Predictors of smoking cessation among elderly smokers treated for nicotine dependence

OBJECTIVE: To examine outcomes and predictors of smoking cessation among elderly patients treated for nicotine dependence. DESIGN: Retrospective analysis of patients aged 65-82 who received a nicotine dependence consultation at the Mayo Medical Center between 1 April 1988 and 30 May 1992. Patients were contacted by telephone by a trained interviewer six months after the consultation and were sent a follow-up survey in August 1993. SETTING: Mayo Medical Center, Rochester, Minnesota, United States. SUBJECTS: A total of 613 patients (310 men, 303 women) with a mean age of 69.0 (SD 3.5) years were seen during the study period. MAIN OUTCOME MEASURES: Point prevalence self-reported smoking status. Patients were considered abstinent if they self- reported not smoking (not even a puff) during the seven days before contact. RESULTS: At six-month follow up, 24.8% of the 613 patients reported abstinence from smoking. On multivariate analysis, smoking abstinence was more likely if patients were hospitalised at the time of the consultation, married to a non-smoking spouse, very motivated to stop smoking, and reported their longest time of previous abstinence to be less than a day or more than a month. The response rate to the mailed follow-up survey was 69.9% (429 of 613). The mean duration of follow up was 40.0 +/- 13.2 months following the consultation. Of the 429 patients, 103 (24.0%) reported abstinence from smoking and 326 (76.0%) were smoking at six-month follow up. Patients who reported abstinence at six months had a higher cessation rate at the last follow up (76.0%) compared with patients who were smoking at six-month follow up (33.0%, P < 0.001). For patients who were not smoking at six months, no factors were found to significantly predict abstinence at last follow up. For patients who were smoking at six months, factors associated with smoking cessation at last follow up were: more than a year as the longest time off cigarettes before the consultation; counsellor rating of less severe nicotine dependence; and older age at first regular smoking. CONCLUSIONS: Several predictors of smoking cessation were identified in this study which may be useful for tailoring smoking interventions for the elderly.


     

Self-help cessation programs for smokeless tobacco users: long-term follow-up of a randomized trial.

This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT.     

Telephone booster sessions for optimizing smoking cessation for patients in rehabilitation centers.

Smokers with smoking-related diseases who are hospitalized in rehabilitation centers should be offered smoking cessation. This is the first study evaluating whether telephone booster sessions after intensive inpatient treatment are an effective strategy. The present study was conducted in 13 rehabilitation centers for somatic disorders as a prospective multicenter study with a randomized treatment-control group design. We compared abstinence rates after hospital discharge from treatment that included a group smoking cessation program with (treatment group) and without telephone booster sessions (control group). Data from 290 smokers were analyzed. After 6 and 12 months the treatment group achieved abstinence rates twice as high as those of the control group. Men profited more from telephone booster sessions than did women. Results indicated that telephone booster sessions were highly effective (even) after an inherently intensive group program during a hospital stay. Further research should focus on the special needs of women receiving telephone counseling.     

Cigarette smoking and smoking cessation among older adults: United States, 1965-94

