Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial

Objective

Observational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates, but field studies lack experimental control. Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a randomized clinical trial involving exposure to modified cigarette packs over a 4-week period. Theories of graphic-warning impact were tested by examining affect toward smoking, credibility of warning information, risk perceptions, quit intentions, warning label memory, and smoking risk knowledge.

Methods

Adults who smoked between 5 and 40 cigarettes daily (N = 293; mean age = 33.7), did not have a contra-indicated medical condition, and did not intend to quit were recruited from Philadelphia, PA and Columbus, OH. Smokers were randomly assigned to receive their own brand of cigarettes for four weeks in one of three warning conditions: text only, graphic images plus text, or graphic images with elaborated text.

Results

Data from 244 participants who completed the trial were analyzed in structural-equation models. The presence of graphic images (compared to text-only) caused more negative affect toward smoking, a process that indirectly influenced risk perceptions and quit intentions (e.g., image->negative affect->risk perception->quit intention). Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings, a process that also indirectly affected risk perceptions and quit intentions (e.g., image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention). Unexpectedly, elaborated text reduced warning credibility. Finally, graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later.

Conclusions

In the first naturalistic clinical trial conducted, graphic warning labels are more effective than text-only warnings in encouraging smokers to consider quitting and in educating them about smoking’s risks. Negative affective reactions to smoking, thinking about risks, and perceptions of credibility are mediators of their impact.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01782053","term_id":"NCT01782053"}}NCT01782053     

Practice and Attitude of Cigarette Smoking: A Community-Based Study

Background

In Saudi Arabia many studies have addressed cigarette smoking from various perspectives. Most of these studies, however, were conducted among males and confined to Riyadh, the capital city. Such limitations have enhanced the need for community-based epidemiological studies that include both genders and various age groups and socio-demographic features, as well as different regions.

Objective

This cross-sectional study aims to assess the prevalence of cigarette smoking and to discuss the association between cigarette smoking habits and socio-demographic factors among community members of the Jazan area in southwest Saudi Arabia.

Methods

A pre-coded questionnaire was designed and tested for data consistency. A well-trained health team was assigned to gather the data from the 30 primary healthcare centers distributed across eight provinces. The response rate was 92.8% (4,326 respondents ≥13 years old). The associations among the subjects'' socio-demographic characteristics were examined by the chi-square test. A multiple logistic regression and odds ratios were calculated as well.

Results

A total of 1,017 (23.5%), 1,042 (24.1%), and 3,284 (75.9%) respondents were, respectively, current smokers (TCS), ever-smokers (TES), and non-smokers (TNS). Though current smokers seem to be more prevalent in urban populations (13.8%) than in rural populations (9.7%), the association of urbanization with a current smoking habit is insignificant.

Conclusion

Having fun, relieving stress, and the influence of parents, particularly of mothers, were the main motives that encouraged participants'' cigarette-smoking habits. This situation was worsened by the fact that accessing cigarettes was either very easy or easy for over 90% of the respondents.     

Smoking,Menthol Cigarettes and All-Cause,Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition Examination Survey (NHANES) and a Meta-Analysis

Background

The U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including menthol, if the scientific evidence indicates harm. Few studies, however, have evaluated the health effects of menthol cigarette use.

Objective

To investigate associations of cigarette smoking and menthol cigarette use with all-cause, cancer and cardiovascular risk in U.S. adults.

Methods

We studied 10,289 adults ≥ 20 years of age who participated in the National Health and Nutrition Examination Survey from 1999-2004 and were followed through December 2006. We also identified studies comparing risk of all-cause mortality, cardiovascular disease and cancer for menthol and nonmenthol cigarette smokers and estimates were pooled using random-effects models.

Results

Fifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The adjusted hazard ratios (95% CI) for former, current nonmenthol and current menthol cigarette smokers compared to never smokers were 1.24 (0.96, 1.62), 2.40 (1.56, 3.71) and 2.07 (1.20, 3.58), respectively, for all-cause mortality; 0.92 (0.62, 1.37), 2.10 (1.02, 4.31) and 3.48 (1.52, 7.99) for cardiovascular mortality; and 1.91 (1.21, 3.00), 3.82 (2.19, 6.68) and 2.03 (1.00, 4.13) for cancer mortality. Using data from 3 studies of all-cause mortality, 5 of cardiovascular disease and 13 of cancer, the pooled relative risks (95% CI) comparing menthol cigarette smokers to nonmenthol cigarette smokers was 0.94 (0.85, 1.05) for all-cause mortality, 1.28 (0.91, 1.80) for cardiovascular disease and 0.84 (0.76, 0.92) for any cancer.

