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PubMed2005

[The tobacco problem in French-speaking Africa and regional perspectives of the French-speaking African tobacco observatory].

The tobacco problem is one which is both global and political. The epidemic and the growing smoking crisis in Africa is a menace to the health of our continent, with significant socio-economic repercussions to follow in the coming years. Approximately 1.1 billion people around the world smoke, and between now and the year 2025, this number will most likely increase to 1.6 billion. By 2030, 10 million tobacco-related deaths will have occurred, and for the most part those deaths will be concentrated in developing countries. The tobacco industry clearly lies at the heart of the development of the tobacco pandemic in the 20th century. Specifically, cigarettes have made tobacco a massively consumed product, constantly expanding and opening up new markets; the day before yesterday it was men, yesterday it was women and youth, and today it is the developing world. The strategy is identical: increase sales, and do goat a price which puts a heavy burden on the population's health. The industries turn themselves towards developing countries, and namely Africa, in order to compensate for their losses in the markets of the Northern Hemisphere at a time when the demand in these countries is decreasing. The industry's cynical strategy targets Africa as its strongest potential market for development, counting on an estimated increase in consumption of 16% over the next decade, according to WHO's recent World Tobacco Atlas. The illegal importation of cigarettes is a practice which is growing more and more within African countries, with a well-structured African network for smuggling. Smuggled cigarettes are even more toxic with very elevated levels of nicotine and tar. Sponsorship as well as direct and indirect advertising are rapidly developing in all kinds of formats, with a proliferation of aggressive advertising messages targeting African populations with cynicism, manipulation, the complicity of smuggling in broad daylight, and disrespect for the law, while exploiting all of the themes which promote tobacco use to the target audiences (youth, women, the poorest groups). Everyday the tobacco industry recruits new African smokers to replace those who die. The future of the industry is represented by about 8 out of 10 people who began smoking before the age of 18 years old. It was imperative to establish a Tobacco Observatory in Francophone Africa (OTAF) in order to resituate the African tobacco situation, contribute to the development of the French-speaking nations in Africa, and to make known and increase awareness of its needs, its initiatives, and its actions across the world, and finally to effectively fight against tobacco and the industry's practices. One year after OTAF was established in Bamako thanks to the consolidated efforts of all its members and support of the French League against Cancer and the International Union against Cancer, OTAF OTAF is an independent entity whose mission is to gather, analyse and disseminate information on all aspects of tobacco with the objective of soliciting and supporting public health activities and interventions. It is a reference centre for Francophone Africa and a technical advisory group for the public authorities on tobacco issues. OTAF's work is counted upon to inform the public authorities on the most effective measures to use in the fight against tobacco. OTAF's duty is to promote activities which protect the health of young people and non-smokers, and communicate on the harmful effects of tobacco and the tobacco industry's practices. The goal is to organise a fight against tobacco based on solid, scientific data of the highest level of quality. OTAF is the only Francophone African surveillance organisation for monitoring the tobacco epidemic, and the practices, schemes and methods of the tobacco industry which are known to be dishonest Today, OTAF is a unique reference centre as far as the fight against tobacco is concerned in Francophone Africa. It is a partner in a number of projects with the French League against Cancer, the International Union against Cancer, and the International Union for Health Promotion and Education, among others. The success of OTAF has been crowned by a trophee having been awarded by WHO and an honorary degree signed by WHO's Director General.

Africa, Northern↗
PubMed2005

[Health consequences of the tobacco epidemic in West African French-speaking countries and current tobacco control].

