Households contaminated by environmental tobacco smoke: sources of infant exposures

Objectives: To examine (1) whether dust and surfaces in households of smokers are contaminated with environmental tobacco smoke (ETS); (2) whether smoking parents can protect their infants by smoking outside and away from the infant; and (3) whether contaminated dust, surfaces, and air contribute to ETS exposure in infants.

Design: Quasi-experiment comparing three types of households with infants: (1) non-smokers who believe they have protected their children from ETS; (2) smokers who believe they have protected their children from ETS; (3) smokers who expose their children to ETS.

Setting: Homes of smokers and non-smokers.

Participants: Smoking and non-smoking mothers and their infants 1 year.

Main outcome measures: ETS contamination as measured by nicotine in household dust, indoor air, and household surfaces. ETS exposure as measured by cotinine levels in infant urine.

Results: ETS contamination and ETS exposure were 5–7 times higher in households of smokers trying to protect their infants by smoking outdoors than in households of non-smokers. ETS contamination and exposure were 3–8 times higher in households of smokers who exposed their infants to ETS by smoking indoors than in households of smokers trying to protect their children by smoking outdoors.

Conclusions: Dust and surfaces in homes of smokers are contaminated with ETS. Infants of smokers are at risk of ETS exposure in their homes through dust, surfaces, and air. Smoking outside the home and away from the infant reduces but does not completely protect a smoker's home from ETS contamination and a smoker's infant from ETS exposure.

     

Correlates of home smoking restrictions among rural smokers.

The prevalence of smoking is greater and smoking restrictions are less common in rural areas in comparison to urban areas. Consequently, rural smokers and their families are at increased risk for adverse health consequences from smoking. The presence of home smoking restrictions (i.e., limiting or banning cigarette smoking in the home) can be a mediator for smoking cessation and can reduce health risks for those who live with smokers. The purpose of the present study was to identify correlates of home smoking restrictions among rural smokers. We surveyed 472 smokers from 40 rural Kansas primary care practices who were enrolled in a smoking cessation intervention study. We assessed the prevalence of home smoking restrictions and examined the relationship between such restrictions, demographic variables, comorbid diagnoses, and psychosocial measures of smoking abstinence self-efficacy and motivation to quit. Complete home smoking restrictions were found among 25.4% of rural smokers with an additional 28.3% reporting some restrictions. Restrictions were associated with younger age, higher controlled motivation to quit (i.e., motivation from external pressure), the presence of children under age 6 years living in the home, fewer friends who smoke, and a partner who does not smoke. Smokers with a comorbid diagnosis of high cholesterol, chronic lung disease, or heart disease were less likely to have restrictions. Most smokers in rural primary care practices do not have home smoking restrictions, particularly those without children or a nonsmoking partner and those with significant risk factors for smoking-related illnesses. These patients may be critical targets for broaching issues of home smoking restrictions.     

To what extent do parents strive to protect their children from environmental tobacco smoke in the Nordic countries? A population-based study

OBJECTIVE—To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home.
DESIGN—A cross-sectional study using an anonymous questionnaire.
SUBJECTS AND SETTING—A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Finland, Iceland, Norway, and Sweden.
MAIN OUTCOME MEASURES—Smoking status of parents, prevalence and magnitude of weekly ETS exposure, rules regarding smoking in the home.
RESULTS—82% of current smokers reported having tried to change their smoking behaviour for the sake of their children. Of all parents who answered the questionnaire, 75% reported having introduced some rules to limit ETS in their home. In households where at least one parent smoked, 57% reported that children were exposed to ETS at home. Child exposure to ETS was most prevalent in single-parent households and in households in which parents had lower levels of education. However, these parents were not less likely than other smoking parents to report having tried to change their smoking behaviour for the sake of their children.
CONCLUSION—Environmental tobacco smoke at home is still a problem for many children in the Nordic countries. However, most smoking parents reported having made efforts to change their smoking behaviour for the sake of their children; and in approximately half of all households containing at least one daily smoker, parents reported protecting their children from ETS exposure in the home. Although actual exposure may be higher owing to possible under-reporting of ETS, our results indicate a general awareness in the Nordic countries of the potential negative effects of ETS on children.


