Exposure to secondhand smoke in Germany: air contamination due to smoking in German restaurants, bars, and other venues.

This study quantified exposure to secondhand smoke in German restaurants, bars, and entertainment venues by determining the concentration of respirable suspended particles measuring 2.5 microm or less (PM2.5) in indoor air. The measurements were taken using an inconspicuous device placed on the investigator's table in the venue. The concentration of particulate matter in the indoor air was measured for a minimum of 30 min. A total of 39 restaurants, 20 coffee bars, 12 bars, 9 discothèques, and 20 restaurant cars in trains were visited throughout Germany from September 30 to October 31, 2005. The readings disclosed a median PM2.5 of 260 microg/m3 and an arithmetic mean PM2.5 of 333 microg/m3. Median values were 378 microg/m3 in bars, 131 microg/m3 in cafes, and 173 microg/m3 in restaurants. The highest medians were measured in discothèques and restaurant cars, with values averaging 432 microg/m3 and 525 microg/m3 PM2.5, respectively. This study was the first to show the magnitude and extent of exposure to secondhand smoke on such an extensive scale in Germany. The contaminated air due to smoking is a human carcinogenic and major health hazard, which would be prevented most effectively and completely by implementing a ban on smoking. This study is important for the ongoing national debate in Germany as well as for debates in all countries without smoke-free air legislation, which includes most countries around the world.     

Tobacco policy rating form: a tool for evaluating worksite and tribal smoking control policies

OBJECTIVE: To report on the development and validation of a rating scale to code the various components of written tobacco policies. DESIGN: A one-page Tobacco Policy Rating Form (TPRF) was developed to apply to written policies in both worksites and American Indian tribes. Fifteen worksite and 24 tribal tobacco policies from a diverse set of companies and tribes of varying size and economic status were rated on the TPRF by two separate sets of experienced and inexperienced raters. Kendall's coefficient of concordance (W) was computed to measure inter- rater agreement. RESULTS: The scale was found to produce a high level of agreement when used by both experienced and inexperienced raters on both tribal and worksite policies. For experienced raters, W = 0.92, P < 0.0001 for tribal policies and W = 0.97, P < 0.0001 for worksite policies; for inexperienced raters, W = 0.89, P < 0.0001 for tribal policies and W = 0.96, P < 0.0001 for worksite policies. CONCLUSIONS: The TPRF seems worthy of future use as a tool to rate the strength and comprehensiveness of written tobacco policies. It may be extended to other settings such as schools and municipalities, or used by investigators studying behavioural or economic consequences of smoking policies. Those interested in policy change may find the TPRF useful as a way of describing existing policies and as a quantitative measure of change.


     

Non-smoking policies, tobacco education, and smoking cessation programmes in facilities serving the elderly in Michigan, United States

OBJECTIVE: To determine the extent of and impetus for smoke-free policies in facilities serving Michigan's elderly, and the extent of tobacco education and smoking cessation programmes for elders and staff of these facilities. DESIGN: Telephone survey in February 1997 of three types of facilities serving Michigan's elderly population. SUBJECTS: Area Agencies on Aging (n = 12), Councils and Commissions on Aging (n = 31), and senior centres (n = 98) located in Michigan, USA. MAIN OUTCOME MEASURES: Prevalence of smoke-free policies, tobacco education, and smoking cessation programmes in facilities serving the elderly. RESULTS: 99% (95% confidence interval (CI) = 97% to 100%) of 141 facilities surveyed have an indoor smoke-free policy. Eighty-five per cent (95% CI = 79% to 91%) of these policies prohibit all smoking inside the facility. Forty-five per cent (95% CI = 37% to 54%) cited a law as requiring the smoke-free policy, whereas 38% (95% CI = 30% to 46%) indicated the policy was adopted voluntarily for health reasons. Forty-two per cent (95% CI = 34% to 50%) of the facilities provided some education on the dangers of tobacco, while 11% (95% CI = 6% to 16%) arranged smoking cessation programmes for staff or elders. CONCLUSIONS: In Michigan, a very high percentage of non-institutional facilities serving the elderly have smoke-free policies, which appear to increase participation at these facilities. Tobacco education programmes are provided in less than half the facilities, and very few arrange smoking cessation programmes for elders or staff.