The burden of disease due to tobacco for each country will depend on the prevalence of tobacco use and the duration of the epidemic. Given that the tobacco epidemic in West African Francophone countries is relatively recent, the burden of disease due to tobacco use is currently low. However, tobacco related burden of disease in Francophone West African countries is increasing as the number of smokers continues to increase and the population has been smoking for a longer period of time. If the current trends continue, West African countries will be suffering the massive consequences of tobacco use in two or three decades. Apart from the classical health consequences of tobacco consumption such as certain types of cancer and cardiovascular diseases, there are some conditions of special importance in low income African countries such as the increased risk of tuberculosis infection and mortality amongst smokers, low birth weight for babies of smoking mothers, and tobacco consumption associated malnutrition especially amongst women. Furthermore, developing countries, with inadequate resources and other important health issues, cannot afford the costs of the chronic degenerating conditions caused by tobacco use, as these are very expensive to treat. Tobacco control in Francophone African countries is still deficient Human and financial resources which are often scarce in West African countries are dedicated to other health issues since tobacco is normally not amongst the public health priorities. Legislation in Francophone African countries is limited and not adequately enforced. A major reason for governments' inaction on tobacco is their fear of creating unemployment and loss of revenue from tobacco taxes. This fear is derived mainly from the arguments of the tobacco industry. Apart from lobbying governments, the tobacco industry uses all kinds of strategies to market their products in these countries and faces practically no barriers to their business in these countries. It is essential that Francophone African countries take immediate action and develop and implement comprehensive multisectoral tobacco control programmes. These programmes must be integrated into the existing public health programmes and make use of existing infrastructure and resources in order to stop the tobacco epidemic from expanding. In February 2005, the WHO Framework Convention for Tobacco Control (WHO FCTC) entered into force. Most Francophone African countries have signed the treaty thus expressing their intention to become Parties in the future. WHO urges these countries to become Parties as soon as possible and to implement the WHO FCTC provisions in order to control the tobacco epidemic. WHO in turn will provide guidelines and assistance for the process of becoming Parties to the treaty and implementing tobacco control measures outlined therein.

Africa, Northern↗
PubMed2002

State expenditures for tobacco-control programs and the tobacco settlement.

BACKGROUND: Despite controversy surrounding the use of funds arising from settlement agreements with the tobacco industry, little is known about the role of these funds in expenditures for state tobacco-control programs. METHODS: We evaluated state expenditures for tobacco-control programs in fiscal year 2001 in the context of the amount of tobacco-settlement funds received and allocated to tobacco-control programs and in the context of other state-level economic and health data. RESULTS: In 2001 the average state received $28.35 per capita from the tobacco settlement but allocated approximately 6 percent of these funds to tobacco-control programs. The average state dedicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-control programs. The proportion of settlement funds allocated to tobacco-control programs varied from 0 to 100 percent and was strongly related to levels of tobacco-control funding (P<0.001). States with higher smoking rates tended to invest less per capita in tobacco-control programs (P=0.007), as did tobacco-producing states (the mean per capita expenditure was $1.20, as compared with $3.81 in non-tobacco-producing states; P<0.008). In a multivariate analysis, the proportion of the settlement revenue allocated to tobacco-control programs was the primary determinant of the level of total funding; the state tobacco-related health burden was unrelated to program funding. CONCLUSIONS: State health needs appear to have little effect on the funding of state tobacco-control programs. Because only a very small proportion of the tobacco settlement is being used for tobacco-control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.

Health Expenditures↗
PubMed2003

Tobacco industry strategy to undermine tobacco control in Finland.

OBJECTIVE: To identify and explain tobacco industry strategy in undermining tobacco control measures in Finland and results of these interferences in tobacco policy development during the 1980s and early 1990s. METHODS: Tobacco industry documents, which have been publicly available on the internet as a result of litigation in the USA, were analysed. Documents were sought by Finland and by names of organisations and tobacco control activists. Documents were accessed and assessed between September 2000 and November 2002. Tactics of the tobacco industry activities were categorised as presented by Saloojee and Dagli. RESULTS: The international tobacco companies utilised similar strategies in Finland as in other industrial markets to fight tobacco control and legislation, the health advocacy movement, and litigation. These activities slowed down the development and implementation of the Tobacco Act in Finland. However, despite the extensive pressure, the industry was not able to prevent the most progressive tobacco legislation in Europe from being passed and coming into force in Finland in 1977 and in 1995. CONCLUSION: Denying the health hazards caused by tobacco-despite indisputable scientific evidence-decreased the credibility of the tobacco industry. Strategy of denial was falsely chosen, as health advocacy groups were active both in society and the parliamentary system. The strong influence of the tobacco industry may have in fact increased the visibility of tobacco control in Finland as the litigation process was also drawing attention to negative health effects of tobacco. Therefore the tobacco industry did not manage to convince public opinion. However, the tobacco industry did obtain experience in Finland in how to object to tobacco control measures.

