Predicting Youth Access to Tobacco: The Role of Youth Versus Store-Clerk Behavior and Issues of Ecological Validity.

Twenty-one 15- to 17-year-olds attempted to purchase cigarettes in 232 stores in the manner that confederates typically do in access studies, as well as in the manipulative ways (e.g., lying about their ages) that youth smokers do, thereby modeling youth access to tobacco within versus outside of studies, respectively. Youth typical-research versus manipulative behavior was contrasted with clerk behavior (requests for youth ID cards) to examine the relative contributions of both to youth access to tobacco for the 1st time. Results revealed that clerk behavior was the strongest predictor of cigarette sales to youth and hence underscore the need for interventions with merchants. Sales nonetheless were higher under youth-manipulative conditions and thereby highlight the low ecological validity of access research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of an enforcement program to reduce tobacco sales to minors

OBJECTIVES: This study evaluated an active enforcement program to increase retailers' compliance with the law prohibiting tobacco sales to minors. METHODS: Tobacco sales to minors were monitored in 319 outlets in 6 pairs of communities in Erie County, New York. One community in each pair was randomly assigned to an enforcement intervention. RESULTS: Retailers' compliance with the law increased from 35% in 1994 to 73% in 1995. However, the change in compliance rates was roughly the same for stores in the enforcement and nonenforcement communities. CONCLUSIONS: Active compliance checking of retail outlets as a strategy to reduce illegal tobacco sales to minors may only be necessary insofar as it contributes to an increase in retailers' perception that the threat of enforcement is real.     

Laying down the law: reducing illegal tobacco sales to minors in central Harlem

OBJECTIVES: This study compared the impact of educational and enforcement interventions on retailers' sale of tobacco to minors in Central Harlem, New York. METHODS: In a randomized trial with repeated measures, 152 stores were randomly divided into control, education, and enforcement groups. RESULTS: Overall tobacco sales to 12- and 13-year-old minors at baseline (98%) were among the highest in the nation. At 6-month and 1-year follow-ups, decreases in rates of tobacco sales to minors were modest among education stores and substantial among enforcement stores. CONCLUSIONS: Effective reduction of tobacco sales to minors may require ongoing enforcement measures, including fines for retailers who violate state and local laws.     

Pharmacy and tobacco

With the recognition that smoking begins in youth and that tobacco products are readily available to those under 18 years of age, new Food and Drug Administration (FDA) regulations restrict the sale, distribution, promotion, and advertising of cigarettes to minors. The objective is to decrease the use of tobacco by young people and consequently reduce the future morbidity and mortality from tobacco. Pharmacists currently have three choices with regard to the sale of tobacco in pharmacies: display and sell tobacco products, refuse to sell tobacco products, or make tobacco products available but counsel on smoking cessation. Each choice, as well as the impact of the new FDA regulations on pharmacy, is discussed.     

The effect of enforcing tobacco-sales laws on adolescents' access to tobacco and smoking behavior

BACKGROUND: Enforcing laws banning tobacco sales to minors is widely advocated as a way to reduce young people's access to tobacco and tobacco use. Whether this approach is successful is not known. METHODS: In a two-year controlled study, we assessed sales of tobacco to minors and young people's access to and use of tobacco in six Massachusetts communities. Three communities (the intervention group) enforced tobacco-sales laws, whereas three matched communities (the control group) did not. To assess compliance with the law, minors working for the study investigators attempted to purchase tobacco from all retail vendors in each community every six months. Three annual anonymous surveys of a total of 22,021 students in grades 9 through 12 (response rate, 84 percent) measured access to tobacco and smoking behavior. RESULTS: At base line, 68 percent of 487 vendors sold tobacco to minors. Compliance with the law improved significantly faster in the intervention communities than in the controls (P<0.001). By the study's end, 82 percent of the merchants in the intervention communities complied with the law, as compared with 45 percent in the control communities (P<0.001). However, adolescents under 18 years old reported only a small drop in their ability to purchase tobacco and no decline in its use. Communities with and those without enforcement programs did not differ with respect to these outcomes. CONCLUSIONS: Enforcing tobacco-sales laws improved merchants' compliance and reduced illegal sales to minors but did not alter adolescents' perceived access to tobacco or their smoking. Test purchases of tobacco do not accurately reflect adolescents' self-reported access to tobacco, and reducing illegal sales to less than 20 percent of attempts -- the goal of a new federal law-- may not decrease young people's access to or use of tobacco.     

