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SMOKING

ARACK, R and BLAKE, H and others. An evaluation of the effects of the smoking ban at an acute NHS trust. International Journal of Health Promotion and Education Vol 47, No 4 - 2009: 112-118
Abstract: The purpose of this study was to explore the effects of a complete smoking ban at an NHS Trust focusing on the attitudes, compliance and smoking behaviour of NHS staff on the smoke-free NHS policy. Questionnaires were distributed to staff 17 months after the Trust implemented its smoking ban and two months before the nationwide smoking ban. Although the study showed that a significant proportion of respondents were in favour of the band (78.3%), results also suggested that many staff felt that designated areas should be provided for those who smoked. Positive staff attitudes towards the ban did not seem to affect actual behaviour as staff continued to smoke on hospital grounds. The study suggest that more work is needed to enforce the smoke-free policy and increase awareness of workplace smoking cessation interventions in order to change smoking behaviour in this workplace.

BORLAND, T and AMOS, A. An exploratory study of the perceived impact of raising the age of cigarette purchase on young smokers in Scotland. Public Health Vol 123, No 10 - October 2009: 673-679
Abstract: Objectives: To explore the perceived impact among a group of Scottish 16- and 17-year-old school leavers of the recent increase in age of sale of cigarettes (1 October 2007) from 16 to 18 years on their ability to purchase and access cigarettes. Study design: Qualitative interviews with friendship pairs. Methods: Twelve paired qualitative interviews conducted in June 2008. Participants were 16- and 17-year-old early school leavers undertaking a work skills programme in Lothian who smoked at least one cigarette per week. Data were analysed thematically. Results: The increase in the age of sale affected participants' perceived ability to purchase cigarettes to differing extents. Three groups were identified: those who were unable to purchase cigarettes either before or after the change in the law, those who could purchase cigarettes before the change in the law but who found it very difficult to do so afterwards, and those who were relatively unaffected as they could purchase cigarettes both before and after the age was raised to 18 years, mostly from small corner shops. Smoking was embedded in participants' social lives and networks. Thus, there was only a limited impact upon their reported ability to access cigarettes due to the availability of alternative social sources of cigarettes from family, friends and others. Conclusions: This exploratory study raises questions about the nature and extent of the impact of raising the age of sale on young smokers' ability to purchase and access cigarettes. The importance of alternative social sources of cigarettes highlights the need for further research to investigate whether the change in legislation had less of an impact on more disadvantaged adolescent smokers, as they are likely to have greater access to alternative sources from their family, friends and community.

DUKE, Jennifer C and VALLONE, Donna M and others. Increasing youths' exposure to a tobacco prevention media campaign in rural and low-population-density communities. American Journal of Public Health Vol 99, No 12 - December 2009: 2210-2216
Abstract: Objectives: We examined the effectiveness of a program to increase exposure to national "truth" tobacco countermarketing messages among youths in rural and low-population-density communities. Methods: A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of "truth" messages. Results: Confirmed awareness of "truth" increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign's messages. Conclusions: Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence- based tobacco prevention campaigns.

DURKIN, Sarah J and BIENER, Lois and others. Effects of different types of antismoking ads of reducing disparities in smoking cessation among socioeconomic subgroups. American Journal of Public Health Vol 99, No 12 - December 2009: 2217-2223
Abstract: Objectives: We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups. Methods: We followed 1491 adult smokers over 24 months and related quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment. Results: On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio [OR]=1.11; 95% confidence interval [CI]=1.00, 1.23; P<.05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR=1.14; 95% CI 1.02, 1.29; P<.05), which was greater among respondents with low and midsocioeconomic status than among high-socioeconomic status groups. Conclusions: Emotionally evocative ads and ads that contain personalized stories about the effects of smoking and quitting hold promise for efforts to promote smoking cessation and reduce socioeconomic disparities in smoking.

HAMMOND, David and DOCKRELL, Martin and others. Cigarette pack design and perceptions of risk among UK adults and youth. European Journal of Public Health Vol 19, No 6 - December 2009: 631-637
Abstract: It is illegal in the EU for tobacco packaging to suggest that some cigarettes are safer than others. This study examined consumer perceptions of cigarette packs in the UK, including perceptions of 'plain packaging', in which colour and other design elements are removed, whilst retaining the brand name. 516 adult smokers and 806 youth aged 11-17 participated in an online survey. Participants were asked to compare pairs of cigarette packs on five measures: taste, tar delivery, health risk, attractiveness and either ease of quitting (adult smokers) or brand they would choose if trying smoking (youth). Adults and youth were significantly more likely to rate packs with the terms 'smooth', 'silver' and 'gold' as lower tar, lower health risk and either easier to quit smoking (adults) or their choice of pack if trying smoking (youth). For example, more than half of adults and youth reported that brands labelled as 'smooth' were less harmful compared with the 'regular' variety. The colour of packs was also associated with perceptions of risk and brand appeal: compared with Marlboro packs with a red logo, Marlboro packs with a gold logo were rated as lower health risk by 53% and easier to quit by 31% of adult smokers. Plain packs significantly reduced false beliefs about health risk and ease of quitting, and were rated as significantly less attractive and appealing to youth for trying smoking. Current regulations have failed to remove potentially misleading information from tobacco packaging. Removing colours from packs (plain packaging), as well as terms such as 'smooth' 'gold' and 'silver' would significantly reduce false beliefs and increase compliance with existing legislation.

