De-normalizing smoking in urban areas: Public smoking bans and smoking prevalence

The effectiveness of command-and-control policies related to tobacco use has been studied in high-income countries. Still, there is limited evidence of their effects in low and middle-income countries. We explore the case of Colombia, a country that introduced a business-supported smoking ban in bars and restaurants and all public indoor spaces in 2010. This paper investigates the effect of smoking bans in bars and restaurants on smoking prevalence in Bogotá, Colombia. In this paper, we use the matching with triple-differences technique in analyzing household consumption data from the 2007 and 2011 quality of life surveys. This is done by exploiting their geographical proximity and variation in the density of commercial areas. We found that after the smoking ban implementation, smoking prevalence reduced in households near high-density commercial blocks compared to households near low-density commercial blocks (−10.8 pp.). The impact is larger for households with children and older household heads. Since households near high-density commercial blocks are more frequently exposed to smoking than households near low-density commercial blocks, the former would be more willing to internalize the smoking de-normalization process.     

Waterpipe smoking: not necessarily less hazardous than cigarette smoking

Context

Cigarette smoking has declined over the last years in modern countries. On the contrary, waterpipe smoking has increased, especially among young people visiting waterpipe bars. Unfortunately, most waterpipe smokers seem to know little about the possible cardiovascular and other health consequences of waterpipe smoking.

Objective

To describe by narrative literature review the known adverse consequences for the human body caused by smoking the waterpipe compared with the consequences of smoking normal cigarettes. Also, to get a picture of public awareness of these consequences as deducted from the literature and a small new survey in the Netherlands.

Results/Conclusions

Tobacco smoking is associated with serious adverse (cardiovascular) health effects, and there is no evidence that these effects are less serious if a waterpipe is used. The increasing use together with the limited amount of awareness and attention for the possible health consequences of smoking the waterpipe is worrisome. Especially considering the increasing acceptance and use of the waterpipe among the youth. Therefore we recommend more systematic research into the possible health hazards of waterpipe smoking. In the meantime education campaigns and materials are needed to raise public awareness on the possible health risks of waterpipe use.     

Craniosynostosis and maternal smoking

BACKGROUND: Several previous studies suggested increased risk of craniosynostosis among infants born to women who smoked. METHODS: This study used data from the National Birth Defects Prevention Study, a multi‐state, population‐based case‐control study of infants delivered from 1997–2003. Nonmalformed, liveborn controls were selected randomly from birth certificates or birth hospitals. Data from maternal telephone interviews were available for 531 cases and 5008 controls. RESULTS: Smoking during the first month of pregnancy was not associated with craniosynostosis. Smoking later in pregnancy was associated with increased risk, but only among mothers who smoked at least one pack/day. For example, during the second trimester, the odds ratio for smoking <5 cigarettes/day was 1.0 (95% confidence interval [CI] 0.6, 1.8), but the odds ratio (OR) for smoking 15 or more cigarettes/day was 1.6 (95% CI 0.9, 2.8), after adjustment for maternal age, education, race‐ethnicity, sub‐fertility, parity, folic acid supplement intake, body mass index, and study center. Among women who did not smoke, adjusted odds ratios suggested that secondhand smoke exposure at home, but not at work/school, was associated with modestly increased risk; the OR for home exposure was 1.3 (95% CI 0.9, 1.9). Results followed a similar pattern for some, but not all, specific suture types, but numbers for some groupings were small. CONCLUSIONS: The results suggest moderately increased risk of craniosynostosis among mothers who were the heaviest smokers and who continued to smoke after the first trimester. Results are somewhat equivocal, given that most confidence intervals included one. Birth Defects Research (Part A), 2008. © 2007 Wiley‐Liss, Inc.     

Naloxone reduces cigarette smoking

In a double-blind drug-placebo cross-over design, naloxone hydrochloride reduced the amount of cigarettes smoked by chronic smokers over a 3 hr period. The number of puffs was reduced by 32%, the weight of the amount smoked by 33%, and the number of trials in which cigarettes were smoked by 30%. The extent of the decreases in smoking was related to the amount of the decrease in the desire to smoke. There were no physiological differences or in side effects between the two conditions, and neither subjects nor experimenters were able to distinguish between the two. These findings are similar to the suppressive effects of naloxone on food, water and ethanol intake in animals and suggest that the endorphins are implicated. A heuristic theory of addiction is presented to explain these diverse effects.Naloxone hydrochloride (NAL) reduces the intake of nonintoxicating positive reinforcers, such as food and water, in animals (1–5), as well as ethanol (6). The reduction does not appear to be part of an abstinence syndrome (3), or of a general suppression of behavior (7), unless massive doses (i.e. 5 mg/kg or more) of the opiate antagonist are used (8). The mechanism for these effects is obscure, although it has been demonstrated that higher levels of Beta endorphin are associated with greater food intake, and that NAL suppresses food intake to a greater extent in genetically obese animals which have higher levels of Beta endorphin than their litter-mates of normal weight (4).Cigarette smoking has often been found to increase corticosteroid levels (9–12), which is considered presumptive evidence that there is an increase in ACTH production. Elevated levels of ACTH are associated with elevated levels of Beta endorphin in man (13–16). Assuming that smoking is another example of a nonintoxicating positive reinforcer, which also releases Beta endorphin because of ACTH release, we administered NAL to chronic smokers, with the expectation that the amount smoked, as well as the desire to do so, would be reduced. However, because of the possible addictive nature of nicotine (17–19), we were not sure whether these effects would be the result of a precipitated abstinence syndrome.