Dose-dependent induction of IL-12 but not IL-10 from human keratinocytes after exposure to ultraviolet light A

OBJECTIVE: Our purpose was to assess the risk of ectopic pregnancy among women who smoke cigarettes. STUDY DESIGN: We used data from a case-control study of ectopic pregnancy conducted from October 1988 to August 1990 at an inner-city hospital in Georgia. Cases were 196 non-Hispanic black women with a surgically confirmed ectopic pregnancy. Controls were non-Hispanic black women who had delivered either a live or a stillborn infant weighing at least 500 gm (n = 882) or who were pregnant and seeking an induced abortion (n = 237). RESULTS: After we adjusted for parity, douching history, history of infertility, and age, the odds ratio for ectopic pregnancy was 1.9 (95% confidence interval 1.4 to 2.7) for women who smoked during the periconception period compared with women who did not smoke at that time. After stratification by the amount of daily smoking during the periconception period, the odds ratio rose from 1.6 (95% confidence interval 0.9 to 2.9) for women who smoked 1 to 5 cigarettes to 1.7 (95% confidence interval 1.1 to 2.8) for women who smoked 6 to 10 cigarettes to 2.3 (95% confidence interval 1.3 to 4.0) for women who smoked 11 to 20 cigarettes, and to 3.5 (95% confidence interval 1.4 to 8.6) for women who smoked >20 cigarettes per day. CONCLUSION: In this inner-city population, cigarette smoking was an independent, dose-related risk factor for ectopic pregnancy among black women. The public health and medical care communities should inform the public of this additional risk associated with cigarette smoking and intensify intervention strategies to reduce cigarette smoking among women of reproductive age.     

Effect of dietary protein and environmental temperature on growth performance and water consumption of male broiler chickens

The purpose of this study was to investigate whether smokers outside buildings with work-place smoking bans smoke "harder" than those smoking in social settings. An unobtrusive random observational study of smokers followed by structured interview was used, with 143 smokers taking smoking breaks outside their office buildings and 113 smokers in social settings. The main outcome measurements were number of puffs per cigarette and cigarette smoking duration. The mean number of puffs per cigarette for the office building group was 18.7% greater than that for the social settings group (10.7 +/- 3.2 vs. 8.7 +/- 2.7, t = 5.58, df = 253, p < 0.001); 74.8% of smokers outside offices took more than the mean number of puffs for the group compared to 42.5% of smokers in social settings (chi 2 df 1 = 26.31, p < 0.0001). Mean cigarette smoking duration was 30.4% shorter for the work-place group than the social settings group (3.9 +/- 1.2 minutes vs. 5.6 +/- 2.6 minutes). Of smokers outside offices, 55.2% had a cigarette smoking duration between 3 and 4.59 minutes, while 53.1% of smokers in social settings took > or = 5 minutes to smoke the observed cigarette (chi 2 df 2 = 31.55, p < 0.0001). Smokers who scored at the 75th percentile on the Fagerstrom Tolerance Scale took a mean 9.5 +/- 2.6 puffs per cigarette compared to 9.3 +/- 2.7 puffs by those who scored in the 25th percentile on the scale (t = 0.34, df = 145, p = 0.73). Regardless of degree of nicotine dependency, smokers leaving work-stations to smoke outside buildings smoked their cigarettes nearly 19% "harder" than cigarettes smoked in social settings. The individual and public health benefits of reduced smoking frequency engendered by work-place smoking bans may be lessened by policies which allow smokers to take smoking breaks.     

Transplacentally induced neuronal migration disorders: an animal model for the study of the epilepsies

OBJECTIVES: This investigation examined whether, despite the Tobacco Institute's Voluntary Cigarette Advertising and Promotion Code, current cigarette print advertising communicates culturally positive messages to youth about smoking. METHODS: Nine hundred thirteen students in grades 6-8 (ages 10-15) were shown a sample of four contemporary cigarette print ads (Camel, Marlboro, Newport, and Virginia Slims) and completed structured written assessments designed to capture their perceptions of each ad. RESULTS: Across the four ads, between 37% and 84% of the students reported that the ads communicated to them that smoking will make people popular, cool, successful in life, sexy, attractive, and healthy. Sizeable percentages of students reported that the ads show people using the product in an "exaggerated" way, and that what people in the ads are doing requires "exercise and physical energy." The median estimated age of the models in the ads was under age 25 for four out of the six models. CONCLUSIONS: As perceived by adolescents, current cigarette print advertising violates basic tenets of the Voluntary Code, thus bringing into question the tobacco industry's ability to self-regulate image advertising. These findings suggest that the FDA ruling to prohibit image advertising for tobacco in publications with significant youth readership deserves serious consideration.     