OBJECTIVE: To characterise patterns of cigarette smoking and smoking cessation among older adults in the United States. DESIGN: Data from the National Health Interview Surveys (NHIS) 1965-94 were analysed. The NHIS is a cross-sectional survey using a representative national sample. SETTING: In most cases interviews were conducted in the home; telephone interviews were conducted when respondents could not be interviewed in person. PARTICIPANTS: Participants were from a representative sample of the American civilian, non-institutionalised population aged 18 and older. Sample sizes for the years analysed ranged from n = 19,738 to n = 138,988 overall, and n = 3806 to n = 12,491 for those aged 65 years and older. MAIN OUTCOME MEASURES: Using the NHIS data from 1965-94, trends in current smoking and the prevalence of smoking cessation by demographic characteristics among older adults (65 years and older) were assessed and compared with trends among younger adults. A logistic regression analysis was conducted to determine the demographic characteristics of former smokers compared with current smokers among those aged 65 and older. RESULTS: The prevalence of current smoking among 65 year olds and older declined from 1965 to 1994 (17.9% to 12.0%). Although smoking prevalence was lower among older adults than younger adults (aged 18- 64), the rate of decline in smoking was slower among older adults. Among older adults, the prevalence of cessation rose with increasing educational attainment, and was consistently higher for men than for women and for whites compared with blacks. After adjustment for demographic factors among older adults who had ever smoked, increasing age and educational attainment were strongly related to the likelihood of being a former smoker. Although there were no racial differences among women, older white (OR = 2.6) and Hispanic (OR = 3.67) men were significantly more likely to be former smokers than older black men. Also, the gender difference in smoking cessation was noted only for whites. CONCLUSIONS: Given the projected increase in the elderly population, the medical and economic consequences of smoking will become a greater burden in the next decades. Therefore, focusing attention on cessation among the elderly is an immediate and urgent priority for public health professionals and clinicians.


     

Proactive, motivationally enhanced smoking cessation counseling among women with elevated cervical cancer risk.

Current treatment guidelines recommend that all smokers be given motivational or action-oriented counseling, as is appropriate to their readiness to quit smoking. The present study assessed the acceptability and impact of a proactively delivered, motivationally tailored phone counseling program targeted to women with elevated risk for cervical cancer. Female smokers with a recent abnormal pap exam or a colposcopy were contacted and invited to participate, regardless of their interest in quitting smoking. Participants were randomly assigned to usual care (UC) or UC plus motivationally enhanced phone counseling (MEC). The intervention was well received: 79% of eligible women enrolled (n = 275), and 90% completed at least three of four calls. Participation did not vary by baseline motivation to quit. Compared with control subjects, counseling participants were more likely to seek additional treatment services and had a higher 7-day point-prevalence abstinence rate at 6 months (20% MEC vs. 12% UC, p<.05). MEC impact was sustained at 12 months, but abstinence increased among the UC group (18% MEC vs. 20% UC, p = ns). There was no difference in repeated point-prevalence abstinence at 6 and 12 months (11% MEC vs. 10% UC, p = ns). Outcomes were similar in a subgroup of 229 women who, at baseline, were interested in quitting in the next 6 months.     

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults

OBJECTIVE—To examine the factors that determine whether or not smokers become long-term quitters, and to study whether determinants of successful cessation differ with levels of motivation to stop.
DESIGN—In a cohort of men and women, aged 30-60 years at first examination in 1982/1984, smoking behaviour was evaluated from questionnaires at baseline and at follow up 10 years later.
SETTING—County of Copenhagen, Denmark
PARTICIPANTS—2554 subjects from the original sample of 4581 were successfully followed. This study deals with the 1365 subjects who were smokers at the first examination.
MAIN OUTCOME MEASURE—Smoking status (abstinent for one year or more) at follow up.
RESULTS—At follow up 15% of the baseline smokers had been abstinent for one year or more. In multivariate analysis, successful smoking cessation was associated with older age, high social status, low prior tobacco consumption, baseline motivation to stop smoking, and having a non-smoking spouse/cohabitant. The same result was obtained when the analyses were repeated separately for smokers with and without motivation to stop.
CONCLUSIONS—Smokers motivated to stop are more likely to quit and remain abstinent than smokers with no such motivation. Age, social status, spouse/cohabitant's smoking behaviour, and the daily consumption of tobacco predict success in smoking cessation, irrespective of smokers' former motivation to stop.


