This paper measures tobacco polices in statewide representative samples of secondary and mixed schools in Victoria, Australia and Washington, US (N = 3,466 students from 285 schools) and tests their association with student smoking. Results from confounder-adjusted random effects (multi-level) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy (odds ratio (OR) = 0.45; 95% CI: 0.25 to 0.82; p = 0.009). There was no clear evidence in this study that a comprehensive smoking ban, harsh penalties, remedial penalties, harm minimization policy or abstinence policy impact on any of the smoking outcomes. Full article

To assess the number and percentage of acute care hospitals in the U.S. that have adopted smoke-free hospital campus (SFHC) policies, researchers conducted an assessment from January 2008 to May 2008 of available data on SFHC policy adoption in each state. Slightly more than one third (34.4%) of acute care, non-Federal hospitals had adopted such policies, with wide variation of policy adoption between states. Full article

The impact of four effective population-based interventions, focusing on individual behavioural change and aimed at reducing tobacco-attributable morbidity, was assessed by modeling with respect to effects on reducing prevalence rates of cigarette smoking, population-attributable fractions, reductions of disease-specific morbidity and its cost for Canada. Results revealed that an implementation of a combination of four tobacco policy interventions would result in a savings of 33,307 acute care hospital days, which translates to a cost savings of about $37 million per year in Canada. Assuming 40% coverage rate for all individually based interventions, the two most effective interventions, in terms of avoidable burden due to morbidity, would be nicotine replacement therapy and physicians’ advice, followed by individual behavioural counselling and increasing taxes by 10%. Although a sizable reduction in the number of hospital days and accumulated costs could be achieved, overall these interventions would reduce less than 3% of all tobacco-attributable costs in Canada. Full article

Background: Tobacco smoking continues to be a major preventable cause of death and disease and therefore tobacco control research is extremely important. However, research in this area is often hampered by a lack in funding and there is a need for scientometric techniques to display research efforts. Methods: The present study combines classical bibliometric tools with novel scientometric and visualizing techniques in order to analyse and categorise research in the field of tobacco control. Results: All studies related to tobacco control and listed in the ISI database since 1900 were identified by the use of defined search terms.Using bibliometric approaches, a continuous increase in qualitative markers such as collaboration numbers or citations were found for tobacco control research. The combination with density equalizing mapping revealed a distinct global pattern of research productivity and citation activity. Radar chart techniques were used to visualize bi- and multilateral research cooperation and institutional cooperation. Conclusions: The present study supplies a first scientometricapproach that visualises research activity in the field of tobacco control. It provides data that can be used for funding policy and the identification of research clusters. Full article

Background: Psychology and addiction research have found that cigarette smokers react with subjective and automatic responses to stimuli associated with smoking. This study examines the association between the number of cigarettes smokers consume per month and their response to cues derived from peer and psychological distress. Methods: We studied 1,220 adult past and current smokers drawn from a national face-to-face interview survey administered in 2004. We defined two types of cues possibly triggering a smoker to have a cigarette: peer cues and psychological cues. We used ordinary least square linear regressions to analyze smoking amount and response to peer and psychological distress cues. Results: We found a positive association between amount smoked and cue response: peer cues (1.06, 95%CI: 0.74-1.38) and psychological cues (0.44, 95%CI = 0.17-0.70). Response to psychological cues was lower among male smokers (–1.62, 95%CI = –2.26- –0.98), but response to psychological cues were higher among those who had senior high school level educations (0.96, 95%CI = 0.40-1.53) and who began smoking as a response to their moods (1.25, 95%CI = 0.68-1.82). Conclusions: These results suggest that both peer cues and psychological cues increase the possibility of contingent smoking, and should, therefore, be addressed by anti-smoking policies and anti-smoking programs. More specifically, special attention can be paid to help smokers avoid or counter social pressure to smoke and to help smokers resist the use of cigarettes to relieve distress. Full article