An ecological perspective on smoking among Asian American college students: The roles of social smoking and smoking motives.

Using electronic diaries, the present study examined the roles of social smoking and smoking motives in relation to cigarette use patterns among Asian American college smokers. Multilevel modeling results showed that participants smoked more cigarettes when smoking with peers than when smoking alone. Participants' coping (but not social) motives moderated the within-person associations between smoking with peers and the cigarettes smoked during a smoking episode. The findings support the utility of an ecological perspective in examining the dynamic interaction between smoking motives and the social settings of cigarette use, and call for further research on the social smoking behaviors in diverse populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The anti-inflammatory action of the mineral bischofite

OBJECTIVE: To determine the prevalence and pattern of smoking amongst Pakistanis. SAMPLING DESIGN: A two stage stratified sample design was adopted for the survey, Primary Sampling Units (PSU's) and Secondary Sampling Units (SSU's). SETTING: Urban and Rural, Pakistan 1990-94. SUBJECTS: Stratified systematic sample of 9441 males and females aged 15 years and above. MAIN OUTCOME MEASURES: Smokers were defined as, subjects who were currently smoking and who had smoked > or = 100 cigarettes/beedis or chillum/huqqa in their life time. RESULTS: In Pakistan 21.6% (36% males and 9% females) of 9441 subjects were smokers. In urban areas it was 20.7% and in rural 22.0%, males were predominant in both urban and rural areas. Proportion of smokers who used cigarette/beedi were significantly higher in males (60%) while chillum/huqqa were more in females (62%). Prevalence increased with age upto 64 years, after which it declined but in urban females it continued to rise with age. Among both males and females; illiterate, married individuals with poor general health were more likely to smoke. These factors were 2 to 3 times more in males and 2 to 5 times more in females who were more likely to be smokers than those who were literate, single individuals with good general health. CONCLUSION: Smoking was more prevalent in illiterate, married persons and those with poor general health.     

Sale of cigarettes to school children aged 14 and 15 years in New Zealand

AIMS: To determine the sources of cigarettes and extent of illegal sales to 14 and 15 year old children, and to examine associated risk factors in order to more effectively reduce tobacco access to children. METHOD: Nationwide cross sectional survey of fourth form school children in New Zealand by means of an anonymous self administered questionnaire. RESULTS: Questionnaires from 14,097 fourteen and fifteen years olds were analysed, with over one third smokers. Twenty four percent of the whole group (3432) had bought cigarettes in the last year. Of smokers, 59.9% bought their own, with the great majority (68.9%) from dairies, particularly females. Ninety five percent said it was "easy" or "very easy" to buy cigarettes, and this was a major risk factor for this behaviour (relative risk (RR) = 2.01, 95% confidence interval (CI) 1.74, 2.32, RR = 2.54, CI 2.28, 2.83, respectively). Only 24.6% children had ever been refused cigarettes because of age and all points of sale were comparable in this respect. Heavy smokers and males were more likely to have been refused. While refusal was associated with a fourfold increase in the perception that it was difficult to buy cigarettes, there was only a minimal reduction in the risk of children buying their own cigarettes (RR = 0.95, CI 0.91, 1.00). CONCLUSION: We have shown that the illegal sale of cigarettes to children is unacceptably easy and accurately perceived as such by children who smoke. The active enforcement of existing or future legislation is essential, with prosecution of offending retailers, if we are to make any progress to reduce the high prevalence of smoking in New Zealand children.     

Cigarette smoking in a multiethnic population of youth: methods and baseline findings