Keywords: children; environmental tobacco smoke; homes     

Is smoking a communicable disease? Effect of exposure to ever smokers in school tutor groups on the risk of incident smoking in the first year of secondary school

OBJECTIVE: To estimate the effect of joining a first year secondary school tutor group with a high prevalence of ever smoking on the risk of incident smoking in schoolchildren. DESIGN: Cross-sectional questionnaire survey. SETTING: 10 randomly selected secondary schools in Nottinghamshire, UK. PARTICIPANTS: Pupils in years (grades) 7-11 (aged 11-16 years). MAIN OUTCOME MEASURE: Incident smoking in the first year of secondary education, defined as pupils who reported smoking their first cigarette during year 7. RESULTS: Of 6522 pupils (75% of those eligible) who completed the questionnaire, 17% were current smokers and 49% had ever smoked, of whom 23% had started smoking in year 7. Incident smoking in year 7 was more common in girls, in children with parents or siblings who smoke, and in more deprived children, and was independently increased in relation to the proportion of ever smokers in the year 7 tutor group joined by the child (adjusted odds ratio of incident smoking for a child joining a year 7 tutor group in the highest relative to the lowest quartile of ever smoking prevalence 1.45, 95% confidence interval (CI) 1.11 to 1.89). Exposure to ever smokers in year 7 tutor groups also accounted for most of the increased risk of incident smoking associated with socioeconomic deprivation. CONCLUSIONS: The risk of incident smoking in children entering secondary education is independently increased by exposure to other ever smokers in school tutor groups. Incident smoking in adolescents is thus to some extent a communicable disorder, and may be partly preventable by policies that reduce exposure to smoking at school.     

Assessment of parents' smoking behaviors at a pediatric emergency department.

The pediatric emergency department is an important source of treatment for children with complaints related to environmental tobacco smoke (ETS) and may provide a teachable moment to address parent smoking. Parents who smoke were recruited from a pediatric emergency department waiting room and completed an interview assessment used to develop intervention messages. Of the 715 parents in the final sample, 77% were women, 60% White, and 60% low income (相似文献   

Socially cued smoking in bars,nightclubs, and gaming venues: a case for introducing smoke-free policies

OBJECTIVE: To assess smokers' perceived effects of smoking bans in bars, nightclubs, and gaming venues on their smoking behaviour. DESIGN: Cross sectional structured interview telephone survey of a random sample of smokers. SETTING: Population survey in Victoria, Australia. PARTICIPANTS: The sample comprised 597 smokers and analyses were conducted on 409 smokers who reported patronising bars, nightclubs or gaming venues at least monthly. OUTCOME MEASURES: Two outcomes studied were socially cued smoking and readiness to quit as a result of restrictions on smoking in social venues. Respondents were identified as socially cued smokers if they reported attending bars, nightclubs or gaming venues at least monthly and said that they smoke more in these venues. The potential influence of bans in social venues on readiness to quit was measured by asking respondents if they would be more or less likely to quit smoking if smoking were banned in hotels, licensed bars, gaming venues, and nightclubs. RESULTS: Of all adult smokers, 69% attended bars, nightclubs or gaming venues at least monthly. Of these smokers, 70% reported smoking more in these settings (socially cued smokers) and 25% indicated they would be likely to quit if smoking were banned in social venues. Compared to smokers not likely to quit if there were bans, smokers likely to quit were more likely to be socially cued (odds ratio (OR) 2.64), to be contemplating or preparing to quit (OR 2.22), to approve of bans in social venues (OR 2.44), and to be aged under 30 years (OR 1.73). Compared with smokers not socially cued, socially cued smokers were more likely to be under the age of 30 years (OR 6.15), more likely to believe that there is a safe level of cigarette consumption (OR 2.25), and more likely to have previously made a quit attempt (OR 2.60). CONCLUSIONS: These findings suggest that bans on smoking in bars, nightclubs, and gaming venues could reduce cigarette consumption and increase quitting among smokers who frequently patronise these settings. These beneficial effects are likely to be strongest among younger smokers.     

A qualitative study on establishing and enforcing smoking rules in family cars.

