several factors. Awareness and familiarity with the guideline are important, as is outcome expectancy. Additionally, motivation, guideline factors and environment factors were mentioned. Besides these previously documented factors, we found that professional collaboration also determined guideline adherence. Increased collaboration in counselling is associated with greater adherence to the guideline, such as provision of counselling and taking required training. The supervision programme helped improve stop-smoking counselling, by making midwives aware of the counselling and giving them an extrinsic motivation to provide counselling.Conclusion: Motivation and environmental aspects were the most important factors related to guideline adherence, and professional environment was added as significant factor. The improved guideline adherence is partly attributable to the supervision programme. [ABSTRACT FROM AUTHOR]

Introduction: In an analysis of smoking using a longitudinal sample of US young adults, we extend research on tobacco vending machine restrictions beyond its prior focus on minors by examining the influence of total vending machine restrictions, which apply to adult-only facilities and represents the only remaining vending machine exemption since the enactment of the Family Smoking Prevention and Tobacco Control Act. We identify whether the passage of a restriction influences an individual's smoking on repeated observations, and if the propensity is lower among those who live in locations with a restriction.Methods: Combining a repository of US tobacco policies at all geographic levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel logistic regression to examine the impact of total vending machine restrictions on any past 30-day smoking and past 30-day smoking of one pack per day among young adults (ages 19-31), while accounting for other tobacco control policy, community, and individual covariates.Results: We find that total vending machine restrictions decrease any recent smoking (OR = 0.451; p < .01), net of other covariates. Though the passage of a restriction does not alter an individual's smoking over time, living longer in an area that has a restriction lowers the propensity that an individual will smoke at all (OR = 0.442; p < .05). We find no effect of total vending machine restrictions on smoking a pack daily.Conclusions: Total vending machine restrictions appear to be an effective, yet highly underutilized, means of tobacco control.Implications: Past scientific inquiries examining vending machine restrictions have focused upon minor access, adolescent perceptions of availability, and subsequent smoking. The potential for total vending machine restrictions, which extend to adult-only facilities, to influence patterns of smoking among those of legal age, remains significant. Those who are subject to total vending machine restrictions for longer periods are less likely to have recently smoked, but individuals do not change their smoking behavior in response to the passage of a restriction. These restrictions do not affect heavy smokers. Such policies are an effective but underutilized policy mechanism to prevent smoking among young adults. [ABSTRACT FROM AUTHOR]

Introduction: Smoke-free legislation has been a great success for tobacco control but its impact on smoking uptake remains under-explored. We investigated if trends in smoking uptake amongst adolescents differed before and after the introduction of smoke-free legislation in the United Kingdom.Methods: Prevalence estimates for regular smoking were obtained from representative school-based surveys for the four countries of the United Kingdom. Post-intervention status was represented using a dummy variable and to allow for a change in trend, the number of years since implementation was included. To estimate the association between smoke-free legislation and adolescent smoking, the percentage of regular smokers was modeled using linear regression adjusted for trends over time and country. All models were stratified by age (13 and 15 years) and sex.Results: For 15-year-old girls, the implementation of smoke-free legislation in the United Kingdom was associated with a 4.3% reduction in the prevalence of regular smoking (P = .029). In addition, regular smoking fell by an additional 1.5% per annum post-legislation in this group (P = .005). Among 13-year-old girls, there was a reduction of 2.8% in regular smoking (P = .051), with no evidence of a change in trend post-legislation. Smaller and nonsignificant reductions in regular smoking were observed for 15- and 13-year-old boys (P = .175 and P = .113, respectively).Conclusions: Smoke-free legislation may help reduce smoking uptake amongst teenagers, with stronger evidence for an association seen in females. Further research that analyses longitudinal data across more countries is required.Implications: Previous research has established that smoke-free legislation has led to many improvements in population health, including reductions in heart attack, stroke, and asthma. However, the impacts of smoke-free legislation on the rates of smoking amongst children have been less investigated. Analysis of repeated cross-sectional surveys across the four countries of the United Kingdom shows smoke-free legislation may be associated with a reduction in regular smoking among school-aged children. If this association is causal, comprehensive smoke-free legislation could help prevent future generations from taking up smoking. [ABSTRACT FROM AUTHOR]