Finland↗
PubMed2005

Tobacco use, access, and exposure to tobacco in media among middle and high school students--United States, 2004.

Two of the national health objectives for 2010 are to reduce the prevalence of any tobacco use during the preceding month to < or =21% and the prevalence of current cigarette use to < or =16% among high school students (objectives 27-2a and 27-2b). The National Youth Tobacco Survey (NYTS), conducted by CDC in 2004, provided estimates of current use of tobacco products and selected indicators related to tobacco use, including youth exposure to tobacco-related media and access to cigarettes. This report summarizes data from the 2004 NYTS and describes changes in tobacco use and indicators related to tobacco use since 2002. During 2002-2004, middle school students reported decreases in pipe use, seeing actors using tobacco on television or in movies, and seeing advertisements for tobacco products on the Internet. Among high school students, no changes were observed in the use of tobacco or in access to tobacco products; however, seeing actors using tobacco on television or in movies declined slightly, and seeing advertisements for tobacco products on the Internet increased. The lack of substantial decreases in the use of almost all tobacco products among middle and high school students underscores the need to fully implement evidence-based strategies (e.g., increasing the retail price of tobacco products, implementing smoking-prevention media campaigns, and decreasing minors' access as part of comprehensive tobacco-control programs) that are effective in preventing youth tobacco use.

Adolescent↗
PubMed1994

Tobacco industry campaign contributions are affecting tobacco control policymaking in California.

OBJECTIVE: To test the hypothesis that tobacco industry campaign contributions are influencing the behavior of members of the California legislature. DESIGN: Multivariate simultaneous-equations regression was used to analyze data on campaign contributions from the tobacco industry to members of the California legislature in 1991 and 1992, members' tobacco control policy positions, and members' personal characteristics. DATA SOURCES: The following sources were analyzed: campaign contributions from disclosure statements filed with the California Fair Political Practices Commission; constituent attitudes on tobacco control from the California Tobacco Survey; legislators' personal characteristics, from a survey of key informants conducted by the California Journal; and the tobacco policy score, a survey of key informants working on tobacco issues in the state legislature. Specific voting on tobacco-related bills was also analyzed. SETTING: California legislature in 1991 and 1992. PATIENTS OR OTHER PARTICIPANTS: All members of the California legislature in 1991 and 1992. MAIN OUTCOME MEASURES: Tobacco policy score, campaign contributions, and votes on individual tobacco-related bills. RESULTS: The tobacco industry is having a statistically detectable effect on behavior of members of the California legislature on tobacco policymaking. On a scale of 0 to 10, a legislator's tobacco policy score dropped (ie, became more protobacco industry) by -0.11 for every $1000 in tobacco campaign contributions, after accounting for the fact that a more protobacco position was associated with greater contributions ($1855 for each -1.0 reduction in score). Members who were rated as effective received larger contributions from the industry. Members rated higher in integrity and intelligence were more antitobacco (higher scores) and Republicans more protobacco (lower scores) after taking into account the effects of contributions from the industry. Constituent attitudes were not reflected in legislators' perceived behavior. CONCLUSION: Tobacco industry campaign contributions influence California legislators in matters related to tobacco policymaking, independent of constituents' support for tobacco control.

California↗
PubMed2005

School tobacco policies in a tobacco-growing state.