With continued expansion of clean indoor air legislation, private spaces such as homes and cars are gaining increased attention as significant sources of secondhand smoke (SHS). This study examines the establishment and enforcement of smoking rules in family cars. Qualitative interviews (N = 136) were conducted with Black and White families in rural Georgia. Participating families had a young adolescent in the home and included households with all nonsmokers, a mix of smokers and nonsmokers, and all smokers. Common car smoking rules included no smoking allowed at any time, smoking allowed if a window is cracked, and no smoking allowed if children or nonsmokers are in the car. Major reasons for rules included protecting children and nonsmokers from SHS, aversion to the smell, and the stifling nature of SHS in cars. Damage to the vehicle from ashes and burns was another reason for smoking rules, particularly among families with smokers. Many families had never discussed car smoking rules. Families with car smoking rules were generally able to enforce them without difficulty, although smokers responded with a range of reactions from acceptance to anger. Families would consider a total ban if the smoker in their family quit or, for a few, if they purchased a new car. These findings have implications for designing intervention strategies to promote smoke-free cars and help family members to negotiate and enforce car smoking rules.     

The impact of workplace smoking bans: results from a national survey

OBJECTIVE: To estimate the impact of workplace smoking restrictions on the prevalence and intensity of smoking among all indoor workers and various demographic and industry groups. DESIGN: Detailed cross sectional data on worker self reported characteristics, smoking histories, and workplace smoking policies were used in multivariate statistical models to examine whether workplace smoking policies reduce cigarette consumption. After analysing the distribution of policies, four main types of workplace programme were defined: (1) 100% smoke-free environments, (2) work area bans in which smoking is allowed in some common areas, (3) bans in some but not all work and common areas, and (4) minimal or no restrictions. SETTING: After environmental tobacco smoke was identified as a health hazard in the mid-1980s, workplace smoking restrictions became more prevalent. By 1993, nearly 82% of indoor workers faced some restriction on workplace smoking and 47% worked in 100% smoke-free environments. PARTICIPANTS: The database included a nationally representative sample from the tobacco use supplements to the September 1992, January 1993, and May 1993 Current Population Surveys of 97,882 indoor workers who were not self employed. MAIN OUTCOME MEASURES: Prevalence of smoking and number of cigarettes smoked daily by smokers. RESULTS: Having a 100% smoke-free workplace reduced smoking prevalence by 6 percentage points and average daily consumption among smokers by 14% relative to workers subject to minimal or no restrictions. The impact of work area bans was lessened by allowing smoking in some common areas. Smoke-free policies reduced smoking for all demographic groups and in nearly all industries. CONCLUSIONS: Requiring all workplaces to be smoke free would reduce smoking prevalence by 10%. Workplace bans have their greatest impact on groups with the highest rates of smoking.     

Environmental tobacco smoke exposure among Korean American nonsmokers in California.

Information about the extent and patterns of environmental tobacco smoke (ETS) exposure among Korean Americans is sparse, despite the population's having one of the highest male smoking rates. This paper estimates the prevalence of ETS exposure among Korean American nonsmokers in California, and identifies demographic and other characteristics associated with exposure. Data were collected during 2001-2002 from telephone interviews (in English or Korean) with 2,328 nonsmoking Korean American adults. ETS was encountered by 31% of respondents during a typical day. Exposure was most common in "other locations," where 24% of respondents were exposed, compared with 6% at home and 9% at work. Among those exposed, the greatest dose of exposure occurred at work (6 cigarettes/day) and at home (5 cigarettes/day). Women were four times more likely than men to be exposed to ETS at home (8% vs. 2%, respectively). For both men and women, the odds of exposure were greater among those who were younger, who were unmarried, and whose friends smoked. Additionally, traditional men and bicultural women had greater odds of ETS exposure than those who were more acculturated. Women who were married to smokers, had no children at home, consumed more alcohol, and had no home smoking ban also had greater likelihood of exposure. The results indicate the need for a complete ban of smoking in workplaces and in private homes to prevent exposure, particularly for women whose husbands smoke.     

Prenatal tobacco use and risk of stillbirth: a case-control and bidirectional case-crossover study.