Keywords: smoking cessation predictors; Denmark     

Evaluation of a culturally appropriate smoking cessation intervention for Latinos

BACKGROUND: Many believe that smoking cessation programmes for Latinos should be tailored to the values and beliefs of the culture. However, randomised studies of culturally appropriate smoking cessation interventions with Latinos are rare. METHODS: Latino smokers (n = 313) were randomised to an intervention condition or a comparison group. The intervention was a three month programme based on social cognitive constructs and delivered in the smoker's home by trained lay health advisors, or promotores. Comparison group participants were referred to the California Smoker's Helpline in Spanish. Predictors of abstinence among all participants also were examined. RESULTS: About one week post-intervention, validated (carbon monoxide) past week abstinence rates were more than twice as high in the intervention group (20.5%) than in the comparison (8.7%) (p < or = 0.005). The pattern of results held for self reported abstinence, and after recoding dropouts to non-abstinence. The primary predictor of abstinence was number of cigarettes smoked per day at baseline, a common measure of addiction. CONCLUSIONS: The culturally appropriate intervention facilitated abstinence in Latino smokers, at least in the short term. Strengths and weaknesses of the study are discussed.     

Evaluating the effectiveness of a single telephone contact as an adjunct to a self-help intervention for smoking cessation in a randomized controlled trial.

This study evaluated the effects of including a single brief prequit telephone counseling session in a self-help program for smoking cessation conducted through the mail, by comparison with the effects of the self-help program alone. Volunteer participants from northwestern Spain (N = 228) were randomly assigned to one of two groups: (a) the self-help-only group (n = 110, mean age = 37.4 years, pretreatment cigarette consumption = 26.5 cigarettes/day) or (b) the telephone-support group (n = 118, mean age = 36.8 years, pretreatment cigarette consumption = 27.7 cigarettes/day). Using a conservative data analysis method (missing data considered as treatment failures), we found that the point-prevalence abstinence rate was significantly higher in the telephone-support group than in the self-help-only group at the end of treatment (44.9% vs. 21.8%) and at the 3-month follow-up (39.0% vs. 26.4%). Likewise, sustained abstinence was significantly higher in the telephone-support group at the 3-month follow-up (33.9% vs. 13.6%), the 6-month follow-up (25.4% vs. 12.7%), and the 12-month follow-up (21.2% vs. 9.1%). The results of this randomized controlled trial indicate that both treatments are an effective aid for smoking cessation, and that a single brief telephone call before the quit date is a low-cost and effective procedure for improving abstinence rates in a mailed self-help program.     

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.




     

Nicotine lozenges for the treatment of smokeless tobacco use.

Nicotine lozenges have been shown to increase tobacco abstinence rates in cigarette smokers, but they have not been evaluated in smokeless tobacco (ST) users. We conducted an open-label, one-arm, phase II clinical trial to evaluate the efficacy of the 4-mg nicotine lozenge for the treatment of withdrawal and craving associated with tobacco abstinence among ST users. Eligible subjects received 4-mg nicotine lozenges for 6 weeks followed by a 6-week taper. Subjects completed daily tobacco withdrawal diaries, and data on lozenge use, adverse events, and lozenge acceptability were collected. Urine anabasine was collected at 3 and 6 months for biochemical confirmation of self-reported tobacco abstinence. Participants were 30 ST users with a mean age of 35.4 years (SD=6.5) using an average of 4.2 cans or pouches (SD=3.2) of ST per week for a mean of 15.1 years (SD=6.5). Among subjects continuously tobacco abstinent for the first 2 weeks, no significant increases in composite withdrawal symptoms were observed, compared with baseline symptoms, whereas craving decreased significantly. Biochemically confirmed 7-day point-prevalence tobacco abstinence was 53% (95% CI=34%-72%) at 12 weeks (end of treatment) and 47% (95% CI=28%-66%) at 6 months. Few adverse events attributable to the nicotine lozenge occurred, and the lozenge was perceived as helpful in assisting subjects quit ST. The use of the 4-mg nicotine lozenge appears promising for the clinical treatment of withdrawal symptoms and craving associated with tobacco abstinence in ST users. Future phase III clinical trials investigating the efficacy of nicotine lozenges are warranted.     