This study examined factors associated with tobacco-free policies and tobacco cessation in schools serving children in grades 6 to 12 in a tobacco-growing state using a cross-sectional telephone survey of school administrators from public and private middle and high schools (N = 691), representing 117 of the 120 Kentucky counties. Trained health department staff contacted 1028 schools; 691 (67%) participated in a phone survey, which lasted an average of 19 minutes. Variables of interest were indoor and outdoor smoking policies, fund-raising in Bingo halls, provision of cessation and prevention programs, owning or leasing a tobacco base, if the school received money from tobacco companies, type of school (public vs private), and school setting (urban vs rural). Only 20% of Kentucky schools reported comprehensive tobacco-free policies. Urban area schools were nearly twice as likely to have a tobacco-free campus than rural schools. Schools that did fund-raising in smoky Bingo halls were 30% less likely to have tobacco-free school policies. While few schools had a tobacco affiliation, those that received money from tobacco companies or grew tobacco were nearly 3 times as likely to provide cessation resources, compared to schools without tobacco affiliation. Rural schools were less likely to be tobacco free and provide cessation services. School-related, off-campus, extracurricular events might be considered as an element of tobacco-free school policy. Schools with tobacco affiliation may provide more cessation resources due to the increased prevalence of tobacco use in these areas.

Adolescent↗
PubMed2005

Teacher tobacco use and tobacco use prevention in two regions in India: results of the Global School Personnel Survey.

BACKGROUND: This paper compares tobacco use patterns and tobacco use prevention efforts among teachers in two Indian states with high versus low prevalence of tobacco use. METHODS: Data from the Global School Personnel Survey compared tobacco use patterns and tobacco use prevention activities among teachers from the Indian states of Maharashtra (N = 954) and Bihar (N = 524). RESULTS: 78% of teachers in Bihar and 31% from Maharashtra were current tobacco users. Tobacco control policies were virtually non-existent in schools in Bihar, while in Maharashtra, over one-fourth of teachers reported that tobacco use was prohibited among both students and teachers. Few teachers in Bihar taught their students about tobacco use prevention, while such teaching was more common in Maharashtra. In Maharashtra, teaching about tobacco use prevention was significantly associated with not currently using tobacco (P < 0.0001), having a policy specifically prohibiting tobacco use among students (P < 0.0001), and having a policy specifically prohibiting tobacco use among school personnel (P < 0.0001). CONCLUSIONS: This study has clear implications for implementation of tobacco control policies in Indian schools and further underscores the need for infrastructure support for tobacco use prevention in developing countries such as India, where tobacco use threatens to contribute to a growing proportion of the burden of disease worldwide.

Adolescent↗
PubMed2003

Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001.

OBJECTIVE: To assess the extent and nature of newspaper coverage of tobacco related issues in Australia in 2001. DESIGN: Content analysis of newspaper articles. SUBJECTS: All articles (n=1188) at least seven lines long and containing at least one paragraph focused on tobacco in all major Australian national and State capital city newspapers (n=12) in 2001. MAIN OUTCOME MEASURES: Number of articles, month of publication, State in which newspaper published, prominence of article, type of article, article theme, and slant of article relative to tobacco control objectives. RESULTS: The number of tobacco articles varied considerably in different months over the course of the year, from a low of 51 in December to a peak of 180 in May. The most frequent theme was secondhand smoke issues (30% of articles), with the second most dominant theme related to education, prevention, and cessation programmes and services (20%). Events that were covered were predominantly positive for tobacco control: 62% of articles were related to events that were positive, compared with 21% that were negative for tobacco control objectives. Excluding news articles, the opinions expressed by the authors of articles were also mainly positive (61%) rather than negative (22%) for tobacco control objectives. The amount of coverage of and population exposure to tobacco focused articles showed considerable variation across different Australian States, with Victoria having the highest frequency and rate of articles and the most media impressions per capita throughout 2001. CONCLUSIONS: : Coverage of events and opinions related to tobacco in Australian newspapers in 2001 was generally positive for tobacco control objectives. Given that over 2 million individuals (out of a population of 19 million) were potentially exposed to tobacco related newspaper articles per day in Australia, this represents good news for tobacco control advocates. The variation in news coverage in different States and at different times in the year, however, illustrates how a combination of local events and advocacy efforts may at times combine to make tobacco more newsworthy. Understanding which tobacco issues are most likely to be covered and the nature of the coverage about them provides valuable feedback for tobacco control advocates and is a useful gauge of actual events as well as the tobacco related agendas promoted by the press.