Conclusions

In a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes. In the systematic review, menthol cigarette use was associated with inverse risk of cancer compared to nonmenthol cigarette use with some evidence of an increased risk for cardiovascular disease.     

Implicit Motivational Impact of Pictorial Health Warning on Cigarette Packs

Objective

The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control.

Methods

Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs’ manipulation, and quantified judgments of warnings’ emotional strength and efficacy against smoking.

Findings

Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants’ judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking.

Conclusions

Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change.     

E-Cigarette Use among Smokers with Serious Mental Illness

Background

We examined electronic cigarette (EC) use, correlates of use, and associated changes in smoking behavior among smokers with serious mental illness in a clinical trial.

Methods

Adult smokers were recruited during acute psychiatric hospitalization (N = 956, 73% enrollment among approached smokers) in the San Francisco Bay Area between 2009–2013. At baseline, participants averaged 17 (SD = 10) cigarettes per day for 19 (SD = 14) years; 24% intended to quit smoking in the next month. Analyses examined frequency and correlates of EC use reported over the 18-month trial and changes in smoking behavior by EC use status.

Findings

EC use was 11% overall, and by year of enrollment, increased from 0% in 2009 to 25% in 2013. In multiple logistic regression, the likelihood of EC use was significantly greater with each additional year of recruitment, for those aged 18–26, and for those in the preparation versus precontemplation stage of change, and unlikely among Hispanic participants. EC use was unrelated to gender, psychiatric diagnosis, and measures of tobacco dependence at baseline. Further, over the 18-month trial, EC use was not associated with changes in smoking status or, among continued smokers, with reductions in cigarettes per day.

Interpretation

Within a clinical trial with smokers with serious mental illness, EC use increased over time, particularly among younger adults and those intending to quit tobacco. EC use was unrelated to changes in smoking. The findings are of clinical interest and warrant further study.     

Association between Smoking Status and Obesity in a Nationwide Survey of Japanese Adults

Objective

A positive association between the number of cigarettes smoked per day and obesity has been reported, whereas how other smoking-related indices, such as pack-years and duration of smoking, are related with obesity has been less investigated. We analyzed the age-adjusted cross-sectional association between smoking and obesity in a general Japanese population.

Methods

We used data from a nationwide epidemiological study of Japanese adults (N = 23,106). We compared the prevalence of obesity (defined as body mass index ≥ 25kg/m²) among groups classified by smoking behavior, pack-years, number of cigarettes per day, duration of smoking, and duration and time of smoking cessation.

Results

In men, current smokers had a lower odds ratio (OR) for obesity of 0.80 (95% confidence interval (CI): 0.72–0.88) compared to non-smokers, whereas past smokers had a higher OR of 1.23 (95% CI: 1.09–1.37) compared to current smokers. In women, there were no differences in obesity between the three groups classified by smoking behavior. However, in both sexes, the prevalence of obesity tended to increase with pack-years and the number of cigarettes per day, but not with duration of smoking in current and past smokers. Further, in male smokers, the risks for obesity were markedly higher in short-term heavy smokers compared with long-term light smokers, even with the same number of pack-years. Regarding the impact of smoking cessation, female past smokers who quit smoking at an age > 55-years had an elevated OR of 1.60 (95% CI:1.05–2.38) for obesity.

Conclusions

In a general Japanese population, obesity is progressively associated with pack-years and number of cigarettes per day, but not with the duration of smoking. When investigating the association between obesity and cigarette smoking, the daily smoking burden and the duration of smoking require to be independently considered.     

Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study

Objective

To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both.

Design

Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up.

Data Sources

Direct contact and structured questionnaires by phone or via internet.

Methods

Adults (30–75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence.

Main Outcome Measures

Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily.

Data Synthesis

We used linear and logistic regression, with region as cluster unit.

Results

Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers (adjusted OR 5.19; 95% CI: 3.35–8.02), whereas adding e-cigarettes to tobacco smoking did not enhance the likelihood of quitting tobacco and did not reduce tobacco cigarette consumption. E-smokers showed a minimal but significantly higher increase in self-rated health than other smokers. Non significant differences were found in self-reported serious adverse events (eleven overall).

