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The New York City Smoke-Free Air Act: second-hand smoke as a worker health and safety issue.

BACKGROUND: Despite the provisions of a Smoke-Free Air Act (SFAA) enacted in 1995, more than 415,000 non-smoking New York City workers reported exposure to second-hand smoke in the workplace all or most of the time in 2002. Continued exposure to second-hand smoke in New York City prompted a renewed debate about a broader smoke-free air law. METHODS: The approach taken by the New York City Department of Health and Mental Hygiene to make the case for workplace protection from second-hand smoke, counter the opposition's arguments, and ultimately win the support of policymakers and the public for comprehensive smoke-free workplace legislation is described. RESULTS: On December 30, 2002, New York City's Mayor signed the SFAA of 2002 into law, making virtually all workplaces, including restaurants and bars, smoke-free. CONCLUSIONS: Proponents for a stronger law prevailed by defining greater protection from second-hand smoke as a matter of worker health and safety. Efforts to enact smoke-free workplace laws will inevitably encounter strong opposition, with the most common argument being that smoke-free measures will harm businesses. These challenges, however, can be effectively countered and public support for these measures is likely to increase over time by focusing the debate on worker protection from second-hand smoke exposure on the job.

Air Pollution, Indoor↗

The effect of smoke generation and manipulation variables on the cytotoxicity of mainstream and sidestream cigarette smoke to monolayer cultures of L-929 cells.

A system for the simultaneous exposure of monolayer cell cultures to mainstream (MS) and sidestream (SS) smoke from the same cigarette was utilized to study the effects of smoke generation and manipulation variables on the cytotoxicity of smoke to monolayer cultures of mouse fibroblast-like L-929 cells. The cytotoxicity of MS smoke was decreased with increasing smoke age (up to 8.7 s), smoke dilution, and the quantity of activated charcoal in filters. Acetate filters had little effect on cell mortality, and the age-of-smoke effect was not evident for MS smoke generated with a low puff volume and rapid dilution. The cytotoxicity of SS smoke also decreased rapidly with increasing smoke age and dilution. The results indicate that the gas phase of smoke may be of major importance in generating the observed toxic effects. These results may be of potential future significance in defining the requirements for a less toxic cigarette, in considering the hazards of SS smoke, and in evaluating in vivo inhalation studies.

Animals↗

[Prevalence of smoking habits of Upper Austria students of the 7th and 8th grade and effect of smoking habits of family and peers].

The aim of the study was to explore the prevalence of different smoking habits in a population of Austrian pupils, 12 to 15 years old, and the relationship of familial and peer group smoking customs with these habits. In 1997 a population-based survey (International Study of Asthma and Allergies in Childhood, ISAAC) was conducted of all 7th and 8th grade school children of a district of Upper Austria. Information on the smoking habits of the adolescents, the family members, and of the peer as well as smoking habits of the teacher, gender, and age of the children was collected. The overall-prevalence of having ever smoked in this population is 57.8%. The percentage of eversmokers among the 12-year-olds is 50%. This amount increases to 63.8% among the 14- to 15-year-olds. The odds ratios for smoking daily is highest among those whose best friend smokes (OR: 70.63, CI: 9.19, 542.40). The risk of daily smoking increases also if the siblings of the juvenile (OR: 4.71, CI: 1.15, 19.35) or the mother (OR: 4.95, CI: 1.67, 14.70) smoke. If the father smokes the risk to smoke monthly is increased (OR: 2.09, CI: 1.28, 3.40). These results point to the fact that smoking prevention programes should take into account the influence of peers and family of the adolescents.

Adolescent↗

Life-history correlates of environmental tobacco smoke: a study on nonsmoking Hong Kong Chinese wives with smoking versus nonsmoking husbands.

Studies to evaluate the effects of environmental tobacco smoke (ETS, passive smoking) often use nonsmoking wives with smoking discordant husbands. To see whether there were differences in exposures and behavior patterns among never-smoked wives with never-smoked vs ever-smoked husbands, the life-history profiles of 136 ever-married women with mean age of 59 were analyzed on 97 quantifiable variables. Overall, the results demonstrated that wives with never-smoked husbands had 'healthier' lifestyles than wives with smoking husbands. The former were better off in terms of socio-economic status, more conscientious housewives, ate better diets, and had better indices of family cohesiveness. They also fared better in variables that reflected health status with lower frequencies of the following: miscarriages/abortions, inhaling through the mouth, chronic cough, and chest X-rays. The differences were usually largest when comparing wives of never-smoked vs heavily smoking (greater than 20 cigarettes/day) husbands. The results indicate some correlates of passive smoking that can act as important confounders when evaluating health risks among families with smoking husbands.

Abortion, Spontaneous↗

Is sham smoking an adequate control condition for the motoric component of smoking?