Attitude to Health↗
PubMed2005

Tobacco on campus: industry marketing and tobacco control policy among post-secondary institutions in Canada.

OBJECTIVE: Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA. DESIGN: Telephone surveys were conducted with campus informants from 35 post-secondary institutions in Canada to evaluate tobacco control policies and the presence of tobacco marketing on campus. MAIN OUTCOME MEASURES: Tobacco marketing on campus, tobacco control policies, and attitudes towards tobacco control. RESULTS: The findings indicate that tobacco marketing is prevalent among post-secondary institutions in Canada. Every university and half of all colleges surveyed had participated in some form of tobacco marketing in the past year. Among universities, 80% had run a tobacco advertisement in their paper and 18% had hosted a tobacco sponsored nightclub event. Tobacco control policies varied considerably between institutions. Although several campuses had introduced leading edge policies, such as campus wide outdoor smoking restrictions and tobacco sales bans, there is a general lack of awareness of tobacco issues among campus decision makers and fundamental public health measures, such as indoor smoke-free policies, have yet to be introduced in many cases. CONCLUSIONS: Post-secondary institutions in Canada remain tobacco friendly environments. Without increased direction and support from the public health community, post-secondary institutions will continue to lag behind, rather than lead current policy standards.

Adult↗
PubMed1997

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.

Adolescent↗
PubMed2003

Tobacco industry strategies to undermine the 8th World Conference on Tobacco or Health.

OBJECTIVE: To demonstrate that Philip Morris and British American Tobacco Company attempted to initiate a wide ranging campaign to undermine the success of the 8th World Conference on Tobacco or Health held in Buenos Aires, Argentina, in 1992. DATA SOURCES: Publicly available tobacco industry documents housed in Minneapolis, Minnesota, USA; Guilford, UK; on-line document websites; and telephone interviews with informed parties. STUDY SELECTION: Those documents determined to be relevant to the companies' campaigns against the 8th World Conference on Tobacco or Health. DATA EXTRACTION: Revision of chapter VIII of the July 2000 WHO report by a committee of experts, entitled: Tobacco company strategies to undermine tobacco control activities at the World Health Organization: report of the committee of experts on tobacco industry documents. DATA SYNTHESIS: Internal documents describe proposed media and science orientated campaigns developed by BAT, Philip Morris, and their consultants to divert attention away from the conference. RESULTS AND CONCLUSION: This work shows that the tobacco industry has the resources and vested interest to combat perceived threats in its regional operating markets, in this case its Latin American market. It is important for the worldwide public heath community to become aware of the numerous ways in which the tobacco industry and its front groups can work against international tobacco control meetings, even including the manipulation of or working with other public health groups to oppose tobacco control efforts. Future world conference planners and participants should be aware that the tobacco industry is likely to continue to employ such methodology. There is no reason to think that the industry is paying less attention to such conferences in the present or future. Rather, it is likely the industry will adopt and expand strategies that were successful while abandoning those that were not effective. Required disclosure of financial support by all participants at all tobacco scientific conferences is recommended. For the tobacco control community, we also recommend careful coalition building and networking with other public health groups on the ways tobacco is implicated in other public health issues.

Congresses as Topic↗
PubMed2006

The role of tobacco advertising and promotion: themes employed in litigation by tobacco industry witnesses.