BACKGROUND: To expand upon recent research studies that have identified dramatic ethnic differences in adolescent cigarette smoking, this study was designed to characterize smoking among a multiethnic population of adolescents and to identify significant factors that may protect against smoking initiation. METHODS: During the first 2 years, this mixed cross-sectional, longitudinal study recruited and collected baseline data from a volunteer sample of 1,441 Houston-area public school students in the 5th, 8th, or 12th grade. A wide range of new and established predictors of smoking behavior was assessed, and their associations with ever smoking and susceptibility to smoking were assessed within ethnicity (white, N = 537; African-American, N = 454; and Hispanic, N = 297). RESULTS: Consistent with previous studies, white students smoked in substantially higher proportions than African-American students, with Hispanic adolescents in-between. Simultaneously adjusting for other variables, the odds of ever smoking (OR = 0.47, P < 0.01) and susceptibility to smoking (OR = 0.64, P < 0.01) were significantly lower among African-American adolescents when compared with whites; odds ratios for Hispanics and whites did not differ. Across all three ethnicities, the most important predictor of both ever smoking and susceptibility to smoking was the smoking status of the three best friends. Several ethnicity-specific variables also were identified. CONCLUSIONS: In concordance with previous investigations, cigarette smoking prevalence differs by ethnicity, and the factors associated with ever smoking and susceptibility to smoking differ among white, African-American, and Hispanic adolescents. The results of this study may be used to develop theory-based, culturally appropriate smoking intervention programs for adolescents.     

How do adolescents process smoking and antismoking advertisements? A social cognitive analysis with implications for understanding smoking initiation.

Youth tobacco use has increased substantially in the United States during the past decade. This increase can be attributed, in part, to the potency of cigarette advertising and relative ineffectiveness of antismoking advertising. In this article, the authors argue that an understanding of the effects of these 2 competing forms of advertising on youth smoking is limited in current theoretical treatments and that an integrative theoretical perspective has yet to be advanced. The authors argue that the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986) offers a framework with sufficient explanatory power in this domain. Prevention and legislative interventions may benefit from this analysis, which ultimately may help to decrease youth tobacco use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blocking filter vents increases carbon monoxide levels from ultralight, but not light cigarettes

Effect of vent blocking on carbon monoxide (CO) exposure from a best-selling light cigarette was examined in 12 daily cigarette smokers. Mean CO boosts were not different from each other with (a) 0% filter vents blocked (5.0 ppm), (b) vents covered with lips (4.9 ppm), (c) 50% of vents covered with tape (4.8 ppm), and (d) vents covered with a pinch of the fingertips (4.9 ppm). A second study in another 12 smokers was conducted to replicate these findings as well as earlier findings that blocking vents doubles CO intake from 1-mg tar cigarettes. While blocking half the vents with fingers significantly increased CO boost from ultralight cigarettes (2.8 vs. 5.4 ppm, p < 0.001), it did not influence boosts from light cigarettes (6.3 vs. 6.5 ppm, p = 0.8). The lowest yield cigarettes (1 mg tar) may be special. Smoking machine simulations provide poor models of human smoke intake. It is unclear whether tar and nicotine intake from light cigarettes was influenced by vent blocking.     

Alpha-Tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance

BACKGROUND: Experimental and epidemiologic investigations suggest that alpha-tocopherol (the most prevalent chemical form of vitamin E found in vegetable oils, seeds, grains, nuts, and other foods) and beta-carotene (a plant pigment and major precursor of vitamin A found in many yellow, orange, and dark-green, leafy vegetables and some fruit) might reduce the risk of cancer, particularly lung cancer. The initial findings of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study) indicated, however, that lung cancer incidence was increased among participants who received beta-carotene as a supplement. Similar results were recently reported by the Beta-Carotene and Retinol Efficacy Trial (CARET), which tested a combination of beta-carotene and vitamin A. PURPOSE: We examined the effects of alpha-tocopherol and beta-carotene supplementation on the incidence of lung cancer across subgroups of participants in the ATBC Study defined by base-line characteristics (e.g., age, number of cigarettes smoked, dietary or serum vitamin status, and alcohol consumption), by study compliance, and in relation to clinical factors, such as disease stage and histologic type. Our primary purpose was to determine whether the pattern of intervention effects across subgroups could facilitate further interpretation of the main ATBC Study results and shed light on potential mechanisms of action and relevance to other populations. METHODS: A total of 29,133 men aged 50-69 years who smoked five or more cigarettes daily were randomly assigned to receive alpha-tocopherol (50 mg), beta-carotene (20 mg), alpha-tocopherol and beta-carotene, or a placebo daily for 5-8 years (median, 6.1 years). Data regarding smoking and other risk factors for lung cancer and dietary factors were obtained at study entry, along with measurements of serum levels of alpha-tocopherol and beta-carotene. Incident cases of lung cancer (n = 894) were identified through the Finnish Cancer Registry and death certificates. Each lung cancer diagnosis was independently confirmed, and histology or cytology was available for 94% of the cases. Intervention effects were evaluated by use of survival analysis and proportional hazards models. All P values were derived from two-sided statistical tests. RESULTS: No overall effect was observed for lung cancer from alpha-tocopherol supplementation (relative risk [RR] = 0.99; 95% confidence interval [CI] = 0.87-1.13; P = .86, logrank test). beta-Carotene supplementation was associated with increased lung cancer risk (RR = 1.16; 95% CI = 1.02-1.33; P = .02, logrank test). The beta-carotene effect appeared stronger, but not substantially different, in participants who smoked at least 20 cigarettes daily (RR = 1.25; 95% CI = 1.07-1.46) compared with those who smoked five to 19 cigarettes daily (RR = 0.97; 95% CI = 0.76-1.23) and in those with a higher alcohol intake (> or = 11 g of ethanol/day [just under one drink per day]; RR = 1.35; 95% CI = 1.01-1.81) compared with those with a lower intake (RR = 1.03; 95% CI = 0.85-1.24). CONCLUSIONS: Supplementation with alpha-tocopherol or beta-carotene does not prevent lung cancer in older men who smoke. beta-Carotene supplementation at pharmacologic levels may modestly increase lung cancer incidence in cigarette smokers, and this effect may be associated with heavier smoking and higher alcohol intake. IMPLICATIONS: While the most direct way to reduce lung cancer risk is not to smoke tobacco, smokers should avoid high-dose beta-carotene supplementation.     