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States)

OBJECTIVES—To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States).
METHODS—Data were obtained via a telephone interview of 774 Vietnamese men in 1994.
DESIGN—Cross-sectional survey administered via telephone in 1994.
SETTING—Massachusetts, United States.
SUBJECTS—Randomly selected Vietnamese men (n = 774).
MAIN OUTCOME MEASURES—Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population.
RESULTS—Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking.
CONCLUSIONS—Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.


Keywords: smoking cessation; tobacco use; Vietnamese     

Comparison of two self-help smoking cessation booklets

OBJECTIVE: To compare two self-help smoking cessation booklets distributed to callers to a Quitline telephone service in Queensland (Australia). DESIGN: Callers were randomised to receive either a structured 14-day quit programme (Time to quit) or another booklet and described four broad stages of quitting (Can quit). Approximately one month later, these callers were interviewed by telephone. MAIN OUTCOME MEASURES: Self-reported smoking status at one month and recent quit attempts together with process measures. RESULTS: Altogether, 521 callers (78.3%) were interviewed. They were heavier smokers when compared with all Queensland smokers: on average they had smoked for more than 15 years, smoked nearly 25 cigarettes per day, and almost two-thirds had attempted to quit smoking in the past year. In each group, significant proportions either did not begin to use the booklet (50.5-56.0%), or did not complete its use (77.4-82.3%). There were no differences in the self-reported quit rates at one month (17.0% vs 16.1%; p = 0.93). In an ordinal regression modelling procedure involving age, sex, number of recent quit attempts, number of cigarettes smoked per day, smoking status of partner, number of five closest friends who smoke, education, and booklet received, only the number of cigarettes smoked per day was significantly related to smoking status at one month. CONCLUSIONS: Callers to telephone Quit-line services are typically heavier smokers than the general smoking population, and simple strategies, such as self-help booklets, appear to achieve relatively high success. Nevertheless, there is potential to improve the effectiveness of these materials by making a range of materials available and encouraging callers to make a serious attempt to quit smoking.     

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.     

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerstrom Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.


     

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia

OBJECTIVE—To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home.
DESIGN—A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. χ² and logistic regression were used for analysis.
SETTING—38 schools in southern, east, and northern Sydney, Australia.
SUBJECTS—Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%).
MAIN OUTCOME MEASURES—Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home.
RESULTS—At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends.
CONCLUSIONS—Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.


Keywords: cigarette smoking; adolescents; ethnicity     

Smoking in Ecuador: prevalence, knowledge, and attitudes

OBJECTIVE: To evaluate the prevalence of, attitudes towards, and knowledge about cigarette smoking in Ecuador in 1991. DESIGN: Survey using in-person interviews; stratified and multiple regression analyses. SUBJECTS AND SETTING: Eight hundred people (> or = 18 years old) representative of the adult populations in the cities of Quito and Guayaquil, Ecuador. MAIN OUTCOME MEASURES: Smoking prevalence, daily cigarette consumption, reasons for smoking, desire to quit smoking, knowledge about the health effects of smoking. RESULTS: About a third of the population in the two major cities of Ecuador are cigarette smokers. Men are not only more likely to be smokers than women (45% vs 17%, respectively), but when they do smoke, they also smoke significantly more cigarettes per day (60% more) than women. Cigarette smoking appears to be more common among younger populations, and among more educated people. Housekeepers are significantly less likely to be smokers compared with people in other occupations. About 80% of smokers consume fewer than 10 cigarettes per day. In Quito, a 40% increase in the number of cigarettes smoked per day on weekdays compared with weekends suggests an effect of the environment on smoking patterns. About 60% of smokers stated their desire to quit smoking, and there was almost universal knowledge about the harmful effects of cigarette smoking on the health of active and passive smokers. CONCLUSIONS: About a third of the population in the two major cities of Ecuador reported smoking cigarettes. Smoking is more common among men, those of younger age, and the more educated. The findings in this study should help the development of antismoking policies in Ecuador and other countries in the region.