We sought to estimate the association between prenatal smoking and stillbirth in a longitudinal cohort using two study designs: a case-control study and a bidirectional case-crossover study. The analysis was conducted using the Missouri maternally linked cohort dataset from 1978 through 1997. In the case-control study, each mother contributed only one birth to the analysis. For the bidirectional crossover design, analysis was restricted to women who gave birth to at least one stillbirth, and the controls comprised all live births before and after the stillbirth. The independent association between prenatal smoking and stillbirth was computed using nonconditional (case-control design) and conditional (bidirectional case-crossover design) logistic regression. Prenatal smoking decreased from 29.7% in 1978 to 21.2% by 1997 (p<.001). The absolute risk of stillbirth was greater among smokers (7.7/1000) than nonsmokers (5.3/1000), p<.001. In the case-control design, the risk of stillbirth was 34% greater among smokers than nonsmokers (OR = 1.34, 95% CI 1.26-1.43). For each 10-unit increase in the number of cigarettes consumed per day prenatally, the likelihood of stillbirth rose by about 14% (p<.001). In the bidirectional case-crossover design, the association between stillbirth and smoking during pregnancy was confirmed, although the magnitude of the relationship was smaller (OR = 1.20, 95% CI 1.03-1.39). In conclusion, we found prenatal smoking to be a risk factor for stillbirth even after minimizing the influence of known and unknown sources of confounding as well as changes in temporal trend in prenatal smoking.     

Characteristics of low-level smokers.

Average daily cigarette consumption has decreased, and some evidence suggests that the rate of "some day" smoking has increased; however, relatively little is known about low-level smokers. The present analysis describes and compares low-level versus heavier smokers, using cross-sectional and longitudinal data. Data from the Community Intervention Trial for Smoking Cessation (COMMIT) were used in this analysis. Population-based cross-sectional tobacco use telephone surveys were performed in 22 North American communities in 1988 and 1993, and the prevalence and characteristics of low-level smoking and reasons for quitting are reported from the 1993 prevalence survey. In addition, a cohort of 6,603 smokers was identified in 1988 and interviewed again in 1993 and 2001 to assess patterns of low-level smoking over time and its association with smoking cessation. In 1988, 7.6% were low-level smokers; in 1993, 10.7% were low-level smokers. Compared with heavier smokers, low-level smokers were more likely to be female, older, not married, Black or Hispanic; to have a 4-year college degree; to have no other adult smokers in the household; and to wait longer in the day to have their first cigarette. Low-level smokers also were less likely to report trying to quit because of the expense of smoking or physician advice to quit. They were more likely to try to quit because of trying to set a good example; concern for second-hand smoke; and factors such as bad breath, smell, or the taste of smoking. Those who smoked full-priced premium brands and who worked in a completely smoke-free worksite were more likely to be low-level smokers. Compared with heavier smokers, low-level smokers had similar rates of making a future quit attempt, lower use rates of nicotine replacement therapy, and higher cessation rates. Low-level smokers may be a growing segment of the smoker population and have different characteristics, health risks, and intervention needs compared with their heavier smoking counterparts.     

The effects of household and workplace smoking restrictions on quitting behaviours

OBJECTIVE: To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking. DESIGN: Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking. SETTING: Large population surveys, United States. SUBJECTS: Respondents (n = 48,584) smoked during the year before interview in 1992-1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed. MAIN OUTCOME MEASURES: The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day). RESULTS: Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers. CONCLUSIONS: Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.     

Cigarette smoking weakens exercise habits in healthy men.

To investigate the longitudinal impact of smoking cessation and relapse on the exercise habits of apparently healthy Japanese men, 750 subjects presenting for a checkup at a metropolitan health center were surveyed annually for 7 years. Exercise was dichotomously classified as none or any. Subjects were grouped in two categories: 98 smokers who ceased smoking during the second year of the study, matched with 196 continuing smokers and 196 men who had never smoked; and 52 relapsed smokers (including 2 new smokers) who did not smoke at baseline or at Year 1 but smoked from Year 2 to final follow-up, matched with 104 continuing smokers and 104 never-smokers. Based on self-reported responses to questionnaires, exercise was consistently less prevalent among smokers who did not quit than among never-smokers throughout the study. Habitual exercise in subjects who had quit smoking increased during the follow-up (any exercise: 42.9% at baseline increased to 51% at final follow-up, p for longitudinal trend = .115). Habitual exercise in matched never-smokers did not change during the study and decreased significantly among persistent smokers (p = .025). Habitual exercise in relapsed smokers decreased during the follow-up (any exercise: 50.0% at baseline declined to 32.7% at final follow-up, p = .007), but habitual exercise in matched persistent smokers and never-smokers did not change. We conclude that smoking and sedentary lifestyle coexist continuously, that smoking cessation is associated with increased habitual exercise among healthy men, and that relapse is associated with reduced habitual exercise, suggesting that cigarette smoking weakens exercise habits.     