Maternal smoking during pregnancy is a major public health problem that has been associated with numerous short- and long-term adverse health outcomes in offspring. However, characterizing smoking exposure during pregnancy precisely has been rather difficult: self-reported measures of smoking often suffer from recall bias, deliberate misreporting, and selective non-disclosure, while single bioassay measures of nicotine metabolites only reflect recent smoking history and cannot capture the fluctuating and complex patterns of varying exposure of the fetus. Recently, Dukic et al. [1] have proposed a statistical method for combining information from both sources in order to increase the precision of the exposure measurement and power to detect more subtle effects of smoking. In this paper, we extend the Dukic et al. [1] method to incorporate individual variation of the metabolic parameters (such as clearance rates) into the calibration model of smoking exposure during pregnancy. We apply the new method to the Family Health and Development Project (FHDP), a small convenience sample of 96 predominantly working-class white pregnant women oversampled for smoking. We find that, on average, misreporters smoke 7.5 cigarettes more than what they report to smoke, with about one third underreporting by 1.5, one third under-reporting by about 6.5, and one third underreporting by 8.5 cigarettes. Partly due to the limited demographic heterogeneity in the FHDP sample, the results are similar to those obtained by the deterministic calibration model, whose adjustments were slightly lower (by 0.5 cigarettes on average). The new results are also, as expected, less sensitive to assumed values of cotinine half-life. Full article

This study presents self-reported and serum cotinine measures of exposure to secondhand smoke (SHS) for nonsmoking children, adolescents, and adults. Estimates are disaggregated by time periods and sociodemographic characteristics based on analyses of the 1999-2006 National Health and Nutrition Examination Survey. Self-reported exposure rates are found to be highest for children, followed by adolescents and adults. Important differences in exposure are found by socioeconomic characteristics. Using serum cotinine to measure exposure yields much higher prevalence rates than self-reports. Rates of SHS exposure remain high, but cotinine levels are declining for most groups. Full article

Implementing the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) relies heavily on enforcement. Little is known of the way different enforcement agencies operate, prioritise or network. A questionnaire was sent to representatives of the International Federation of Environmental Health (IFEH) in 36 countries. Tobacco control was given low priority. Almost two thirds did not have any tobacco control policy. A third reported their organisation had worked with other agencies on tobacco control. Obstacles to addressing tobacco control included a lack of resources (61%) and absence of a coherent strategy (39%). Full article

This study’s goal was to characterize physical and social environments of stand-alone bars associated with indoor smoking despite California’s smokefree workplace law. In a random sample of 121 stand-alone bars in San Francisco, trained observers collected data on patrons, staff, neighborhood, indoor settings and smoking behaviors. Using bivariate (chi-square) and hierarchical linear modeling analyses, we identified four correlates of patrons’ indoor smoking: 1) bars serving predominantly Asian or Irish patrons, 2) ashtrays, 3) bartender smoking, and 4) female bartenders. Public health officials charged with enforcement of smokefree bar policies may need to attend to social practices within bars, and heighten perceptions of consistent enforcement of smokefree workplace laws. Full article

A school-based environmental program to reduce adolescent smoking was conducted in 20 schools (10 intervention; 10 control) in south central Louisiana. The 9th grade cohort (n = 4,763; mean age = 15.4 yrs; 51% female; 61% Caucasian; 30-day smoking prevalence at baseline = 25%) was followed over four years for 30-day smoking prevalence with the school as the unit of analysis. Although prevalence decreased in intervention schools and increased in control schools in Year 2 the significant difference between the two groups at baseline was not overcome by the intervention and increases in prevalence were observed in both groups in Years 3 and 4. The higher the percentage of white students in a school the higher the prevalence rates regardless of intervention/control status. Boys’ and girls’ smoking rates were similar. These outcome data, student feedback and process evaluation provide a basis for continuing to create more innovative adolescent tobacco control programs. Full article

Smoking prevention efforts should either prevent target groups from becoming susceptible to smoking or prevent susceptible adolescents from progressing to becoming regular smokers. To describe the prevalence of susceptibility to smoking among never smoker students from cities that applied the GYTS in 2003 and 2006. The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 12-15 years enrolled in public, private, and technical schools. The survey was undertaken at 399 schools in 9 cities. The GYTS surveyed 33,297 students during the academic years 2003-04 and 2006-07. Among never smokers, about 25% are likely to initiate smoking in the next 12 months. There are no differences in susceptibility to smoking by gender. When comparing results from 2003 and 2006, the susceptibility index has not changed, but for one city. The GYTS results are useful for monitoring susceptibility to smoking among adolescents and provide evidence for strengthening the efforts of tobacco control programs in Mexico. Full article

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization’s initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p≤0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted. Full article