Necrotizing enterocolitis in horses: a retrospective study

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.     

Clinical study of total intravenous anesthesia with droperidol, fentanyl and ketamine--effects of nicardipine, diltiazem and nifedipine on intraoperative hypertension

The purpose of the study was to explore the relationship between the exposure of adolescents in the seventh and eighth grades to cigarette advertising and their being smokers. A survey questionnaire given to 602 adolescents assessed their exposure to cigarette advertising and provided measures of their smoking behavior, demographic characteristics, and some psychosocial variables. The results indicated that exposure to cigarette advertising and having friends who smoked were predictive of current smoking status. Adolescents with high exposure to cigarette advertising were significantly more likely to be smokers, according to several measures of smoking behavior, than were those with low exposure to cigarette advertising. The findings extend previous research identifying factors that may play a role in the initiation and maintenance of smoking among adolescents.     

Association of coffee drinking with cigarette smoking in the natural environment.

Coffee drinking may serve as a cue for cigarette smoking. The association of coffee drinking and cigarette smoking in the natural environment was studied in 6 participants who recorded every instance of ad lib cigarette smoking and coffee drinking for 4 consecutive days. The rate of cigarette smoking was higher during intervals associated with coffee drinking (2.4 cigarettes/hr) than at other times of the day (1.0 cigarettes/hr). However, diary records revealed that on average only 14% of cigarettes were smoked while drinking coffee, and only 55% of coffee-drinking events were accompanied by cigarettes. These results suggest that coffee drinking may exert some stimulus control over smoking in the natural environment. However, given the limited number of coffee-drinking episodes compared with cigarettes consumed in a day, the contributions of coffee drinking to maintaining smoking behavior are probably minimal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Study of the Relationship Between Depressive Symptoms and Cigarette Use Among African American Adolescents.

The relationship between depressive symptoms and cigarette use was examined in a sample of 623 African Americans during adolescence and transition to adulthood by using hierarchical linear modeling. Participants in the study were interviewed across 6 occasions over 8 years. Results indicate that depressive symptoms tend to decrease over time, whereas cigarette use tends to increase for both female and male adolescents. The results also suggest that depressive symptoms predict later cigarette use. Male adolescents who reported more depressive symptoms were more likely than female adolescents to use cigarettes as a way to cope with their mood. These results suggest that depressive symptoms may be important to consider when developing smoking cessation interventions for African American youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deadly targeting of women in promoting cigarettes

The history of tobacco marketing portrays a strong relationship between cigarette advertising targeted to women and the rise in the prevalence of women smoking. This article describes how tobacco companies crafted their marketing strategies to obfuscate the growing evidence of the health hazards of tobacco and to circumvent attempts to regulate cigarette advertising. It shows how the tobacco industry understood and capitalized on the women's liberation movement to sell cigarettes as symbols of freedom and emancipation, tracing the creation and promotion of Virginia Slims as a case study. And it documents the unfortunate success of these marketing strategies as reflected in the trends of tobacco use, especially among underage girls, and the commensurate increase in tobacco-related disease and death among women.