Conclusions

Adding e-cigarettes to tobacco smoking did not facilitate smoking cessation or reduction. If e-cigarette safety will be confirmed, however, the use of e-cigarettes alone may facilitate quitters remaining so.

Registration Number

NCT01785537.     

Socioeconomic Differentials in Smoking Duration among Adult Male Smokers in China: Result from the 2006 China Health and Nutrition Survey

Background

A smoker’s risk of diseases and death from smoking is closely related to his/her smoking duration. But little is known about the average length of smoking and the association between smoking duration and socio-economic status (SES) among Chinese smokers.

Methods

A sample of male ever smokers (N = 2,637) aged 18+ years was drawn from the 2006 China Health and Nutrition Survey to examine the average length of smoking and socioeconomic differentials in smoking duration. Kaplan-Meier analysis was used to obtain median smoking duration. Log-logistic regression models were employed to estimate the relative duration of smoking, adjusted for demographic characteristics, smoking history, and health status.

Results

Results showed that Chinese male ever smokers aged 18 years and older had a median duration of smoking of 58 years (95% CI: 56–61). Male ever smokers with a lower status job (i.e. farmers, manual and skilled workers, service workers, and office staff) had a significantly longer duration of smoking than those with a professional or administrative job after adjusted for demographic characteristics, smoking history, and health status. Individuals who earned the lowest income and who had no education or were being illiterate smoked for 11% and 14% longer, respectively, relative to those who had the highest income or who had college or above education.

Conclusion

The findings demonstrated the problem of long smoking duration and a pattern of social disparities in smoking duration among Chinese male smokers. Social disparities in smoking behavior may exacerbate the already existing social inequalities in health. Thus, policies and interventions to promote smoking cessation should pay more attention to disadvantaged social groups.     

Intention to Switch to Smokeless Tobacco Use among South African Smokers: Results from the 2007 South African Social Attitudes Survey

Background

Some smokeless tobacco products (SLT) have been shown to be associated with only a fraction of the risks of cigarettes. This study assessed South African smokers’ interest in switching to a hypothetical reduced harm SLT product.

Methods

The 2007 South African Social Attitudes Survey was analysed for 678 exclusive cigarette smokers. Respondents were asked about their perceptions about relative harm of snuff compared to cigarettes, and their interest in switching to snuff if informed it was 99% less harmful than cigarettes.

Results

About 49.7% of exclusive cigarette smokers believed that snuff was equally as harmful as cigarettes; 12.9% thought snuff was more harmful; 5.7% thought snuff was less harmful; while 31.8% did not know if there was a difference in harm between snuff and cigarettes. Approximately 24.2% of exclusive cigarette smokers indicated interest in switching to snuff, with significantly greater interest observed among those exposed to 100% smoke-free work environment. Interest in switching was highest (34.7%) among smokers who believed a priori that using snuff was more harmful than cigarettes, and lowest (14.5%) among those who did not know if there was a difference in harm. In a multi-variable adjusted logistic regression model, this latter group remained less likely to be interested in harm reduction switching (adjusted odds ratio = 0.42; 95% CI: 0.19–0.91).

Conclusion

About a quarter of smokers indicated interest in harm reduction switching to snuff. SLT products have a potential role in reducing the harm from smoking in South Africa, but only if they are not used to circumvent smoke-free laws that have been associated with reduced smoking.     

Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices,North Carolina, 2013

Introduction

Electronic cigarettes (e-cigarettes) are not currently approved or recommended by the Food and Drug Administration (FDA) or various medical organizations; yet, they appear to play a substantial role in tobacco users’ cessation attempts. This study reports on a physician survey that measured beliefs, attitudes, and behavior related to e-cigarettes and smoking cessation. To our knowledge this is the first study to measure attitudes toward e-cigarettes among physicians treating adult smokers.

Methods

Using a direct marketing company, a random sample of 787 North Carolina physicians were contacted in 2013 through email, with 413 opening the email and 128 responding (response rate = 31%). Physicians’ attitudes towards e-cigarettes were measured through a series of close-ended questions. Recommending e-cigarettes to patients served as the outcome variable for a logistic regression analysis.

Results

Two thirds (67%) of the surveyed physicians indicated e-cigarettes are a helpful aid for smoking cessation, and 35% recommended them to their patients. Physicians were more likely to recommend e-cigarettes when their patients asked about them or when the physician believed e-cigarettes were safer than smoking standard cigarettes.