OBJECTIVES: To identify key themes related to tobacco advertising and promotion in testimony provided by tobacco industry-affiliated witnesses in tobacco litigation, and to present countervailing evidence and arguments. METHODS: Themes in industry testimony were identified by review of transcripts of testimony in the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta) from a sample of defence witnesses, including three academic expert witnesses, six senior executives of tobacco companies, and one industry advertising consultant. Counterarguments to the themes embodied in defence testimony were based on information from peer-reviewed literature, advertising trade publications, government reports, tobacco industry documents, and testimony provided by expert witnesses testifying for plaintiffs. RESULTS: Five major themes employed by defence witnesses were identified: (1) tobacco advertising has a relatively weak "share of voice" in the marketing environment and is a weak force in affecting smoking behaviour; (2) tobacco advertising and promotion do not create new smokers, expand markets, or increase total tobacco consumption; (3) the tobacco industry does not target, study, or track youth smoking; (4) tobacco advertising and promotion do not cause smoking initiation by youth; and (5) tobacco companies and the industry adhere closely to relevant laws, regulations, and industry voluntary codes. Substantial evidence exists in rebuttal to these arguments. CONCLUSIONS: Tobacco industry-affiliated witnesses have marshalled many arguments to deny the adverse effects of tobacco marketing activities and to portray tobacco companies as responsible corporate citizens. Effective rebuttals to these arguments exist, and plaintiffs' attorneys have, with varying degrees of success, presented them to judges and juries.

Adolescent↗
PubMed2005

Predicting perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pediatric cancer survivors.

OBJECTIVE: To examine predictors of perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pre-adolescents and adolescents previously treated for cancer. METHODS: Written self-report measures of tobacco knowledge, perceived vulnerability, perceived positive value of tobacco use, past and present tobacco use, and intentions to use tobacco were completed by 103 cancer survivors, 10-18 years of age (51.5% males, 78.6% Caucasians). Patient reports of peer and parent tobacco use were also obtained. RESULTS: Perceived vulnerability was influenced by demographic variables, knowledge, and gender-related past tobacco use. Fifty-seven percent of non-smoking survivors reported some intention to use tobacco. Survivors who perceived some positive value associated with tobacco use and who used tobacco in the past reported greater intentions for future tobacco use. CONCLUSION: Modifiable cognitive-motivational variables directly associate with smoking-related outcomes among pediatric survivors of childhood cancer. PRACTICE IMPLICATIONS: Preventive tobacco interventions with this vulnerable cohort are warranted and should inform about tobacco-related health risks and attempt to modify misperceptions of the positive value associated with tobacco use.

Adolescent↗
PubMed2005

Cotinine levels and green tobacco sickness among shade-tobacco workers.

STUDY OBJECTIVE: Symptoms consistent with Green Tobacco Sickness (GTS) were found in 4% (13/331) to 15% (45/303) of the migrant, mostly Latino, shade-tobacco workers who sought medical care at a Connecticut clinic. The objective of this study was to determine whether or not shade-tobacco farm workers absorb nicotine from the tobacco leaves and have a corresponding increase in both salivary cotinine levels (a breakdown product of nicotine) and symptoms consistent with GTS. METHODS: The study utilized a prospective cohort design to evaluate salivary cotinine and symptoms consistent with GTS in a population of shade tobacco farm workers compared to a control group of nursery workers. The workers were assessed at two points in time, the early tobacco planting season and the harvest season. RESULTS: There was not a significant increase in salivary cotinine levels among shade-tobacco workers. Salivary cotinine levels over the work season did not significantly increase in shade-tobacco workers when compared with nursery workers. During the harvest season, none of the tobacco workers reported symptoms consistent with GTS. CONCLUSIONS: Migrant workers in Connecticut who harvest shade-tobacco appear to have a low-risk of occupational nicotine dermal absorption and a low incidence of GTS. The work practices associated with harvesting shade-tobacco, in addition to the fact that shade tobacco may actually have a lower level of nicotine than either burley or flue cured tobacco, may explain these results. Our study appears to reinforce the GTS prevention recommendations made by investigators in other tobacco growing regions, specifically the importance of minimizing close skin contact with tobacco leaves and avoiding dermal contact with the plants when they are wet.

Adult↗
PubMed1997

The role of social influences and tobacco availability on adolescent smokeless tobacco use.