     

Workplace smoking policies in the United States: results from a national survey of more than 100,000 workers

OBJECTIVE: To determine the prevalence of smoking policies in indoor work environments as reported by a nationally representative sample of workers in the United States. DESIGN: Cross-sectional survey of households within the United States. SETTING: All 50 state and the District of Columbia, 1992-93. PARTICIPANTS: Currently employed indoor workers 15 years of age and older who responded to the National Cancer Institute's Tobacco Use Supplement to the Current Population Survey (n = 100,561). MAIN OUTCOME MEASURES: The prevalence and restrictiveness of workplace smoking policies as reported by workers currently employed in indoor workplaces in the United States. RESULTS: Most of the indoor workers surveyed (81.6%) reported that their place of work had an official policy that addressed smoking in the workplace; 46.0% reported that their workplace policy did not permit smoking in either the public/common areas--for example, restrooms and cafeterias--or the work areas of the workplace. The reporting of these "smoke-free" policies varied significantly by gender, age, race/ethnicity, smoking status, and occupation of the worker. CONCLUSIONS: Although nearly half of all indoor workers in this survey reported that they had a smoke-free policy in their workplace, significant numbers of workers, especially those in blue-collar and service occupations, reported smoke-free rates well below the national average. If implemented, the US Occupational Safety and Health Administration's proposed regulation to require worksites to be smoke-free has the potential to increase significantly the percentage of American workers covered by these policies and to eliminate most of the disparity currently found across occupational groups.


     

Measurement and definition for smoking cessation intervention research: the smoke-free families experience. Smoke-Free Families Common Evaluation Measures for Pregnancy and Smoking Cessation Projects Working Group

The measures, definitions, and processes used in the Smoke-Free Families clinical trials to assure consistent measurement and reporting of various aspects of the trials are described. Definitions of current smokers at different points in the pregnancy, levels of addiction, biological verification, cessation, stages of change, and intervention approaches are presented along with the rationale underlying their adoption and development.     

A rationale for introducing a subsidiary fishery in tropical reservoirs and lakes to augment inland fish production: case study from Sri Lanka

An extra 30–40 million tonnes of food fish will be required by 2050 to meet the increasing need for a growing population. In the wake of plateauing of the traditional food fish supplies from marine capture fisheries, the gap in the supplies will have to be met from aquaculture and other plausible strategies, including increased inland fish production. The existing fisheries in tropical reservoirs and lakes traditionally tend to target only table-sized fish, often exotics and/or translocated species, using a single type of gear, mostly gill nets. In such fisheries, many small indigenous species (SIS) are unexploited due to the prohibition of the use of suitable fishing gear. The status of fisheries for small, indigenous species of four Sri Lankan reservoirs was investigated with a view to identifying regulatory constraints to the establishment of SIS fisheries without adversely impacting existing commercial fisheries. It is estimated that a potential of 7.5 t per fisher per annum of SIS through the introduction of a new fishery is obtainable. This study is significant as SIS are recognized as important sources of essential macro- and micronutrients which can play a crucial role in combating malnutrition and micronutrient deficiencies in rural populations of many South and Southeast Asian countries.     

Costs and benefits of smoking cessation aids: making a case for public reimbursement of nicotine replacement therapy in Australia

Background

Tobacco smoking is the leading preventable cause of morbidity and mortality in Australia and other developed countries. Of the pharmacological aids that are available for smoking cessation, bupropion (Zyban SR) is eligible for public reimbursement on the Australian Pharmaceutical Benefits Scheme (PBS), whereas nicotine replacement therapy (NRT) is not. Information on the cost‐effectiveness and financial impact of public reimbursement of these strategies can better inform debate about their inclusion or exclusion in public reimbursement schemes.

Objective

To estimate the cost‐effectiveness of bupropion and NRT, and the potential financial impact of public reimbursement of NRT in Australia.

Design

A cost‐effectiveness analysis using a deterministic Markov model, and cost per disability‐adjusted life year (DALY) averted over a lifetime as the outcome measure.

Population

Current smokers, motivated to quit, in Australia in 2000.

Interventions

(1) NRT; (2) bupropion; and (3) a combined strategy using bupropion as the first‐line treatment and NRT in those who fail to quit smoking or have adverse reactions to bupropion.

Results

Quitting smoking can increase life expectancy of current smokers by 1–7.6 years depending on age at cessation and sex. Providing bupropion to current smokers who are motivated to quit would cost A$7900 (95% uncertainty interval A$6000 to A$10 500) for each DALY averted; NRT patches would cost A$17 000 (A$9000 to A$28 000) for each DALY averted, with similar results even if used as a second‐line treatment following initial failure to quit using bupropion. If 6% of current smokers were to use NRT following inclusion on the PBS, this would result in an annual cost of A$40–110 million to the PBS depending on the listed price.