Conclusions

Many North Carolina physicians are having conversations about e-cigarettes with their patients, and some are recommending them. Future FDA regulation of e-cigarettes may help provide evidence-based guidance to physicians about e-cigarettes and will help ensure that patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.     

The Consequences of High Cigarette Excise Taxes for Low-Income Smokers

Background

To illustrate the burden of high cigarette excise taxes on low-income smokers.

Methodology/Principal Findings

Using data from the New York and national Adult Tobacco Surveys from 2010–2011, we estimated how smoking prevalence, daily cigarette consumption, and share of annual income spent on cigarettes vary by annual income (less than $30,000; $30,000–$59,999; and more than $60,000). The 2010–2011 sample includes 7,536 adults and 1,294 smokers from New York and 3,777 adults and 748 smokers nationally. Overall, smoking prevalence is lower in New York (16.1%) than nationally (22.2%) and is strongly associated with income in New York and nationally (P<.001). Smoking prevalence ranges from 12.2% to 33.7% nationally and from 10.1% to 24.3% from the highest to lowest income group. In 2010–2011, the lowest income group spent 23.6% of annual household income on cigarettes in New York (up from 11.6% in 2003–2004) and 14.2% nationally. Daily cigarette consumption is not related to income.

Conclusions/Significance

Although high cigarette taxes are an effective method for reducing cigarette smoking, they can impose a significant financial burden on low-income smokers.     

Predictors of Intention to Smoke among Junior High School Students in Shanghai,China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model

Background

Adolescent smoking is a worldwide problem that is particularly severe in low- and middle-income countries. Many endogenous and environmental factors affect the intention to smoke, so a comprehensive model is needed to understand the significance and relationship of predictors. The study aimed to test the associations among information-motivation-behavioral skills (IMB) model constructs as predictors of intention to smoke in junior high school students in Shanghai, China.

Methods

We conducted a cross-sectional study of 16,500 junior high school students in Shanghai, China. Data on tobacco-related information, motivation, behavioral skills, and behaviors were collected from students. Structural equation model (SEM) was used to assess the IMB model.

Results

The mean age of participants was 13.8 years old (standard deviation = 1.02; range 11–17). The experimental smoking rate among junior high school students was 6.6% and 8.7% of the participants expected that they would be smokers in 5 years. The IMB model provided acceptable fit to the data (comparative fit index = 0.984, root mean square error of approximation = 0.04). Intention to smoke was predicted by behavioral skills (β= 0.670, P < 0.001) and motivation (β= 0.095, P<0.001) among junior high school students.

Conclusion

The IMB model provides a good understanding of the predictors of intention to smoke and it suggests future interventions among junior high school students should focus on improving motivation and behavioral skills.     

Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies

Background and Objectives

Standardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm.

Methods

Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted.

Results

Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample.

Conclusions

The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient.     

Smoking Cessation Increases Short-Term Risk of Type 2 Diabetes Irrespective of Weight Gain: The Japan Public Health Center-Based Prospective Study

Objective

The effect of smoking cessation on the risk of diabetes has been reported previously. However, it is unknown whether the association is influenced by weight gain and other potential risk factors.

Methods

The Japan Public Health Center-Based Prospective Study established in 1990 for Cohort I and in 1993 for Cohort II provided data, and 25,875 men and 33,959 women were analyzed. The response rate to the baseline questionnaire was 80.9%, and 68.4% of the respondents participated both the 5- and 10-year follow-up surveys. Smoking cessation was noted during the initial five years and the development of diabetes was reported in the subsequent five years.

Results

An increased risk was observed among individuals who newly quit smoking compared with never smokers among men (odds ratio (OR) = 1.42, 95% CI = 1.03–1.94) and women (OR = 2.84, CI = 1.53–5.29). The risk of developing diabetes among male new quitters who gained 3 kg or more during the 5-year follow-up did not substantially differ from the risk among male never smokers with less than 3 kg of weight gain or no weight gain, while an increased risk was observed among male new quitters with less or no weight gain (OR = 1.46, 95%CI 1.00–2.14). An insignificant increased risk was observed among male new quitters with a family history of diabetes compared with male never smokers with a family history of diabetes. The risk was more than twice as high for male new quitters who used to smoke 25 or more cigarettes per day compared with never smokers (OR = 2.15, 95%CI: 1.34–3.47).

Discussion

An increased risk of diabetes was implied among individuals who quit smoking. However, the increased risk was not implied among those who gained weight over the 5-years of follow-up. Those who had major risk factors for diabetes or who smoked heavier had a higher risk.     