HUTCHINSON, J and PICKETT, K E and others. Smoking in pregnancy and disruptive behaviour in 3-year-old boys and girls : an analysis of the UK Millennium Cohort Study. Journal of Epidemiology and Community Health Vol 64, No 1 - January 2010: 82-88
Abstract: Background: Maternal smoking during pregnancy has been consistently associated with disruptive behaviour in male offspring; however, results for girls are inconsistent and little is known about emergent patterns in young children. Additionally, it is unclear whether maternal smoking is independently associated in offspring with hyperactivity-inattention or only when it co-occurs with conduct problems. Further, few studies have controlled for a broad range of maternal psychosocial problems. Methods: Associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour were analysed in more than 13000 3-year-old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity-inattention problems were assessed using the Strength and Difficulties Questionnaire. Results: Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity-inattention problems compared with sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, OR 1.92 (95% CI 1.29 to 2.86); and hyperactivity-inattention only for sons of light or heavy smokers, OR 1.79 (95% CI 1.27 to 2.51) and 1.64 (1.10 to 2.46). Daughters of light or heavy smokers were at significant risk of conduct-only problems, OR 1.73 (95% CI 1.14 to 2.61) and 1.73 (1.06 to 2.83). Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct 0.61(0.39 to 0.97) or co-occurring problems 0.26(0.08 to 0.82), although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors. Conclusions: Associations between maternal smoking during pregnancy and disruptive behaviour in 3-year-old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.

JARVIS, M J and MINDELL, J and others. Smoke-free homes in England: prevalence, trends and validation by cotinine in children. Tobacco Control Vol 18, No 6 - December 2009: 491-495
Abstract: Objective: To examine the prevalence of smoke-free homes in England between 1996 and 2007 and their impact on children’s exposure to second-hand smoke via a series of annual cross-sectional surveys: t the Health Survey for England. These comprised nationally representative samples of non-smoking children aged 4-15 (n = 13 365) and their parents interviewed in the home. Main outcome measures were cotinine measured in saliva, smoke-free homes defined by "no" response to "Does anyone smoke inside this house/flat on most days?", self-reported smoking status of parents and self-reported and cotinine validated smoking status in children. Results: The proportion of homes where one parent was a smoker that were smoke free increased from 21% in 1996 to 37% in 2007, and where both parents were smokers from 6% to 21%. The overwhelming majority of homes with non-smoking parents were smoke free (95% in 1996; 99% in 2007). For children with non-smoking parents and living in a smoke-free home the geometric mean cotinine across all years was 0.22 ng/ml. For children with one smoking parent geometric mean cotinine levels were 0.37 ng/ml when the home was smoke free and 1.67 ng/ml when there was smoking in the home; and for those with two smoking parents, 0.71 ng/ml and 2.46 ng/ml. There were strong trends across years for declines in cotinine concentrations in children in smoke-free homes for the children of smokers and non-smokers. Conclusions: There has been a marked secular trend towards smoke-free homes, even when parents themselves are smokers. Living in a smoke-free home offers children a considerable, but not complete, degree of protection against exposure to parental smoking.

LARSEN, Jeff T and COHEN, Lee M. Smoking attitudes, intentions, and behavior among college student smokers : positivity outweighs negativity. Addiction Research and Theory Vol 17, No 6 - December 2009: 637-649
Abstract: Smokers’ attitudes toward smoking tend to be characterized by ambivalent feelings of positivity and negativity, thereby raising the question of whether the effect of smoking attitudes on smoking behavavior is mediated by the absence of negativity and/or by the presence of positivity. In two studies, undergraduate smokers rated how positive and negative they felt about smoking and reported how much they had smoked the previous month. Study 2's participants also reported how much they intended to smoke over the next month and, at 1-month follow-up, how much they actually had smoked during the previous month. Positivity, but not negativity, toward smoking predicted past smoking behavior, concurrent intentions to smoke, and future smoking behavior. Results suggest that weakening positive reactions toward smoking may deter smoking more than strengthening negative reactions does. Potential mechanisms are discussed, as well as the prospect of increasing negativity's deterrent effect.