Tobacco use among Swedish schoolchildren

Objective: To study the prevalence of snus use and of smoking among Swedish schoolchildren from 1989 to 2003. Design: Surveys conducted by the Swedish Council for Information on Alcohol and Other Drugs. Setting: All of Sweden. Subjects: 84 472 boys and girls age 15–16 years. Main outcome measures: Subjects are classified as non-smokers, occasional smokers, and regular smokers, and into three similar categories for snus use. Tobacco use is reported as sex specific prevalence. Results: During the period 1989 to 2003, the prevalence of tobacco use declined both among boys and girls. For boys, regular smoking declined after 1992 from 10% to 4%. Their snus use was about 10% in the 1990s but increased to 13% by 2003. Regular smoking among girls was 20% in early years and declined to 15%. Smoking among girls was always double that among boys. Patterns of occasional tobacco use were similar to those of regular use. Conclusions: The high prevalence of snus use in Sweden not only reduces smoking rates among Swedish men, but suppresses smoking among boys as well.     

Overcoming barriers to recruitment and retention in adolescent smoking cessation.

Participant recruitment and retention have been identified as challenging aspects of adolescent smoking cessation interventions. Problems associated with low recruitment and retention include identifying smokers, obtaining active parental consent, protecting participants' privacy, respecting participants' autonomy, and making participation relevant and accessible to adolescents. This paper describes nine strategies for minimizing these recruitment and retention problems via a proactive telephone counseling intervention, and reports on their simultaneous implementation among 1,058 smokers from 25 high schools in Washington state. Results are as follows: (a) 85.9% of parents of minor-age seniors provided active consent for their teen's participation, (b) 89.8% of eligible smokers were successfully contacted by counselors, (c) 86.5% of contacted smokers consented to participate in the cessation counseling, (d) 93.8% of consented smokers participated in smoking cessation counseling calls, and (e) 72.2% of participating smokers completed their full intervention. These results demonstrate that older teens who smoke, and their parents, are receptive to confidential cessation counseling that is personally tailored, supportive of their autonomy, and proactively delivered via the telephone.     

Gender and ethnic differences in young adolescents' sources of cigarettes

OBJECTIVE: To identify the sources used by young adolescents to obtain cigarettes. DESIGN: In early 1994 a survey assessing usual sources of cigarettes and characteristics of the respondents was administered in homeroom classes. SETTING: A large urban, predominantly African American school system. SUBJECTS: A population-based sample of 6967 seventh graders averaging 13 years of age. MAIN OUTCOME MEASURE: Reports of usual sources of cigarettes. RESULTS: At this age level, young smokers were more likely to get cigarettes from friends (31.2%) than buy them in stores (14.3%). However, the odds of purchasing varied for different groups of children. Regular smokers were much more likely (48.3%) to have purchased cigarettes than experimental smokers (9.6%), p < 0.001. Girls were less likely to have bought their cigarettes than boys (p < 0.001), and black smokers were less likely to have purchased cigarettes than white children (p < 0.001). Results suggested that family members who smoke may constitute a more important source of tobacco products than previously recognised, particularly for young girls. CONCLUSIONS: In this middle-school sample, peers provided the major point of cigarette distribution. However, even at this age, direct purchase was not uncommon. Sources of cigarettes varied significantly with gender, ethnicity, and smoking rate.     

Leaders and elites: portrayals of smoking in popular films

Design: This study conducted a content analysis of the top 100 grossing films in 2002, with a total global gross of US$12.4 billion.

Outcome measures: Three outcome measures were frequency of smoking incidents, traits of characters who smoke, and consequences of tobacco use.