Introduction: Numerous studies document the causal relationship between prenatal smoking and adverse maternal and child health (MCH) outcomes. Studies also reveal the impact that tobacco control policies have on prenatal smoking. The purpose of this study is to estimate the effect of tobacco control policies on prenatal smoking prevalence and adverse MCH outcomes.Methods: The US SimSmoke simulation model was extended to consider adverse MCH outcomes. The model estimates prenatal smoking prevalence and, applying standard attribution methods, uses estimates of MCH prevalence and relative smoking risks to estimate smoking-attributable MCH outcomes over time. The model then estimates the effect of tobacco control policies on adverse birth outcomes averted.Results: Different tobacco control policies have varying impacts on the number of smoking-attributable adverse MCH birth outcomes. Higher cigarette taxes and comprehensive marketing bans individually have the biggest impact with a 5% to 10% reduction across all outcomes for the period from 2015 to 2065. The policies with the lowest impact (2%-3% decrease) during this period are cessation treatment, health warnings, and complete smoke-free laws. Combinations of all policies with each tax level lead to 23% to 28% decreases across all outcomes.Conclusions: Our findings demonstrate the substantial impact of strong tobacco control policies for preventing adverse MCH outcomes, including long-term health implications for children exposed to low birth weight and preterm birth. These benefits are often overlooked in discussions of tobacco control. [ABSTRACT FROM AUTHOR]

Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5-6 million deaths annually. One billion tobacco-related deaths are predicted for the 21st century, with about half occurring before the age of 70. In this paper, we consider a complete ban on the sale of cigarettes and find that such a ban, if effective, would be justified. As with many policy decisions, the argument for such a ban requires a weighing of the pros and cons and how they impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer because of smoking. These harms, moreover, disproportionally affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals' freedom, its failure to respect some individuals' autonomous choice and the likelihood that it may, in individual cases, reduce well-being. [ABSTRACT FROM AUTHOR]

Objectives: To assess support for a future ban on smoking and for increasing tobacco taxes in Denmark, and to explore if support differed across sex, age, educational attainment, smoking status and intention to quit.Methods: Data from a 2013 health survey representative of the population aged ≥16years in the Capital Region of Denmark (N=41,356, response rate=43.5) was linked with data on sex, age and education from central registers. Participants were asked if they supported: 1) a future ban on smoking in Denmark, and 2) increased taxes on tobacco products. Subgroup differences were explored using logistic regression.Results: 30.6% supported a future ban on smoking, while 59.0% supported increased taxes. Women were less supportive of a future ban (OR=0.83 (0.78-0.88)) and more supportive of increasing taxes (OR=1.11 (1.06-1.18)) than men. Support for both measures was higher among the youngest. Only small differences were found in ban support across educational attainment, while support for taxes increased with increasing education. Support for both measures were greatest among never smokers (OR=2.66 (2.40-2.93) and OR=9.69 (8.83-10.63)) compared to daily smokers. Smokers intending to quit were two to three times as likely to support a future ban or increased taxes compared to smokers with no quit intensions.Conclusion: One third supported a future ban on smoking, while six out of ten supported increasing taxes. This first Danish study of support for more radical tobacco control adds to the growing literature on tobacco endgame and sets a baseline for future assessments of public support. [ABSTRACT FROM AUTHOR]

Purpose: The study objectives are to examine prevalence of current smoking, and to assess the association of both health insurance (HI) and access to care with smoking cessation among cancer survivors.Methods: We performed an analysis from a cross-sectional study of cancer survivors aged 18-64 years using nationally representative data from the 2009 Behavioral Risk Factor Surveillance System survey. We assessed the prevalence of current smoking among cancer survivors. Also, in a subset excluding never smokers, we assessed cessation status of cancer survivors operationalized as comparing current to former smokers.Results: The study population (N = 18,896) was predominantly 45-64 years of age, female, and white. The prevalence of current smoking was substantially greater among cancer survivors without HI (40.9 %) than for those with HI (19.5 %). Cancer survivors with no HI had 2-fold greater adjusted odds of not quitting cigarette smoking compared to those with HI. Among those with insurance, cancer survivors who did not have regular health care provider or could not see doctor due to cost or had their last routine checkup ≥1 year ago had 60-80 % fold greater adjusted odds of not quitting cigarette smoking compared to cancer survivors who had better access to health care.Conclusions: Cancer survivors without HI have substantially greater current smoking rates compared with those with HI. Among cancer survivors with HI, those who experienced health care access-related problems had lower cessation rates than their counterparts.Implications For Cancer Survivors: Smoking cessation needs to be recognized as a crucial component of preventive care for cancer survivors. Continuous patient engagement and cancer-patient-centered strategies are urgently needed to achieve optimal results for quit rates particularly for young cancer survivors who are most susceptible to current smoking. [ABSTRACT FROM AUTHOR]