LOCHBEUHLER, Kirsten and ENGELS, Rutger C M E and others. Influence of smoking cues in movies on craving among smokers. Addiction Vol 104, No 12 - December 2009: 2102-2109
Abstract: Aims: Research has shown that smoking-related cues are important triggers for craving. The objective of the present study was to test whether smoking cues in movies also function as triggers to evoke craving. To accomplish this, we conducted a pilot study in which we examined smokers' reactivity to smoking cues from a particular movie in a common cue-reactivity paradigm using pictures. In the main study, we tested whether smokers who are confronted with smoking characters in a movie segment have a greater desire to smoke than smokers confronted with non-smoking characters. Design: Using an experimental design, participants were assigned randomly to one of two movie conditions (smoking versus non-smoking characters). Setting: In a laboratory, that reflected a naturalistic setting, participants watched a 41-minute movie segment. Participants: A total of 65 young adults who smoked on a daily basis participated in the experiment. Measurements: Craving was assessed before and after watching the movie. Findings: The pilot study revealed that pictures of smoking characters had strong effects on craving. However, when smokers actually watched a movie segment, no differences in craving were found between those who watched smoking characters and those who watched non-smoking characters. This finding was not affected by baseline craving, the time of the last cigarette smoked and daily smoking habits. Conclusions: No effect of smoking cues in movies on craving was found, in contrast with research supporting the cue-craving link. Thus, if replicated, this might indicate that smoking cues in such contexts do not affect smokers' desire to smoke as expected.

MILLER, Caroline L and HILL, David J and others. Response of mass media, tobacco industry and smokers to the introduction of graphic cigarette pack warnings in Australia. European Journal of Public Health Vol 19, No 6 - December 2009: 644-649
Abstract: In the year 2006, Australia introduced graphic cigarette packet warnings. Previous warnings were text only. New warnings include one of 14 pictures, many depicting tobacco-related pathology. This study monitored the roll-out of the health policy initiative using multiple methodologies. Print media coverage of new pack warnings was observed over 3 years. Story content was coded as positive (supportive of pack warnings), neutral or negative. An observational study of small random sample of metropolitan stores (n = 16) over 7 months measured the pace of the roll-out in shops. Once new packs were readily available in stores, smokers (n = 152) were intercepted in city streets and asked about their reactions. Of the 67 media stories, 85% were positive or neutral about the new warnings and 15% were negative. Supportive content presented health benefits. Unsupportive content presented industry arguments. After the legislative change, it took 2 months before any new packs appeared in stores. After 6 months, the majority carried them. Newest images had highest recall among smokers. About 60% said new warnings detracted from the look of their brand. About 51% felt the increased risk of dying from smoking-related illness. About 38% felt motivated to quit. Plans by government to introduce graphic warnings were delayed up to 2 years, apparently by heavy industry lobbying. Actual widespread appearance in shops occurred several months after the implementation date. While media coverage of the new warnings reported the industry arguments against them, the balance of coverage was overwhelmingly positive. Smokers' initial reactions were in line with tobacco control objectives.

ORBELL, Sheina and LIDIERTH, Patrick and others. Social-cognitive beliefs, alcohol, and tobacco use: a prospective community study of change following a ban on smoking in public places. Health Psychology Vol 28, No 6 - November 2009: 753-761
Abstract: Objective: To examine social-cognitive change associated with behavior change after the introduction of a smoke-free public places policy. Design: Adults (N = 583) who use public houses licensed to sell alcohol (pubs) completed questionnaires assessing alcohol and tobacco consumption and social-cognitive beliefs 2 months prior to the introduction of the smoking ban in England on July 1, 2007. Longitudinal follow-up (N = 272) was 3 months after the introduction of the ban. Main outcome measures: Social-cognitive beliefs, daily cigarette consumption, and weekly alcohol consumption. Results: Smokers consumed considerably more alcohol than did nonsmokers at both time points. However, a significant interaction of Smoking Status × Time showed that while smokers had consumed fewer units of alcohol after the ban, nonsmokers showed an increase over the same period. There was a significant reduction in number of cigarettes consumed after the ban. Subjective norms concerning not smoking, and perceived severity of smoking-related illness increased across time. Negative outcomes associated with not smoking were reduced among former smokers and increased across time among smokers. Regression analyses showed that changes in subjective norm and negative outcome expectancies accounted for significant variance in change in smoking across time. Conclusion: Results suggest that the smoking ban may have positive health benefits that are supported by social-cognitive change.

TE POEL, Fam and BOLMAN, Catherine and others. Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months. Health Education Research Vol 24, No 6 - December 2009: 930-940
Abstract: To date, few Internet-delivered smoking cessation interventions have been tested. This study tested the efficacy, understandability, credibility and personal relevance of an e-mail-delivered computer-tailored smoking cessation intervention. It included tailored action plan feedback, as recent studies have demonstrated the importance of planning in facilitating quitting smoking. Participants (Dutch adults) were randomly assigned to the intervention (computer-tailored e-mail; N?=?224) or the control group (generic, non-tailored e-mail; N?=?234). The results 6 months after baseline (N?=?195) showed that significantly more participants in the intervention group reported not having smoked in the last 24 hours (21.5%) and 7 days (20.4%) in contrast with participants in the control group (9.8 and 7.8%, respectively). Intention-to-treat analyses revealed similar results, though overall lower quitting percentages. Furthermore, participants in the intervention group appreciated the computer-tailored e-mail significantly more in terms of understandability, credibility and personal relevance. Hence, the computer-tailored intervention is effective for the Dutch smoking population motivated to quit smoking. Further research is needed into the efficacy of the intervention for smokers who are not motivated to quit smoking and into the benefits of (multiple) e-mail-delivered tailored letters with tailored action plan feedback over and above tailoring without action plan feedback.

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