OBJECTIVE: To examine the potential explanatory effect of various demographic, social influence, sanction, and tobacco availability variables on the use of smokeless tobacco (ST) by adolescent males. DESIGN: The data used in our analyses are from a community-based tobacco policy intervention trial that included a 60-item baseline school survey. During Spring 1993, all 8th, 9th, and 10th-grade students enrolled in 14 school districts in small Minnesota cities were surveyed. We used mixed-model logistic regression to determine which variables were significantly correlated with smokeless tobacco use by males in the past week. RESULTS: Of this sample of 2924 adolescent males, 10% (n = 291) reported using smokeless tobacco in the past week. Compared to the overall sample, smokeless tobacco users reported higher family and friend use of smokeless tobacco. In addition, 64% of users reported smoking in the past 30 days, and almost half (49.1%) said they had attempted to purchase tobacco in the past 30 days. Variables found to be significantly associated with smokeless tobacco use in the past week included younger age, having a best friend using tobacco, inflated perceptions of their peers' use of tobacco products, beliefs that school and parental sanctions are not high for tobacco use, recent tobacco purchase, and perceived belief that tobacco is not difficult to obtain from social sources. CONCLUSIONS: This study confirms previous research correlating demographic and social influence factors with ST use and demonstrates the role that sanction and availability variables play in ST use.

Adolescent↗
PubMed2000

A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives.

OBJECTIVE: To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence. PARTICIPANTS: An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update. EVIDENCE: Approximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses. CONSENSUS PROCESS: One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised. CONCLUSIONS: This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective-practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence-sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch-are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline. JAMA. 2000;283:3244-3254

Cost-Benefit Analysis↗
PubMed2005

The pediatric resident training on tobacco project: baseline findings from the Parent/Guardian Tobacco Survey.

BACKGROUND: Pediatricians have an important and unique role to play in the anti-tobacco arena. They may prevent relapse to smoking in women who stopped smoking during pregnancy, encourage parents to protect infants and young children from environmental tobacco smoke (ETS), prevent the onset of smoking in children and adolescents, and help patients and parents who smoke or use other forms of tobacco to quit. Unfortunately, few pediatricians intervene on tobacco use or ETS, and few pediatric residency training programs prepare residents to address tobacco. The Pediatric Residency Training on Tobacco Project is a 4-year randomized prospective study of the effectiveness of training pediatric residents to intervene on tobacco in patients and parents. In this paper, we present findings from the Baseline Parent/Guardian Tobacco Survey. METHODS: Fifteen pediatric residency training programs participated in the Pediatric Residency Training on Tobacco Project, and they were assigned randomly to special and standard training conditions. The Baseline Parent/Guardian Tobacco Survey was administered to 1770 participants, a minimum of 100 from each site. The Parent/Guardian Survey was designed to describe the population under study. It addressed demographic information, family tobacco use, rules concerning smoking in the home and elsewhere, smoking behavior and beliefs, and parent/guardian reports of resident intervention on tobacco. Data analyses described the population served by Continuity Clinics associated with the pediatric residency training programs and determined the degree to which residents addressed tobacco in parents/guardians. RESULTS: The parents/guardians were primarily low-income African American and Hispanic females. Approximately 20% reported that they smoked cigarettes, and about 60% prohibited smoking in their home. Seventy percent of the parents reported that the resident asked about cigarette smoking, and about half indicated that the resident talked with them about ETS. However, only about 10% of the smokers stated that the doctor offered to help them stop smoking, and just 25% of all parents/guardians indicated that the doctor offered to help them stop exposing their children to ETS in the home or elsewhere. CONCLUSIONS: Parents of children brought to Continuity Clinic may benefit from advice and assistance on quitting cigarette smoking and protecting their children from ETS. While pediatric residents offer advice and encouragement, few provide the assistance parents require. These findings underscore the importance of training pediatric residents to address tobacco with the parents/guardians of the patients they serve.

Adult↗