The ATTEMPT cohort study is multi-national, longitudinal study of smokers intending to quit recruited in the U.S.A., Canada, U.K. and France. Data on demographics, medical history, body mass index (BMI), weight concerns and smoking status were collected at baseline and after six months. A total of 2,009 subjects provided data at baseline and 1,303 at six months. High baseline BMI was associated with recent quit attempts, high weight concerns and high cigarette consumption. Weight gain was associated with low income, being single and number of cigarette-free days, but not with baseline weight concerns and confidence in preventing weight gain. Quit attempts were more frequent in subjects with a high baseline BMI and low weight concerns. Full article

This investigation is a secondary analysis of demographic, smoking, and depression information in a global sample of Spanish- and English-speaking smokers who participated in a series of randomized controlled smoking cessation trials conducted via the Internet. The final sample consisted of 17,579 smokers from 157 countries. Smoking profiles were similar across languages and world regions and consistent with characteristics of participants in traditional smoking cessation studies. Participants were predominantly Spanish-speakers, evenly divided between men and women and relatively few indicated using traditional smoking cessation methods (e.g., groups or medication). This study demonstrates that substantial numbers of smokers from numerous countries seek Web-based smoking cessation resources and adds to the growing support for Web-assisted tobacco interventions as an additional tool to address the need for global smoking cessation efforts. Full article

This investigation is aimed at providing information about structural and organizational characteristics of smoking cessation services (SCS) set up within the Italian National Health Service. Local health units and hospitals are the main institutions connected with SCS which are mainly located within the Department of Drug Addiction and the Department of Lung and Breath Care. SCS provide different tobacco-use cessation programs. Although pharmacotherapy is always used, a combination of therapeutic treatments is highly preferred. This study shows the importance of maintaining a national coordination among different SCS supporting their activity and encouraging the start up of additional services throughout the country. Full article

Antismoking helplines have become an integral part of tobacco control efforts in many countries, including Italy. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of antismoking helplines. However, information on how these helplines operate in actual practice is not often readily available. This paper provides an overview of the Italian Antismoking Helpline, an increasingly popular telephone service for tobacco problems operating in Italy since 2000. As many states, regions and nations are contemplating various telephone programs as part of large scale anti-tobacco campaigns, this paper briefly discusses the reasons the helpline is well suited to lead the cessation component of a comprehensive tobacco control program, how it operates and how it can be used in conjunction with other tobacco control activities. The Italian Antismoking Helpline provides Italians with free services that include counselling, cessation related information, self help quit kits and current legislation information. The helpline is promoted statewide by media campaigns, health care providers, local tobacco control programs and public school system. The Helpline is centrally operated through the Istituto Superiore di Sanità and it has served over 17.000 tobacco users and others. Full article

The national truth© campaign has exposed U.S. youth to antismoking messages since 2000. Tobacco industry–sponsored campaigns, such as “Think. Don’t Smoke” (TDS), have also aired nationally. We examine the effects of recall of the truth^© and TDS campaigns on changes in tobacco-related beliefs, intentions, and smoking initiation in a longitudinal survey of U.S. youth. Recall of truth^© was associated with increased agreement with antismoking beliefs, decreased smoking intentions, and lower rates of smoking initiation. Recall of TDS was associated with increased intentions to smoke soon but was not significantly associated with tobacco beliefs or smoking initiation among youth overall. Full article

Tobacco smoke contains many toxic, carcinogenic and mutagenic chemicals, as well as stable and unstable free radicals and reactive oxygen species (ROS) in the particulate and the gas phase with the potential for biological oxidative damage. Epidemiological evidence established that smoking is one of the most important extrinsic factor of premature morbidity and mortality. The objective of this study was to investigate oxidative and carcinogenic mechanisms of tobacco and synergistic action with other respirable particles in the respiratory system of smokers. Electron Paramagnetic Resonance (EPR) and spin- trapping techniques were used to study stable free radicals in the cigarette tar, and unstable superoxide anion (O₂^·-) and hydroxyl (HO^·) radicals in the smoke Results showed that the semiquinone radical system has the potential for redox recycling and oxidative action. Further, results proved that aqueous cigarette tar (ACT) solutions can generate adducts with DNA nucleobases, particularly the mutagenic 8-hydroxy-2’-deoxyguanosine (a biomarker for carcinogenesis).Also, we observed synergistic effects in the generation of HO^·, through the Fenton reaction, with environmental respirable particles (asbestos fibres, coal dust, etc.) and ambient particulate matter (PM), such as PM₁₀, PM_2.5 and diesel exhaust particles (DEP). The highest synergistic effects was observed with the asbestos fibres (freshly grounded), PM_2.5 and DEP. Finally, we discuss results from our previous study of conventional cellulose acetate filters and “bio-filters” with hemoglobin impregnated activated carbon, which showed that these filters do not substantially alter the free radical content of smoke in the particulate and in the gaseous phase. Full article