This study aimed to determine if there was an association between the implementation of smoking regulation policies and the urine cotinine concentrations of Korean non-smokers. The subjects of this study were 4612 non-smoking Korean citizens (aged 19 or older) selected from the first stage of the Korean National Environmental Health Survey conducted by the National Institute of Environmental Research from 2009 to 2011. Cotinine concentrations in urine were measured by GC-MS (limit of detection: 0.05 ng/mL). Changes in the urine cotinine concentration were analyzed using a weighted general linear model and linear regression and values were shown as geometric mean (GM). The GM urine cotinine concentration decreased over time (2.92 ng/mL in 2009, 1.93 ng/mL in 2010, and 1.25 ng/mL in 2011). The total decrease in the subjects' urine cotinine concentration between 2009 and 2011 was 2.79 ng/mL, representing a relative decrease of 54.7%. The decrease in GM urine cotinine concentration in each subgroup ranged from 2.17 ng/mL to 3.29 ng/mL (relative decreases of 46.4% and 62.8%, respectively), with the largest absolute reductions in subjects in the following groups: females, aged 40-49 years, detached residence type, no alcohol consumption, employed, secondhand smoke exposure. All groups had negative regression coefficients, all of which were significant (p < 0.001). Our results provide indirect indicators of the effectiveness of smoking regulation policies including the revision of the National Health Promotion Act in Korea. [ABSTRACT FROM AUTHOR]

Background: Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the National Institute for Health and Care Excellence guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. Aim: The aim of this paper was to determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation. Method: This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study’s main aim was to understand unit managers’ perceived reasons for success or failure of smoke-free policy. Results: Unit managers (n = 131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers, whereas smoker unit managers were more likely than non-smoker unit managers to think that stopping smoking aggravated patients’ mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering nicotine replacement therapy and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit, whereas unit managers’ knowledge, attitude and practices vary by their smoking status. Discussion: There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognise the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients’ smoking and providing staff education and support continue to be key strategies to successful smoke-free policy. Conclusions: Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy and addressing staff smoking. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco control policies seemed to have failed to reduce socioeconomic inequalities in smoking in the past. It has been argued that a comprehensive mix of policies is needed. Our aim was to assess whether tobacco control policy development in the Netherlands between 1988 and 2011 was associated with educational inequalities in smoking cessation and cigarette consumption.Methods: Data were derived from the cross-sectional Dutch Continuous Survey of Smoking Habits, with a study sample of 259,140 respondents from 1988 through 2011. Outcomes were the quit ratio and mean number of cigarettes smoked per day. The determinant was the Tobacco Control Scale (TCS). We used multilevel logistic regression modeling, with years, quarters, and individuals as levels, and controlled for sex, age, and time.Results: A significant association between the TCS and smoking cessation was found in 2001-2011, but not in 1988-2000. Associations for low- and high-education groups were similar (OR = 1.23; 95% CI = 1.12-1.34 and OR = 1.17; 95% CI = 1.03-1.32 respectively). The TCS was not significantly associated with the number of cigarettes smoked per day for either the low- or high-education groups (B = -0.09; 95% CI = -0.46-0.27 and B = -0.59; 95% CI = -1.24-0.06 respectively).Conclusions: Strong tobacco control policies introduced in the Netherlands after 2000 were positively associated with national trends in smoking cessation, whereas weaker policies introduced gradually before 2000 were not. However, these measures do not seem to have either widened or narrowed educational inequalities in smoking cessation rates-both groups benefitted about equally. [ABSTRACT FROM AUTHOR]

Background According to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality. Method The study evaluated the TCL as an intervention in a natural experiment during the period 2003–2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes – hospital discharge rates (HDRs) and standardized death rates (SDRs) – were then compared to test for an impact associated with the TCL. Results Pre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear. Conclusion This study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable. [ABSTRACT FROM AUTHOR]

Introduction: E-cigarettes (ECs) have gained significant attention in recent years. They have been introduced in jurisdictions with divergent existing laws that affect their legality. This provides the opportunity for natural experiments to assess effects of such laws in some cases independent of any formulated government policy. We compare patterns of EC awareness and use over a 3 year period in Australia where laws severely restrict EC availability, with awareness and use in the United Kingdom where ECs are readily available.Methods: Data analyzed come from Waves 8 and 9 (collected in 2010 and 2013, respectively) of the International Tobacco Control surveys in Australia and the United Kingdom (approximately 1,500 respondents per wave per country).Results: Across both waves, EC awareness, trial, and use among current and former smokers were significantly greater in the United Kingdom than in Australia, but all 3 of these measures increased significantly between 2010 and 2013 in both countries, and the rate of increase was equivalent between countries. Seventy-three percent of U.K. respondents reported that their current brands contained nicotine as did 43% in Australia even though sale, possession and/or use of nicotine-containing ECs without a permit are illegal in Australia. EC use was greater among smokers in both countries, at least in part due to less uptake by ex-smokers.Conclusions: EC awareness and use have risen rapidly between 2010 and 2013 among current and former smokers in both Australia and the United Kingdom despite different EC regulatory environments. Substantial numbers in both countries are using ECs that contain nicotine. [ABSTRACT FROM AUTHOR]