This is a study of the similarities and differences between real and sham smoking; 15 participants, all of whom had a smoking history of more than two years, attended on two occasions within a balanced design. They were instructed to either smoke or sham smoke their own brand of cigarette as normally as possible. Real and sham smoking were highly correlated for various measures: frequency of puffs, puff duration, interpuff interval, puff volume, and puff pressure. This showed that the pattern of smoking was common across the two conditions. At the same time, there were differences between the two conditions in the intensity of smoking, such that sham smoking led to significant increases in puff duration, volume, frequency, and decreases in the length of interpuff interval. Sham smoking is often used in smoking experimentation as a control for various aspects of smoking. This is the first study to examine the commonalities between real and sham smoking in a detailed and systematic fashion.

Adolescent↗

Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment.

AIMS: To assess the effect of partner smoking status on the success of a cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). PARTICIPANTS: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. MEASUREMENTS: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. FINDINGS: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. CONCLUSIONS: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.

Adult↗

Changes in the influence of parents' and close friends' smoking on adolescent smoking transitions.

This paper examined changes in the influence of parents' and close friends' smoking on smoking transitions occurring over the course of adolescence, using a large (N=6,006) longitudinal study. The three grade periods were 5th to 7th (ages 10-12), 7th to 9th (ages 12-14), and 9th to 12th grade (ages 14-17). Smoking transitions examined were: (1) never to trying, (2) trying to monthly, and (3) monthly to daily. Results showed that the influence of parents' smoking was substantial for all three transitions during most of the grade periods and, for the transition from monthly to daily smoking, increased (p=.006) during adolescence. In contrast, the influence of close friends' smoking was strongest for the transition to trying smoking and did not significantly change (all p>.05) for any of the smoking transitions as the adolescent became older. In conclusion, the influence of close friends' smoking on smoking transitions might be stable during adolescence whereas the influence of parents' smoking on the transition to daily smoking might markedly increase across adolescence.

Adolescent↗

Do popular students smoke? The association between popularity and smoking among middle school students.

BACKGROUND: Several studies have shown an association between popularity and behavior, indicating that popular people tend to reflect the norms of their group. Among adolescents, it has been hypothesized that popular students are more likely to smoke, especially in schools with high smoking prevalence. METHODS: Data were collected on friendship patterns and smoking from 1,486 sixth and seventh graders in 16 middle schools in southern California. Susceptibility to smoke was measured as not stating a commitment not to smoke in the future, and smoking as ever taken a puff or smoked a whole cigarette. We measured popularity as the number of times a student was chosen as a friend. Multivariate logistic regression was used to correlate popularity with susceptibility to smoke and smoking at follow-up controlling for baseline outcomes, demographic characteristics, and clustering within schools. RESULTS: Popularity was associated with increased susceptibility to smoke (Adjusted Odds Ratio [AOR] = 5.64, p < .001) and smoking (AOR = 5.09, p < .05) over the 1-year interval between surveys. Although the association was strongest for non-White boys, we did not find evidence of interactions between popularity and gender or ethnicity. CONCLUSIONS: Popular middle school students were more likely to become smokers compared to their less popular peers. Although there seems some difference in the association by gender and ethnicity, the evidence does not suggest subgroup effects in this population. Implications for the study of adolescent smoking and prevention programming are discussed.

Adolescent↗

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample.

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.

Black or African American↗

Smoking expectancies as mediators between dietary restraint and disinhibition and smoking in college women.

Women's beliefs about the appetite and weight control properties of cigarette smoking, dietary restraint and disinhibition, and smoking status were examined. As hypothesized, dietary restraint and disinhibition predicted appetite and weight control expectancies and smoking rate, such that women higher in dietary restraint and disinhibition reported stronger beliefs in the appetite and weight control properties of cigarettes and were more likely to be smoking than those lower in dietary restraint and disinhibition. Consistent with previous research, smoking expectancies for appetite and weight control predicted smoking status and smoking rate. Smoking expectancies for appetite and weight control were found to mediate the relationship between dietary restraint and smoking, and between disinhibition and smoking. This relationship between smoking and dietary constructs should be considered in smoking cessation and dietary interventions with young women.

Adult↗

Relationship of passive smoking to risk of lung cancer and other smoking-associated diseases.

In the latter part of a large hospital case-control study of the relationship of type of cigarette smoked to risk of various smoking-associated diseases, patients answered questions on the smoking habits of their first spouse and on the extent of passive smoke exposure at home, at work, during travel and during leisure. In an extension of this study an attempt was made to obtain smoking habit data directly from the spouses of all lifelong non-smoking lung cancer cases and of two lifelong non-smoking matched controls for each case. The attempt was made regardless of whether the patients had answered passive smoking questions in hospital or not. Amongst lifelong non-smokers, passive smoking was not associated with any significant increase in risk of lung cancer, chronic bronchitis, ischaemic heart disease or stroke in any analysis. Limitations of past studies on passive smoking are discussed and the need for further research underlined. From all the available evidence, it appears that any effect of passive smoke on risk of any of the major diseases that have been associated with active smoking is at most small, and may not exist at all.

Adult↗

Factors associated with continued smoking during pregnancy: analysis of socio-demographic, pregnancy and smoking-related factors.