Childhood exposure to secondhand smoke (SHS) is a serious threat to public health and can be influenced by parental lifestyle habits and beliefs. Taking the above into account we aimed at locating predictors of parental induced exposure to SHS in the house and family car among 614 children who visited the emergency department of two large pediatric hospitals in Athens, Greece. The multivariate analysis revealed that the factors found to mediate household exposure to paternal SHS were the number of cigarettes smoked per day (O.R 1.13, p<0.001) while, having a non-smoking spouse had a protective effect (O.R 0.44, p=0.026). Maternally induced household SHS exposure was related to cigarette consumption. For both parents, child exposure to SHS in the family car was related to higher numbers of cigarettes smoked (p<0.001), and for fathers was also more often found in larger families. Additionally, lower educated fathers were more likely to have a spouse that exposes their children to SHS inside the family car (O.R 1.38 95%C.I: 1.04-1.84, p=0.026). Conclusively, efforts must be made to educate parents on the effects of home and household car exposure to SHS, where smoke free legislation may be difficult to apply. Full article

Tobacco cessation telephone quitlines are an effective population-wide strategy for smoking cessation, but funding for this service varies widely. State-level factors may explain this difference. Data from the 2005 and 2006 North American Quitline Consortium surveys and from publicly available sources were analyzed to identify factors that predict higher levels of per capita quitline funding. The best-fitting multivariate model comprised higher per capita tobacco control funding (2005 p = 0.004, 2006 p=0.000), not securitizing Master Settlement Agreement payments (2005 p = 0.008, 2006 p=0.01), and liberal political ideology (2005 p = 0.002, 2006 p=0.002). Select state-level factors appear to have influenced per capita quitline services funding. These findings can help inform advocates and policymakers as they advocate for quitlines and tobacco control funding. Full article

Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113) were surveyed pre- and post-implementation. Administrators reported more support and less difficulty than anticipated. Actual cost was 10-50% of anticipated cost. Few negative effects and numerous positive effects on employee performance and retention were reported. The results may be of interest to hospital administrators and demonstrate that state legislation can play a positive role in facilitating broad health-related policy change. Full article

The number of smokers in developing countries is expected to increase as markets in high income countries begin to decline and multinational tobacco companies shift their marketing efforts to lower income countries. We determined the prevalence and distribution of smoking in a cross-sectional study of 1,015 urban civil servants in Accra, Ghana (82.7% participation rate) in 2006. The results were compared to the findings from a previous study in 1976 of civil servants in Accra to estimate the changes in smoking patterns over a 30 year period. In our 2006 study, the smoking prevalence rate was 6.1% (95% CI: 4.8-8.9) and 0.3% (95% CI: 0.006-1.4) in men and women respectively. These figures were dramatically lower than the rates of 32% and 5.9% reported for men and women respectively in the previous study. Knowledge of the health risks associated with smoking may have contributed to the lower rates. Full article

The recent interest in cigarette smoking among university students has brought attention to problems concerning opinions, attitudes, prevention, health education, policy formulation and implementation. This survey research tested five hypotheses on the views of college students about smoking in school hallways and cafeteria, compliance with anti smoking laws, considering cigarette smoking as an expression of freedom of choice, teachers’ smoking in classrooms and in their offices, and school administration’s policy on enforcing the law. Hypothesized differences between students’ views on the issues according to gender, smoking status and years at school were investigated. Data were obtained from 3,659 students attending six universities in Ankara, Turkey. The study findings provided support for all the hypothesized differences (except a single issue). Males and females differed significantly on all the issues studied. The majority of nonsmoking students have anti-smoking views in regards of the studied issues as compared to regular and occasional smokers. Smokers and nonsmokers markedly disagree on banning cigarette smoking in the cafeteria and hallways. However, the majority of students are against teachers’ smoking in classrooms and in their offices with the doors open. Although most students want a smoke free environment, there is no active-anti smoking policy on smoking by universities. Findings point out the need for campus-wide effective smoking prevention programs, as well as cessation programs and services for the students. Full article

