Are comprehensive environmental changes as effective as health education for smoking cessation?

Objectives

To compare the effectiveness of health education on smoking cessation for all smokers regardless of their willingness to quit smoking and cumulative environmental changes including designation of smoking places, legislation, and price rise.

Design

Comparison of smoking cessation rates over two time periods: the period of health education on smoking cessation (1997–1999), and the period of cumulative environmental changes (2002–2004).

Setting

An occupational setting in a radiator manufacturing factory in Japan.

Subjects

All habitual male smokers who remained in the worksite through the pertinent time period (n  =  202 in the period of health education and n  =  170 in the period of environmental changes).

Main outcome measurements

Smoking cessation rates at the end of each time period.

Results

The smoking cessation rates over the periods of health education and environmental changes were 8.9% and 7.1%, respectively. There was no difference between these two proportions in a χ² test (p  =  0.513). The age adjustment did not significantly alter the cessation rate.

Conclusions

Cumulative environmental changes are fairly effective in promoting smoking cessation, and may yield similar smoking cessation rates as a health education intervention reaching all smokers regardless of their willingness to quit smoking.     

Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades?

This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 years (1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact = effectiveness × reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate.     

Ethyl carbamate in fermented foods and beverages: dietary exposure of the Hong Kong population in 2007–2008

To evaluate the potential public health risk of ethyl carbamate (EC), EC exposure from fermented foods and beverages for Hong Kong population was estimated. In 276 samples analysed, EC was detected (limit of detection (LOD) at 0.4?µg?kg^?1) in 202 samples (73%), with higher levels in fermented red bean curd (150–650?µg?kg^?1) and yellow wine (140–390?µg?kg^?1), while low or non-detected (ND) in preserved vegetables (ND–10?µg?kg^?1) and fermented tea (ND–15?µg?kg^?1). The estimated dietary exposure from all fermented foods and beverages was 8.27?ng?kg^?1?bw?day^?1, while exposure excluding alcoholic beverages was 5.42?ng?kg^?1?bw?day^?1, with calculated margins of exposure (MOEs) at 3.6?×?10⁴ and 5.5?×?10⁴ respectively. The risk of adverse health effects was low for the average population but higher (MOE?of?10³) for high consumers of alcoholic beverages especially habitual drinkers of alcoholic types with high EC contents.     

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.     

Public health measures to reduce smoking prevalence in the UK: how many lives could be saved?

Objective: To estimate the number of deaths that could be prevented in the UK by implementing population strategies to reduce smoking prevalence. Design: A prospective analysis of future mortality using recent national smoking prevalence data and relative risks of mortality in current smokers, ex-smokers, and never-smokers. Population: Smokers in the UK. Interventions: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer. Main outcome measure: Estimated deaths from smoking prevented in the 35–75 year age group. Results: Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69 049 deaths at ages between 35 and 74 years during that period. The model of reduction by 13% over 19 years would prevent 54 308 and 194 493 deaths in 10 and 19 years, respectively. Continued prevalence reductions at the current rate of 0.4 percentage points each year will prevent 23 192 deaths over 10 years. Conclusions: Full implementation of simple population measures to encourage smoking cessation could prevent substantial numbers of deaths in the UK.     

Tollbooth workers and mobile source-related hazardous air pollutants: how protective is the indoor environment?

Tollbooth workers are potentially exposed to high levels of mobile source-related air pollutants due to the proximity and intensity of the source. To evaluate this worker hazard, we measured the concentration of air toxins including volatile organic compounds (VOCs) and particle-bound polycyclic aromatic hydrocarbons (PAHs) inside and outside a Baltimore Harbor Tunnel tollbooth during the summer of 2001. Mean outdoor benzene and 1,3-butadiene concentrations varied by shift with the morning (10.7 and 19.8 microg/m3) exceeding afternoon (7.2 and 14.9 microg/m3) and the lowest levels observed during the night (3.7 and 4.9 microg/m3, respectively) when traffic volume was the lowest. In comparison, considerable protection was provided to workers bythe indoor environment where lower concentrations of 1,3-butadiene and benzene were observed for all three shifts (2.9 and 6.7, 0.9 and 3.2, and 0.9 and 2.4 microg/m3, respectively). The greatest protection offered by the tollbooth was observed during the afternoon shift (5-8-fold reduction in indoor concentration), whereas the morning and night shifts experienced similar protection (2-4-fold reduction). Chlorinated hydrocarbons were observed at higher concentrations within the tollbooth, indicating the presence of indoor sources and the opportunity for exposure mitigation. Levels of PAHs were similarly reduced from outdoors (50 ng/m3) to indoors (15.4 ng/m3). The protective nature of the tollbooth highlighted in this study is likely due to the positive pressure control ventilation system that was present at this specific facility, which represents 55% of tollbooths in Maryland. This study provides an estimate of tollbooth workers potential exposures to various mobile source-related pollutants and highlights the protective nature of tollbooths equipped with positive pressure control ventilation systems.