     

Quitting smoking: why, how, and what might help

OBJECTIVE: To examine reasons for quitting smoking, methods used in quitting, reasons for continuing smoking and potential aids to quitting in the population of Ontario, Canada. DESIGN: Two population-based, telephone interview surveys, conducted by random-digit dialing. SUBJECTS: Adults aged 18 years of age and older in 1983 (n = 1383) and 1991 (n = 1421). MAIN OUTCOME MEASURES: Information was obtained from former smokers on why and how they quit smoking, and from continuing smokers on why they smoked and what might help them quit. RESULTS: The proportion of current smokers in the population decreased from 35.5% in 1983 to 27.2% in 1991. In both surveys, former smokers cited a variety of reasons for quitting, including personal health concerns, social and environmental factors, personal attitude factors, cost, and health education messages. Responses concerning the most important reason also revealed a range of factors; "advice of a physician" was not prominent among them. When questioned about methods used in quitting, most former smokers in both surveys responded that they "just decided to quit". Very few reported using other aids such as cessation clinics or nicotine gum. More smokers in 1991 than in 1983 reported that they continued smoking for enjoyment, to satisfy a craving or addiction, and for relaxation. With regard to what might help them quit, continuing smokers in both surveys cited a wide variety of potential aids, including information on harmful effects, more restrictions on smoking and on sales, cessation clinics, programmes on radio/TV, and higher taxes. CONCLUSIONS: These findings support a multifaceted approach to tobacco control.


     

Smoking in the workplace: do smoking patterns and attitudes reflect the legislative environment?

OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with regard to workplace smoking were markedly different, with workplaces in the City of Toronto being covered by a much more stringent bylaw. RESULTS: In comparison with other workers, City of Toronto workers reported workplace restrictions to be more common and widespread. These workers were also less likely to smoke at work, and more likely to smoke less at work and to have cut down on smoking at work. Quit-smoking rates, however, were similar. There was evidence of some compensatory smoking outside work, but additional compensation in association with more stringent restrictions was not found. City workers and other workers were similar in their support for smoke-free workplaces, in their attitudes to the role of governments in regulating workplace smoking, and in their perceptions of conflict between smokers and non-smokers. Reports of quit-smoking programmes and educational interventions in the workplace were similarly uncommon, although both groups of workers indicated strong support for the role of business and industry in helping people quit. CONCLUSIONS: Restrictions on smoking and smoking patterns reflected the legislative environment; a more stringent environment was associated with more restrictions and less smoking at work.


     

Smokers are unaware of the filter vents now on most cigarettes: results of a national survey

OBJECTIVE: To evaluate awareness and knowledge of cigarette filter ventilation in a national probability sample of smokers of Ultra-light, Light, and regular cigarettes. DESIGN: Random-digit-dialling and computer-assisted telephone interviewing was used on a probability sample of daily cigarette smokers (ages 18 and above). SUBJECTS AND SETTING: 218 Smokers of Ultra-light cigarettes, 360 smokers of Light cigarettes, and 210 smokers of Regular cigarettes living in the continental United States. MAIN OUTCOME MEASURES: Percentage of respondents indicating knowledge of the presence of filter vents and the consequences of behavioural blocking of vents. RESULTS: Many smokers had not heard about or seen the filter holes: 43% (95% CI = 36 to 50%) of smokers of Ultra-lights, 39% (95% CI = 34 to 44%) of smokers of Lights, and 47% (95% CI = 40 to 54%) of smokers of Regulars. About two in three smokers either did not know of the existence of rings of small holes on the filters of some cigarettes, or did not know that blocking increases tar yields: 69% (95% CI = 63 to 75%) of Ultra- lights, 66% (95% CI = 61 to 71%) of Lights, and 69% (95% CI = 63 to 75%) of Regulars. CONCLUSIONS: Smokers are generally unaware of the presence and function of filter vents-a major design feature subject to behavioural blocking by smokers and now present on most cigarettes in the United States. Smokers and policy-makers need to be informed about the presence of filter vents and how vent blocking increases tar and nicotine yields from ostensibly very low-yield cigarettes.