Association between Smoking and Latent Tuberculosis in the U.S. Population: An Analysis of the National Health and Nutrition Examination Survey

Background

Evidence of an association between cigarette smoking and latent tuberculosis infection (LTBI) is based on studies in special populations and/or from high prevalence settings. We sought to evaluate the association between LTBI and smoking in a low prevalence TB setting using population-based data from the National Health and Nutrition Examination Survey (NHANES).

Methods

In 1999–2000, NHANES assessed LTBI (defined as a tuberculin skin test measurement ≥10 mm) in participants, and those ≥20 years of age were queried regarding their tobacco use and serum cotinine was measured. We evaluated the association of LTBI with self-reported smoking history and smoking intensity in multivariable logistic regression models that adjusted for known confounders (gender, age, birthplace, race/ethnicity, poverty, education, history of BCG vaccination, and history of household exposure to tuberculosis disease).

Results

Estimated LTBI prevalence was 5.3% among those ≥20 years of age. The LTBI prevalence among never smokers, current smokers, and former smokers was 4.1%, 6.6%, and 6.2%, respectively. In a multivariable model, current smoking was associated with LTBI (OR 1.8; 95% CI, 1.1–2.9). The association between smoking and LTBI was strongest for Mexican-American and black individuals. In multivariate analysis stratified by race/ethnicity, cigarette packs per day among Mexican-American smokers and cotinine levels among black smokers, were significantly associated with LTBI.

Conclusions

In the large, representative, population-based NHANES sample, smoking was independently associated with significantly increased risks of LTBI. In certain populations, a greater risk of LTBI corresponded with increased smoking exposure.     

Happiness and Depression in Adolescence after Maternal Smoking during Pregnancy: Birth Cohort Study

Background

Prenatal cigarette smoke exposure may have adverse psychological effects on offspring. The objective was to assess the association between parental smoking during pregnancy and offspring happiness at age 18, as well as depression.

Methodology

Participants were part of a birth cohort study in Pelotas, Brazil (5,249 participants). Happiness was measured by the Subjective Happiness Scale, a Likert-like scale with four questions generating a score from 1 to 7, with ≥ 6 indicating "happiness". Depression was measured using the Mini International Psychiatric Interview.

​Results

About one third of mothers reported having smoked during pregnancy and 4.6% reported smoking 20 or more cigarettes a day. The prevalence of happiness was 32.2% (95% CI 30.8; 33.7), depression 6.8% (95% CI 6.1; 7.6), and simultaneous happiness and depression less than 1%. The prevalence of offspring happiness decreased as smoking in pregnancy increased, even after control for confounding variables, showing an OR = 0.79 [95% CI 0.55; 1.13]. The opposite happened to depression; the prevalence of offspring depression increased as smoking in pregnancy increased (<20 cigarettes/day OR = 1.38 [95% CI 1.03; 1.84] and ≥20 cigarettes/day OR = 2.11[95% CI 1.31; 3.40]. Smoking by the partner was associated with decreased offspring happiness after adjustment for confounders, but did no show association with offspring depression.

Conclusions

Offspring were less likely to be happy and more likely to be depressed if their mother smoked during pregnancy, and less likely to be happy if their father smoked during mother’s pregnancy. Although we can not affirm that this is a “causal pathway”, public policies to reduce smoking in pregnancy could improve the health of the offspring in the short and long term.     

High intensity smoking cessation interventions: Cardiac patients of low socioeconomic status and low intention to quit profit most

Background

Without assistance, smokers being admitted to the hospital for coronary heart disease often return to regular smoking within a year.

Objective

This study assessed the 12-month effectiveness of a telephone and a face-to-face counselling intervention on smoking abstinence among cardiac patients. Differential effects for subgroups varying in their socioeconomic status and intention to quit smoking were also studied.

Methods

A randomised controlled trial was used. During hospital stay, smokers hospitalised for coronary heart disease were assigned to usual care (n = 245), telephone counselling (n = 223) or face-to-face counselling (n = 157). Eligible patients were allocated to an intervention counselling group and received nicotine patches. After 12 months, self-reported continued abstinence was assessed and biochemically verified in quitters. Effects on smoking abstinence were tested using multilevel logistic regression analyses applying the intention-to-treat approach.