Conclusions

Compared with other drugs included on the PBS, bupropion and NRT are both highly cost‐effective smoking cessation interventions, and including NRT on the PBS would have a moderate financial impact. Given the sizeable health burden of smoking, and the large individual benefits of quitting smoking, increasing the availability of alternative aids and uptake of these strategies through public reimbursement would be a positive and rational step towards further reducing tobacco‐related disease burden in Australia and other countries where NRT is currently not subsidised.Tobacco smoking is the largest preventable cause of morbidity and mortality in Australia and other developed countries. Despite projected declines in tobacco‐related diseases in line with decreasing prevalence, tobacco is still expected to be among the leading causes of disease burden in 2016.¹ Worldwide, it is the second highest cause of death and fourth highest cause of disease burden.Effective policies to control tobacco use are crucial. Although preventing individuals from starting smoking is an important aim of tobacco control, cessation in current smokers is also critical. As nicotine is highly addictive, smokers often require assistance to maintain abstinence. Modestly effective cessation aids are available, including pharmacological agents, such as bupropion (Zyban SR) and nicotine replacement therapy (NRT).^2,3Australia has implemented many strong tobacco control policies. The retail price of tobacco in Australia is among the top three worldwide.⁴ Advertising and promoting tobacco products has been totally banned, pictorial pack warnings have recently been implemented, opportunities to smoke cigarettes in public places are severely limited and there is legislation in place forcing an upcoming ban of smoking in bars and hotels.^5,6,7 Despite these measures, nearly one in five Australian adults still smoke daily, indicating the need for further strategies to encourage cessation.⁸In 1995, the Australian government rejected a recommendation by the Pharmaceutical Benefits Advisory Committee to include NRT on the public reimbursement scheme—the Pharmaceutical Benefits Scheme (PBS).⁹ By contrast, bupropion was made available on the PBS in February 2001.¹⁰ The continued exclusion of NRT and inclusion of bupropion may or may not be a rational decision. Valid and comparable information on the cost‐effectiveness and financial implications of including these interventions on the PBS are important inputs into this debate.The cost‐effectiveness of both NRT and bupropion has been studied previously.² A lack of consistency in the methods of these studies, however, makes comparisons difficult, and the context‐specific nature of inputs into cost‐effectiveness analyses such as disease outcomes means that these results may not be applicable to the Australian setting.^2,11 This study aims to evaluate the cost‐effectiveness of NRT and bupropion in the Australian context, as well as the potential financial impact of including NRT on the PBS.     

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     

Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden

Objectives

The strategies used to support smoking cessation among quitters were investigated according to year of smoking cessation and sociodemographic characteristics.

Methods

The 2004 public health survey in Skåne, Sweden, is a cross‐sectional study. A total of 27 757 people aged 18–80 answered a postal questionnaire. The participation rate was 59%. Different strategies to support smoking cessation—that is, no therapy, nicotine replacement (NRT), professional therapy and snus (snuff) use, were investigated among quitters according to year of smoking cessation, and demographic and socioeconomic characteristics.

Results

14.9% of the men and 18.1% of the women were daily smokers. The prevalence of daily snus use was 19.5% among men but only 2.3% among women. Stratifying the data according to year of smoking cessation (1938–2004) revealed a significant increase in active smoking cessation strategies such as NRT, professional therapy and snus use. NRT was more common among women (23.6%) than men (14.8%) among smokers who quit in 2000–4, but snus use was more common among men (30.4% versus 8.7%). No replacement or other therapy at all was significantly more common among women (63.6%) than men (52.1%). People aged 35–80 years used more nicotine replacement than people aged 18–34, while men aged 18–34 used snus to quit smoking significantly more than men aged 55–80.

Conclusions

Snus is used commonly among men as a support for smoking cessation in Sweden. Women use pharmacological NRT to a greater extent, but this can probably not compensate for the much higher extent of snuff use as a cessation strategy among men.     

Date fruit: a review of the chemical and nutritional compounds,functional effects and food application in nutrition bars for athletes

Date fruit is an excellent source of nutritional and health benefits. The chemical composition of dates includes carbohydrates, dietary fibre, proteins, fats, minerals and vitamins, enzymes, phenolic acid and carotenoids, all of which are directly linked to nutritional and health benefits for consumers. A number of studies have also confirmed the therapeutic effects of dates and their efficacy in the treatment of many disease conditions. As a result, a number of food products such as date syrup, date juice and date paste have been developed in order to harness the nutritional potential of dates. Adequate sources of nutrition are important for all consumers, especially for active lifestyle individuals such as athletes and sportspeople. As the goal of every athlete is to enhance athletic performance and prevent energy deficit, the use of dietary supplements has been highly recommended as a solution in this regard. For example, nutrition bars are one source of high energy and nutrients that can provide the required energy for enhanced athletic performance, and date fruits could be valorised into nutrition bars in order to help athletes to achieve their performance and nutritional goals. In this paper, we review the chemical composition and health benefits of date fruit, its food application and consequently its formulation in nutrition bars for athletes.