This study evaluated the effects of tobacco PUP (Purchase, Use and Possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and reducing minors’ access to commercial sources of tobacco, and the condition for the control group involved only efforts to reduce minors’ access to commercial sources of tobacco. The present study found that adolescents in the control group had a significantly greater increase in the percentage of youth who smoked 20 or more cigarettes per day when compared to the experimental group. Full article

Aims: To examine existing evidence on the effectiveness of interventions that are designed to prevent the illegal sale of tobacco to young people. The review considers specific sub-questions related to the factors that might influence effectiveness, any differential effects for different sub-populations of youth, and barriers and facilitators to implementation. Methods: A review of studies on the impact of interventions on young people under the age of 18 was conducted. It included interventions that were designed to prevent the illegal sale of tobacco to children and young people. The review was conducted in July 2007, and included 20 papers on access restriction studies. The quality of the papers was assessed and the relevant data was extracted. Results: The evidence obtained from the review indicates that access restriction interventions may produce significant reductions in the rate of illegal tobacco sales to youth. However, lack of enforcement and the ability of youth to acquire cigarettes from social sources may undermine the effectiveness of these interventions. Conclusions: When access interventions are applied in a comprehensive manner, they can affect young people’s access to tobacco. However, further research is required to examine the effects of access restriction interventions on young people’s smoking behaviour. Full article

According to World Health Organisation figures, 30% of all cancer deaths, 20% of all coronary heart diseases and strokes and 80% of all chronic obstructive pulmonary disease are caused by cigarette smoking. Environmental Tobacco Smoke (ETS) exposure has also been shown to be associated with disease and premature death in non-smokers. In response to this environmental health issue, several countries have brought about a smoking ban policy in public places and in the workplace. Countries such as the U.S., France, Italy, Ireland, Malta, the Netherlands, Sweden, Scotland, Spain, and England have all introduced policies aimed at reducing the population exposure to ETS. Several investigations have monitored the effectiveness of these smoking ban policies in terms of ETS concentrations, human health and smoking prevalence, while others have also investigated a number of alternatives to smoking ban policy measures. This paper reviews the state of the art in research, carried out in the field of ETS, smoking bans and Tobacco Control to date and highlights the need for future research in the area. Full article

One hundred million deaths were caused by tobacco in the 20^th century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21^st century. Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis with smoking being recognized as its most important causative factor. The most effective available treatment for COPD is smoking cessation. There is mounting evidence that the rate of progression of COPD can be reduced when patients at risk of developing the disease stop smoking, while lifelong smokers have a 50% probability of developing COPD during their lifetime. More significantly, there is also evidence that the risk of developing COPD falls by about half with smoking cessation. Several pharmacological interventions now exist to aid smokers in cessation; these include nicotine replacement therapy, bupropion, and varenicline. All pharmacotherapies for smoking cessation are more efficacious than placebo, with odds ratios of about 2. Pharmacologic therapy should be combined with nonpharmacologic (behavioral) therapy. Unfortunately, despite the documented efficacy of these agents, the absolute number of patients who are abstinent from smoking at 12 months of follow-up is low. Full article

According to the World Health Organization (WHO), tobacco-related disease is the single largest preventable cause of death in the world today, killing around 5.4 million people a year – an average of one person every six seconds. The total number of death caused by tobacco consumption is higher than that of tuberculosis, HIV/AIDS and malaria combined. Unlike other communicable diseases, however, tobacco-related disease has a man-made consensus vector – the tobacco companies that play an active role to promote tobacco consumption, which directly heightens the disease morbidity. Any public health policy designed to curb smoking behavior has to prepare for opposite lobbying actions from tobacco companies that undermine the effects of the health measures. Another unique nature of the tobacco epidemic is that it can be cured, not by medicines or vaccines, but on the concerted actions of government and civil society. Many countries with a history of tobacco control measures indeed experienced a reduction of tobacco consumption. As most of these governments launched a range of measures simultaneously, it is hard to quantify the relative merits of different control strategies that contributed to the drop in the number of smokers. These packages of strategies can come in different forms but with some common features. Political actions with government support, funding, and protection are crucial. Without these, antismoking efforts in any part of the world are unlikely to be successful. Full article

Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually.In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT) and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, school-based programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective. Full article

Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a “gateway” for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking. Full article