Results

Compared with usual care, differential effects of telephone and face-to-face counselling on continued abstinence were found in patients with a low socioeconomic status and in patients with a low quit intention. For these patients, telephone counselling increased the likelihood of abstinence threefold (OR = 3.10, 95?% CI 1.32–7.31, p = 0.01), whereas face-to-face counselling increased this likelihood fivefold (OR = 5.30, 95?% CI 2.13–13.17, p < 0.001). Considering the total sample, the interventions did not result in stronger effects than usual care.

Conclusion

Post-discharge telephone and face-to-face counselling interventions increased smoking abstinence rates at 12 months compared with usual care among cardiac patients of low socioeconomic status and low quit intentions. The present study indicates that patients of high socioeconomic status and high quit motivation require different cessation approaches.

     

The Prevalence of and Factors Associated with Current Smoking among College of Health Sciences Students,Mekelle University in Northern Ethiopia

Background

Tobacco smoking is one of the greatest causes of preventable morbidity and mortality globally, and is responsible for many causes of untimely deaths. This survey was aimed to determine prevalence and factors associated with current smoking among the students of College of Health Sciences, Mekelle University, Ethiopia.

Methods

A cross-sectional study was employed using a structured self-administered questionnaire among College of Health Sciences students in March 2013. A stratified random sampling method was employed to select study participants. Data were entered and analysed using of Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Of the 193 students, 57 (29.5%) of the students were current smokers. Most of the current smokers (89.4%) smoked between 1–10 sticks of cigarette per day. The two main reasons cited for smoking cigarettes were peer pressure (43.9%) and to relieve stress (36.8%). Being female (adjusted OR [AOR] = 0.49; 95% CI: 0.25, 0.95) and Tigre by ethnicity (AOR = 0.32; 95% CI: 0.14, 0.74) were significantly less associated with current smoking. On the other hand, being second year students (AOR = 3.84; 95% CI: 1.41, 10.46), khat chewing (AOR = 8.36; 95% CI: 2.60, 26.85) and taking illicit drugs (AOR = 10.59; 95% CI: 2.77, 40.51) were positively associated with current smoking cigarettes.

Conclusions

The current smoking prevalence among students in College of Health Sciences, Mekelle University is high and therefore, effective smoking prevention and cessation intervention programs are required to reduce smoking among university students.     

Influence of Perceived Parent and Peer Endorsement on Adolescent Smoking Intentions: Parents Have More Say,But Their Influence Wanes as Kids Get Older

Purpose

The aim of the study is to investigate how adolescents'' perception of parents'' and peers'' smoking approval influences adolescent smoking intention, and how age affects this influence in a Swiss sample of adolescents. To know the influence of age can help to develop specific prevention programs tailored to the age groups needs.

Method

in a cross sectional survey, students aged between 11 and 14 from public and private middle schools in the Italian region of Switzerland (Ticino) answered questions on smoking habits, parents'' and peers'' approval and intention to smoke.

Results

peers'' and parents'' approval significantly influence students'' smoking intention, and students'' age significantly moderates this relation: the effect of parents'' approval decreases for older adolescents, while the effect of peers'' approval increases with age. No difference is found between girls and boys, while non-Swiss are more likely to smoke than Swiss students.

Conclusions

as literature suggests, results evidence the role parents play during early adolescence. Prevention programs targeting parent-child communication in early adolescence for preventing children''s tobacco consumption are strongly supported.     

Changes in the Prevalence of Tobacco Consumption and the Profile of Spanish Smokers after a Comprehensive Smoke-Free Policy

Background

A partial smoke-free regulation in Spain was introduced on January 1, 2006, which was subsequently amended to introduce a comprehensive smoke-free policy from 2 January 2011 onward. The objective of this study was to compare the prevalence of tobacco consumption in Spain and the profile of smokers before (2006) and after (2011) the comprehensive smoking ban passed in 2010.

Methods

Two independent, cross-sectional, population-based surveys were carried out among the adult (≥ 18 years old) Spanish population in 2006 and 2011 through telephone interviews. Both surveys used the same methods and questionnaire. Nicotine dependence was assessed with the Fagerström Test for nicotine dependence and readiness to quit according to the stages of change.

Results

The prevalence of tobacco consumption showed a nonsignificant decrease from 23.4% in 2006 to 20.7% in 2011. No changes were observed in nicotine dependence or readiness to quit. In 2011, most smokers (76%) showed low nicotine dependence and were mainly in the precontemplation stage (72%).

Conclusions

The prevalence of smokers has slightly decreased since the introduction of the total smoking ban in Spain. No differences were found in nicotine dependence or readiness to quit.