Objective We examine the potential role for taxation in the tobacco endgame in New Zealand, where the goal is to become 'smokefree' (less than 5% smoking prevalence) by 2025. Design Modelling study using a dynamic population model. Setting and participants New Zealand, Māaori and non-Māaori men and women. Interventions Annual increases in tobacco excise tax of 5%, 10%, 15% and 20% (with 10% reflecting the annual increase recently legislated by the New Zealand Government to 2016). Results With a continued commitment to annual 10% increases in tobacco excise tax, in addition to on-going Quitline and cessation support, New Zealand's smoking prevalence is projected to fall from 15.1% in 2013 to 8.7% (95% uncertainty interval 8.6% to 8.9%) by 2025. This is compared to 9.9% without any further tax rises. With annual tax increases of 20%, the prevalence is projected to fall to 7.6% (7.5% to 7.7%) by 2025. The potential reductions in smoking prevalence are substantial for both Māaori and non-Māaori populations, although annual tax increases as high as 20% will still only see Māaori smoking prevalence in 2025 approaching the non-Māaori smoking levels for 2013. Scenario analyses did not suggest that growth of the illicit tobacco market would substantively undermine the impact of tobacco tax rises. Nevertheless, unknown factors such as the gradual denormalisation of smoking and changes to the 'nicotine market' may influence sensitivity to changes in tobacco prices in the future. Conclusions Regular increases in tobacco taxation could play an important role in helping to achieve tobacco endgames. However, this modelling in New Zealand suggests that a wider range of tobacco endgame strategies will be needed to achieve a smokefree goal of less than 5% prevalence for all social groups--a conclusion that could also apply in other countries. [ABSTRACT FROM AUTHOR]

Understanding policy change is among the most enduring pursuits of public policy studies. Despite the wealth of policy change literature, a central challenge in the study of policy change remains measuring and assessing change. A useful starting point in measuring and assessing policy change is a thorough analysis of policy composition. The textual composition of policy change is analyzed by drawing on the Institutional Analysis and Development framework for conceptual definitions and data collection methods. Lessons from the policy implementation, design, and tools' literatures guide comparative data analysis and evaluation. The approach is illustrated through a study of smoking ban change in Colorado, USA. The conclusion discusses the methodological contribution offered in this paper and its potential for facilitating theoretical development. [ABSTRACT FROM AUTHOR]

BACKGROUND: Global Adult Tobacco Survey India 2009-2010 revealed that more than one-third (35%) of adults in India use tobacco in some form: 21% use smokeless tobacco, 9% smoke, and 5% are mixed users (they smoke and use smokeless tobacco), and the quit rate is very low. In an effort to decrease prevalence of tobacco use, it is thus important to understand the factors that are related to intention to quit among Indian tobacco users. Research has shown consistently that intention to quit is a strong predictor of future quitting. The present study reports the factors encouraging quitting tobacco products in India. SUBJECTS AND METHODS: Cross-sectional data from Wave 1 of the International Tobacco Control Policy Evaluation India Survey conducted in four cities and surrounding rural areas (i.e. Mumbai [Maharashtra], Patna [Bihar], Indore [Madhya Pradesh], and Kolkata [West Bengal]) between August 2010 and December 2011 were analyzed. A total of 8051 tobacco users (15+ years) were randomly sampled from 8586 households: 1255 smokers, 5991 smokeless users, and 805 mixed (smoke and smokeless) users. Validated, standardized questions were asked about current tobacco use, intention to quit, and factors encouraging quitting. RESULTS: Overall, 19.6% of tobacco users intended to quit. Smokers had less intention to quit as compared to smokeless tobacco users whereas mixed users had more intention to quit (odds ratio [OR] =1.48, 95% confidence interval [CI] =1.12-1.97) compared to smokeless tobacco users. Highly educated people were more likely to report intention to quit (OR = 1.82, 95% CI = 1.09-3.02) compared to less educated. Advice by doctors to quit tobacco had a strong impact on intention to quit (OR = 1.68, CI = 1.29-2.15). Tobacco users who were exposed to antitobacco messages at work places (OR = 1.74, CI = 1.23-2.46), at restaurants (OR = 1.65, CI = 1.12-2.43), bars (OR = 1.81, CI = 1.07-3.06), on public transportation (OR = 2.14, CI = 1.49-3.08) and on tobacco packages (OR = 1.77, CI = 1.29-2.14) also expressed greater intention to quit tobacco use. CONCLUSION: Around one-fifth of tobacco users in India intended to quit tobacco use. Higher education, doctor's advice, and antitobacco messages were positively associated with users' intention to quit tobacco. [ABSTRACT FROM AUTHOR]