Exploitation by design-could tobacco industry documents guide more effective smoking prevention and cessation in women?
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Biomedical subjects
Frances A Stillman
Publications and source records attributed to Frances A Stillman.
The landscape in global tobacco control research: a guide to gaining a foothold.
Smoking prevalence is shifting from more- to less-developed countries. In higher-income countries, smoking surveillance data, tailored treatments, public health campaigns, and research-based policy implementation have led to a decrease in tobacco use. In low- and middle-income countries, translating research into practice and policy is integral for tobacco control. We describe the landscape of existing resources, both financial and structural, to support global tobacco control research and strengthen research capacity in developing countries. We identify key organizations that support international efforts, provide examples of partnerships between developed and developing countries, and make recommendations for advancing global tobacco research. There is a need for increased commitment from organizations to support global tobacco control research.
Biomedical Research↗
Building capacity for international tobacco control research: the global tobacco research network.
The Global Tobacco Research Network (GTRN) was developed to enhance global tobacco control research through information sharing and collaboration among researchers. The formation of the GTRN is timely because of the need to ratify, implement, and track the Framework Convention on Tobacco Control. While the spectrum of international tobacco control research continues to expand, resources to support these efforts are still quite limited. As an issue-specific network focused on information sharing and capacity building associated with tobacco control research, the GTRN will provide an opportunity for enhancing the effectiveness of tobacco control initiatives.
Cooperative Behavior↗
Secondhand tobacco smoke in public places in Latin America, 2002-2003.
CONTEXT: The success of measures to restrict smoking in indoor environments and the intensity of enforcement vary among countries around the world. In 2001, the Pan American Health Organization (PAHO) launched the Smoke-Free Americas Initiative to build capacity to achieve smoke-free environments in Latin America and the Caribbean. OBJECTIVE: To assess secondhand smoke concentrations in public places in the capital cities of Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, and Uruguay in conjunction with the Smoke-Free Americas Initiative. DESIGN AND SETTING: Multicountry assessment of vapor-phase nicotine concentrations using a common protocol in all 7 Latin American countries. A total of 633 sampling devices were placed for 7 to 14 days in 1 hospital, 2 secondary schools, 1 city government building, 1 airport (2 in Argentina), and restaurants and bars in each country. MAIN OUTCOME MEASURE: Concentrations of airborne nicotine. RESULTS: Airborne nicotine was detected in most (94%) of the locations surveyed. By country, Argentina and Uruguay had the highest median concentrations in most environments (eg, in hospitals: 1.33 [interquartile range [IQR], 0.51-3.12] microg/m3 and 0.8 [IQR, 0.30-1.69] microg/m3, respectively). Overall, bars and restaurants had the highest median concentrations (3.65 [IQR, 1.55-5.12] microg/m3 and 1.24 [IQR, 0.41-2.48] microg/m3, respectively). Nicotine concentrations were also found in a number of key, sentinel buildings, including 95% (155/163) of hospital samples (in the physicians' and nurses' stations the median was 0.27 [IQR, 0.02-1.94] microg/m3), schools, government buildings, and/or airports in most countries. CONCLUSIONS: The finding of airborne nicotine in critical locations in Latin America provides a basis for enforcing smoke-free initiatives and for strengthening the protection of the public from unwanted exposure to secondhand smoke.
Argentina↗
Evaluation of the American Stop Smoking Intervention Study (ASSIST): a report of outcomes.
BACKGROUND: The National Cancer Institute funded an 8-year, nonrandomized demonstration project for tobacco prevention and control, the American Stop Smoking Intervention Study (ASSIST). To evaluate ASSIST, we compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia. METHODS: The strength of tobacco control index was used to measure state-level program elements directed at tobacco control, and the initial outcomes index (IOI) was used to measure states' tobacco control policy outcomes. Prevalence data were obtained from the Tobacco Use Supplement to the Current Population Survey, and consumption data were obtained from the Tobacco Institute's bimonthly sales figures for cigarette packs moved from wholesale warehouses. Two-stage regression and mixed-effects linear modeling were used to analyze the various outcomes. Statistical analyses for testing individual regression coefficients were one-sided. RESULTS: ASSIST states had a greater decrease in adult smoking prevalence than non-ASSIST states, with an adjusted difference of -0.63% (P =.049). Per capita cigarette consumption was not statistically significantly different between ASSIST and non-ASSIST states. However, an increase in the IOI of a state from the 25th to the 75th percentile was associated with a reduction in per capita cigarette consumption by 0.57 packs per person per month. State IOI was also inversely, albeit not statistically significantly, associated with smoking prevalence (regression coefficient = -0.11;P =.06). CONCLUSIONS: The reduction in adult smoking prevalence associated with ASSIST could have translated into approximately 278 700 fewer smokers nationwide if all states had implemented ASSIST. Investment in building state-level tobacco control capacity and promoting changes in tobacco control policies are effective strategies for reducing tobacco use.
Adolescent↗
Distribution of daily smokers by stage of change: Current Population Survey results.
BACKGROUND: Population-based national estimates of stage of change among daily smokers are unknown. This study described the proportion of U.S. daily smokers, 18 and older, by stage of change. Selected sociodemographic characteristics were delineated. METHODS: Cross-sectional data were collected via telephone or face-to-face interview in daily smokers who responded to the Current Population Survey in 1992-1993 (n = 39,706), 1995-1996 (n = 34,865), or 1998-1999 (n = 30,153). Main outcomes included stage of change: (1) Precontemplation-not interested in quitting smoking in next 6 months; (2) Contemplation-interested in quitting smoking in next 6 months but not next 30 days; (3) Preparation-interested in quitting smoking in next 30 days and stopped at least 1 day during past year. RESULTS: During 1992-1993, 59.1% of respondents were precontemplators, 33.2% contemplators, and 7.7% in preparation stage. This distribution was similar in subsequent surveys (1995-1996; 1998-1999). Gender differences were not apparent. Whites were more likely to be precontemplators. As education and income increased, the percentage in precontemplation decreased. Rural residents were more likely in precontemplation and less frequently in preparation. CONCLUSIONS: Among daily smokers, little movement in stage of change was apparent in the United States during the 1990s. Tobacco control efforts must receive high priority to address these static patterns.
Adolescent↗
Descriptive methods for evaluation of state-based intervention programs.
In this article, the authors discuss program evaluation of intervention studies when the outcome of interest is collected routinely at equally spaced intervals of time. They illustrate concepts using data from the American Stop Smoking Intervention Study, where the outcome is state per capita tobacco consumption. States differ widely in mean tobacco consumption, and these differences should be accounted for in the analysis. A large difference in the variance of the intervention effect may be obtained depending on whether the variation in the between-state effects are considered. The confidence limits obtained by ignoring between-state effects are too optimistic in many cases.
Humans↗