Results: 6% of characters smoked in 453 incidents, including 3% of children. In 92% of incidences, smoking had no consequences. The most frequent consequence was a verbal reprimand. Although tobacco is a leading cause of preventable deaths globally, only 0.4% of tobacco incidences resulted in death. No deaths were caused by disease. Characters who smoked tended to be major characters playing leadership roles. They tended to be from privileged elites: male, white, and mature.

Conclusions: Films portray characters that smoke as leaders from privileged elites, making smoking more attractive to audience members. Because 99.6% of characters suffer no life threatening consequences from smoking on screen, smokers seem invincible, belying tobacco's role as a leading cause of preventable deaths.

     

Quit and Win campaigns as a long-term anti-smoking intervention in North Karelia and other parts of Finland

OBJECTIVE: To evaluate Quit and Win campaigns repeated in North Karelia and rest of Finland. DESIGN: Repeated comparisons of participation rates, abstinence rates, and other measures between North Karelia and the rest of Finland. SUBJECTS: Adult daily smokers in Finland participating in the Quit and Win contests in 1986-1997. INTERVENTIONS: Quit and Win smoking cessation campaigns targeted at adult daily smokers throughout Finland in 1986, 1989, 1994, 1996, and 1997, including more intensive activities in North Karelia. MAIN OUTCOME MEASURES: Participation rates, self reported six-month abstinence rates, other effectiveness measures (% of smokers who attended, intended, tried, and succeeded in cessation). RESULTS: North Karelia's participation rates were significantly higher in each campaign compared with the rest of Finland. The abstinence rates in North Karelia were also higher, the difference being significant in 1986 and 1994 (p < 0.05). In the target population in 1996 over 75% of smokers in North Karelia, compared with 40% of smokers surveyed elsewhere, reported awareness of the campaign (p < 0.001). Approximately 9% of the smokers in North Karelia and 6% elsewhere intended to participate (p = NS). Over 2% in North Karelia, compared with less than 1% elsewhere, tried to quit (p < 0.001). Among the targeted group, 0.3% of North Karelian smokers were complete abstainers throughout the 12 months of follow up, compared with an average of 0.1% in other areas (p < 0.001). CONCLUSIONS: The Quit and Win campaign is a feasible cessation method in long-term community-wide programmes. Intensified community activities are associated with higher success. In repeat campaigns, high participation and abstinence rates can be maintained.     

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.




     

Waterpipe-associated particulate matter emissions.

Waterpipe tobacco smoking is increasingly common worldwide, and evidence about its harmful effects to smokers is emerging. However, no studies have investigated the potential exposure of nonsmokers to waterpipe smoke. We measured particulate matter (PM) emissions (PM2.5, PM10) before and during laboratory sessions in which 20 individuals used a waterpipe to smoke tobacco and 20 individuals smoked a cigarette (10 for each particle-size/smoking-method), as well as 10 waterpipe and 10 cigarette smoldering sessions (i.e., without a smoker). A TSI-SidePak aerosol monitor obtained PM2.5, PM10 background, smoking, and maximum levels. Mean PM2.5 rose 447% for waterpipe (from 48 microg/m3 background to 264 microg/m3 smoking), and by 501% for cigarettes (from 44 microg/m3 to 267 microg/m3), whereas mean PM10 rose by 563% for waterpipe (from 55 microg/m3 to 365 microg/m3), and by 447% for cigarettes (from 52 microg/m3 to 287 microg/m3) (p<.05 for all). The increase in PM during cigarette smoking was due primarily to PM2.5, given that the proportion of PM2.5 from total PM10 increase was 95% compared with 70% for waterpipe (p<.05). Maximum PM2.5 was 908 microg/m3 for waterpipe and 575 microg/m3 for cigarettes, whereas maximum PM10 was 1052 microg/m3 for waterpipe and 653 microg/m3 for cigarettes. Mean PM2.5 and PM10 smoldering levels did not differ from background for waterpipe but were significantly higher for cigarettes (PM2.5: 33-190 microg/m3; PM10: 42-220 microg/m3). Policymakers considering clean air regulations should include waterpipe tobacco smoking, and the public should be warned about this source of smoke exposure.