This study investigated the characteristics associated with smoking during pregnancy. A total of 7836 pregnant women were surveyed between 1992 and 1999 in England. Of these 27% were smoking during pregnancy. Pregnant women were more likely to smoke if they were less educated, living in rented accommodation, in unskilled manual or unemployed groups, and single or had a partner who smokes. Analysed by logistic regression, whether or not a pregnant women has a partner and, if so, his smoking status, was by far the biggest predictor of the pregnant woman's current smoking status. Thus, compared with women with partners who never smoke, the odds ratio (OR) of smoking during pregnancy for women with a partner who smokes was 2.3 (1.9-2.7) while those with no partner had an OR of 4.8 (3.8-6.0). For women exposed to passive smoke at home or at work the OR was 2.5 (2.1-3.0). Housing tenure was the most important socio-demographic predictor. Thus pregnant women living in rented council housing were nearly twice as likely (OR 1.93;1.63-2.29) as those buying their own home to be current smokers. The number of women who continued to smoke during pregnancy increased 10-fold from the least to the most deprived group. These findings highlight the importance of tobacco control strategies that address pregnant women's life circumstances and broader inequalities as well as those that focus on individual smoking behaviour.

Adolescent↗

Withdrawal and pre-menstrual symptomatology during the menstrual cycle in short-term smoking abstinence: effects of menstrual cycle on smoking abstinence.

This study employs a rigorous inpatient laboratory setting to test the hypothesis that withdrawal symptomatology in short-term smoking cessation in women is increased in the late luteal phase when pre-menstrual symptomatology is the highest. Twenty-one female smokers with clinical, anatomical, and hormonal verification of their menstrual cycle phase were randomized to either a smoking abstinence group (n = 16) or a continued smoking group (n = 5). Participants were admitted to the General Clinical Research Center during alternate phases of their cycle for two 7-day admissions with a 1-month interim period when they resumed smoking. Dependent measures, i.e., Minnesota Nicotine Withdrawal Scale scores, Questionnaire on Smoking Urges scores and Pre-menstrual Assessment Form scores were collected during 2 days of baseline and 5 days of smoking deprivation. Smoking behavior was documented by self-report, breath CO levels and saliva cotinine measurements. Withdrawal symptomatology was not affected by menstrual cycle phase during short-term cessation in spite of increased pre-menstrual changes seen in the late luteal phase. In addition, no phase effect on smoking behavior was detected and cigarette consumption remained stable across the cycle in both groups. These results suggest that for some smoking cessation studies, complex strategies to control for menstrual cycle effects may not be necessary. However, Smoking Urges scores did suggest increased desire to smoke and desire to relieve negative affect in the late luteal phase when women have higher pre-menstrual symptomatology. This suggests women may have greater difficulty quitting smoking in late luteal phase, and it seems prudent to recommend that women quit during the follicular phase of their cycle.

Adult↗

A closed-loop control "playback" smoking machine for generating mainstream smoke aerosols.

A first generation smoking machine capable of reading and replicating detailed puffing behavior from recorded smoking topography data is presented. Unlike standard smoking machines, which model human puffing behavior as a steady periodic waveform with a fixed puff frequency, volume, and duration, this novel machine generates a mainstream smoke aerosol by automatically "playing-back" puff topography recordings. Because combustion chemistry is highly non-linear, representing real smoking behavior with a smoothed periodic waveform may result in a tobacco smoke aerosol with a significantly different chemical composition and physical properties than that generated by a smoker. The machine presented here utilizes a rapid closed-loop control algorithm coded in Labview to generate smoke aerosols for toxicological assessment and inhalation studies. To illustrate its use, dry particulate matter and carbon monoxide yields generated using the playback and equivalent periodic puffing regimens are compared for a single smoking session by a 26-year-old male narghile water-pipe smoker. It was found that the periodic puffing regimen yielded 20% less carbon monoxide (CO) than the played-back smoking session, indicating that steady periodic smoking regimens, which are widely used in tobacco smoke research, may not produce realistic smoke aerosols.

Aerosols↗

Maternal smoking during childhood and increased risk of smoking in young adulthood.

BACKGROUND: Effective prevention of smoking depends on the identification of factors that determine smoking onset. We examined the influence of family factors during childhood (household income, parents' education and smoking behaviour) on the subsequent risk of smoking in young adults. METHODS: In 1979, 1300 children aged 6-18 years, whose parents were randomly selected for participation in the Copenhagen City Heart Study were invited to a health examination. Information about health and smoking behaviour was obtained from 73% of the children. A random sample of 579 of the children were invited to a follow-up examination 13 years later. In all, 486 (84%) participated in the follow-up. RESULTS: The influence of household income, parents' smoking behaviour and education on the child's risk of becoming a smoker in young adulthood was estimated. Household income and parents' education did not significantly affect the risk of adult smoking. Maternal smoking during childhood increased the risk in comparison with the mother being a non-smoker (adjusted odds ratio = 1.95; 95% confidence interval: 1.07-3.58). CONCLUSION: Maternal smoking during childhood increases children's risk of becoming young adult smokers, independent of age and smoking behaviour in childhood, gender and social background. In Denmark 28% of smoking in young adults could be attributed to maternal smoking.

Adolescent↗